Research Open Access
Like 0



Compliance with infection prevention and control (IPC) measures is critical to preventing COVID-19 transmission in healthcare settings.


To identify and explain factors influencing compliance with COVID-19-specific IPC measures among healthcare workers (HCWs) in long-term care facilities (LTCF) in Finland.


The study included a web-based survey and qualitative study based on the Theoretical Domains Framework (TDF). The link to the anonymous survey was distributed via email to LTCFs through regional IPC experts in December 2020. Outcome was modelled using ordinary logistic regression and penalised ridge logistic regression using regrouped explanatory variables and an original, more correlated set of explanatory variables, respectively. In-depth interviews were conducted among survey participants who volunteered during January–March 2021. Data were analysed thematically using qualitative data analysis software (NVIVO12).


A total of 422 HCWs from 17/20 regions responded to the survey. Three TDF domains were identified that negatively influenced IPC compliance: environmental context and resources, reinforcement and beliefs about capabilities. Twenty HCWs participated in interviews, which resulted in identification of several themes: changes in professional duties and lack of staff planning for emergencies (domain: environmental context and resources); management culture and physical absence of management (domain: reinforcement), knowledge of applying IPC measures, nature of tasks and infrastructure that supports implementation (domain: beliefs about capabilities), that explained how the domains negatively influenced their IPC behaviour.


This study provides insights into behavioural domains that can be used in developing evidence-based behaviour change interventions to support HCW compliance with pandemic-specific IPC measures in LTCFs.


Article metrics loading...

Loading full text...

Full text loading...



  1. Arons MM, Hatfield KM, Reddy SC, Kimball A, James A, Jacobs JR, et al. Presymptomatic SARS-CoV-2 infections and transmission in a skilled nursing facility. N Engl J Med. 2020;382(22):2081-90.  https://doi.org/10.1056/NEJMoa2008457  PMID: 32329971 
  2. Telford CT, Onwubiko U, Holland DP, Turner K, Prieto J, Smith S, et al. Preventing COVID-19 outbreaks in long-term care facilities through preemptive testing of residents and staff members — Fulton County, Georgia, March–May 2020. MMWR Morb Mortal Wkly Rep. 2020;69(37):1296-9.  https://doi.org/10.15585/mmwr.mm6937a4  PMID: 32941413 
  3. Pitkälä KH. COVID-19 has hit nursing homes hard. Eur Geriatr Med. 2020;11(6):889-91.  https://doi.org/10.1007/s41999-020-00411-1  PMID: 33011911 
  4. Forma L, Aaltonen M, Pulkki J. COVID-19 and clients of long-term care in Finland - Impact and measures to control the virus. LTCcovid, International long term care policy network, CPEC-LSE. 12 Jun 2020. Available from: https://ltccovid.org/wp-content/uploads/2020/06/ltccovid-country-reports_Finland_120620-1.pdf
  5. Danis K, Fonteneau L, Georges S, Daniau C, Bernard-Stoecklin S, Domegan L, et al. High impact of COVID-19 in long-term care facilities, suggestion for monitoring in the EU/EEA, May 2020. Euro Surveill. 2020;25(22):2000956. PMID: 32524949 
  6. Houghton C, Meskell P, Delaney H, Smalle M, Glenton C, Booth A, et al. Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database Syst Rev. 2020;4(4):CD013582. https://doi.org/10.1002/14651858.CD013582  PMID: 32315451 
  7. Rhee C, Baker M, Vaidya V, Tucker R, Resnick A, Morris CA, et al. Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. JAMA Netw Open. 2020;3(9):e2020498.  https://doi.org/10.1001/jamanetworkopen.2020.20498  PMID: 32902653 
  8. Sikkema RS, Pas SD, Nieuwenhuijse DF, O’Toole Á, Verweij J, van der Linden A, et al. COVID-19 in health-care workers in three hospitals in the south of the Netherlands: a cross-sectional study. Lancet Infect Dis. 2020;20(11):1273-80.  https://doi.org/10.1016/S1473-3099(20)30527-2  PMID: 32622380 
  9. Ylinen T, Ylinen V, Kalliomaa-Puha L. Ylinen. Governmental response to the COVID-19 pandemic in Long-Term Care residences for older people: preparedness, responses and challenges for the future: Finland’, 2021; MC COVID-19 working paper 04/2021.  https://doi.org/10.20350/digitalCSIC/13692  https://doi.org/10.20350/digitalCSIC/13692 
  10. Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6(1):42.  https://doi.org/10.1186/1748-5908-6-42  PMID: 21513547 
  11. Nevala MS, Vuorela S. Early Nurse Management Experiences from Finnish COVID-19 Hubs: An In-Action Review. Int J Environ Res Public Health. 2022;19(8):4885.  https://doi.org/10.3390/ijerph19084885  PMID: 35457757 
  12. Collins N, Crowder J, Ishcomer-Aazami J, Apedjihoun D. Perceptions and experiences of frontline urban indian organization healthcare workers with infection prevention and control during the COVID-19 pandemic. Front Sociol. 2021;6:611961.  https://doi.org/10.3389/fsoc.2021.611961  PMID: 33996989 
  13. Atkins L, Francis J, Islam R, O’Connor D, Patey A, Ivers N, et al. A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):77.  https://doi.org/10.1186/s13012-017-0605-9  PMID: 28637486 
  14. Debono D, Taylor N, Lipworth W, Greenfield D, Travaglia J, Black D, et al. Applying the Theoretical Domains Framework to identify barriers and targeted interventions to enhance nurses’ use of electronic medication management systems in two Australian hospitals. Implement Sci. 2017;12(1):42.  https://doi.org/10.1186/s13012-017-0572-1  PMID: 28347319 
  15. Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7(1):37.  https://doi.org/10.1186/1748-5908-7-37  PMID: 22530986 
  16. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77-101.  https://doi.org/10.1191/1478088706qp063oa 
  17. World Health Organization (WHO). WHO guidelines on hand hygiene in health care. First global patient safety challenge clean care is safer care. Geneva: WHO; 2009. Available from: https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf?sequence=1
  18. World Health Organization (WHO). Improving infection prevention and control at the health facility. Interim practical manual supporting implementation of the WHO Guidelines on Core Components of Infection Prevention and Control Programmes. Geneva: WHO; 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/279788/WHO-HIS-SDS-2018.10-eng.pdf?sequence=1&isAllowed=y
  19. Phillips CJ, Marshall AP, Chaves NJ, Jankelowitz SK, Lin IB, Loy CT, et al. Experiences of using the Theoretical Domains Framework across diverse clinical environments: a qualitative study. J Multidiscip Healthc. 2015;8(8):139-46. https://doi.org/10.2147/JMDH.S78458  PMID: 25834455 
  20. Tavolacci MP, Merle V, Pitrou I, Thillard D, Serra V, Czernichow P, Alcohol-based Hand Rub Commission of Infection Control Committee. Alcohol-based hand rub: influence of healthcare workers’ knowledge and perception on declared use. J Hosp Infect. 2006;64(2):149-55.  https://doi.org/10.1016/j.jhin.2006.05.021  PMID: 16891041 
  21. Pogorzelska-Maziarz M, Chastain AM, Mangal S, Stone PW, Shang J. Home health staff perspectives on infection prevention and control: implications for coronavirus disease 2019. J Am Med Dir Assoc. 2020;21(12):1782-1790.e4.  https://doi.org/10.1016/j.jamda.2020.10.026  PMID: 33256957 
  22. Corley A, Hammond NE, Fraser JF. The experiences of health care workers employed in an Australian intensive care unit during the H1N1 Influenza pandemic of 2009: a phenomenological study. Int J Nurs Stud. 2010;47(5):577-85.  https://doi.org/10.1016/j.ijnurstu.2009.11.015  PMID: 20036360 
  23. Rice L, Sara R. Updating the determinants of health model in the Information Age. Health Promot Int. 2019;34(6):1241-9.  https://doi.org/10.1093/heapro/day064  PMID: 30212852 
  24. Isomursu M, Kuoremäki R, Eho J, Teikari M. The effect of Covid-19 in digital media use of Finnish physicians - Four wave longitudinal panel survey. Int J Med Inform. 2022;159:104677.  https://doi.org/10.1016/j.ijmedinf.2021.104677  PMID: 35007925 
  25. Leigh L, Taylor C, Glassman T, Thompson A, Sheu JJ. A cross-sectional examination of the factors related to emergency nurses’ motivation to protect themselves against an Ebola infection. J Emerg Nurs. 2020;46(6):814-26.  https://doi.org/10.1016/j.jen.2020.05.002  PMID: 32800328 
  26. Mortada E, Abdel-Azeem A, Al Showair A, Zalat MM. Preventive behaviors towards covid-19 pandemic among healthcare providers in Saudi Arabia using the protection motivation theory. Risk Manag Healthc Policy. 2021;14:685-94.  https://doi.org/10.2147/RMHP.S289837  PMID: 33628067 
  27. Kang J, Kim EJ, Choi JH, Hong HK, Han SH, Choi IS, et al. Difficulties in using personal protective equipment: Training experiences with the 2015 outbreak of Middle East respiratory syndrome in Korea. Am J Infect Control. 2018;46(2):235-7.  https://doi.org/10.1016/j.ajic.2017.08.041  PMID: 29050907 
  28. Hoernke K, Djellouli N, Andrews L, Lewis-Jackson S, Manby L, Martin S, et al. Frontline healthcare workers’ experiences with personal protective equipment during the COVID-19 pandemic in the UK: a rapid qualitative appraisal. BMJ Open. 2021;11(1):e046199.  https://doi.org/10.1136/bmjopen-2020-046199  PMID: 33472794 
  29. Rücker F, Hårdstedt M, Rücker SCM, Aspelin E, Smirnoff A, Lindblom A, et al. From chaos to control - experiences of healthcare workers during the early phase of the COVID-19 pandemic: a focus group study. BMC Health Serv Res. 2021;21(1):1219.  https://doi.org/10.1186/s12913-021-07248-9  PMID: 34758837 
  30. El Sharif N, Ahmead M, Imam A. COVID-19 infection prevention and control procedures and institutional trust: Perceptions of Palestinian healthcare workers. Front Public Health. 2022;10:947593.  https://doi.org/10.3389/fpubh.2022.947593  PMID: 36062099 
  31. Nguyen LKN, Megiddo I, Howick S. Challenges of infection prevention and control in Scottish long-term care facilities. Infect Control Hosp Epidemiol. 2020;41(8):943-5.  https://doi.org/10.1017/ice.2020.113  PMID: 32317037 
  32. Locatelli SM, LaVela SL, Hogan TP, Kerr AN, Weaver FM. Communication and information sharing at VA facilities during the 2009 novel H1N1 influenza pandemic. Am J Infect Control. 2012;40(7):622-6.  https://doi.org/10.1016/j.ajic.2012.01.035  PMID: 22732657 
  33. Burki T. Global shortage of personal protective equipment. Lancet Infect Dis. 2020;20(7):785-6.  https://doi.org/10.1016/S1473-3099(20)30501-6  PMID: 32592673 

Data & Media loading...

Supplementary data

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error