| The aspect of the Report | Critiquing Questions |
| Title | The article is by Erasmus et al. 2009. The title of the article is good since it provides clear information on what the authors want to achieve with the study, which is the evaluation of poor hand hygiene. The population of focus is hospital workers. |
| Abstract | The abstract is short, clear, and precise and begins with outlining the objective of the study, which is to identify the possible causes of hand hygiene among hospital workers. The abstract also outlines the design, setting, participants, results, and a conclusion section, which are all clear to understand, providing a depth to the study. |
Introduction Statement of the problem | The introduction starts with a clear statement problem, which establishes a strong purpose on why factors that determine hand hygiene among health workers are essential to be identified and addressed due to the financial burden that poor hand hygiene practices bring to the healthcare system. The study is vital to nursing since nurses are among hospital workers that are at the forefront of contracting germs from patients and contaminated surfaces and hence have to maintain proper hand hygiene. Hand, hygiene is a behavioral issue; thus qualitative approach is effective for the study |
| Research Questions | Yes, research questions were clearly stated. Erasmus et al. 2009 state that qualitative research has never been done to assess hand hygiene compliance among health workers, yet hand hygiene is a behavioral issue. The authors state that adherence to hand hygiene is influenced by cultural beliefs and practices that may differ among groups of health workers such as physicians, nurses, and medical students. |
| Literature review | The article does not sufficiently summarize the existing body of literature stating that the issue of hand hygiene has only of late started receiving attention from different researchers, and a qualitative approach had never been used to evaluate hand hygiene. However, the literature body provides a sufficient basis for the study on the need for a qualitative approach to hand hygiene compliance. The authors state that despite intervention placed to improve hand hygiene, the impact of the interventions has not been felt and has not lasted long. Hence, the need for behavioral studies for implementing behavioral interventions. |
| Conceptual Underpinnings | The key concepts were hand hygiene compliance and behavior influence on hand hygiene adherence, which have clearly explained and hence the need for a qualitative study. The philosophical basis is that behavioral practices influence hand hygiene differently in various health workers. Most studies have been bases on quantitative studies, which have been a significant block in establishing interventions to improve hand hygiene. |
Method Protection of participants’ rights | The authors do not state whether the study was subjected to an ethical review by IRB or an ethics review board. The study was designed to maximize the benefits to participants. Participants were reassured that the focus groups were not a test session and that there was no wrong or right answer. Also, participants were allowed to express their opinions to the diversity of views openly. |
| Research design and research tradition | Yes, the choice of qualitative approach was in line with methods used to collect data: researchers used focused group interviews, face to face interviews. An adequate amount of time was spent with each participant, with a total of 110 minutes spent in a focus group and face to face interviews. Through the interviews, the researchers collected adequate information that validated their study design. |
| Sample and setting | The population of interest was hospital workers was described sufficiently, and the setting for the study is described as location-based though no additional information is provided. The method of participant recruitment was effective since the participants were recruited from five different hospitals, which were easy to access. The author’s method of sampling was productive; they chose participants from a small hospital, big hospital, teaching hospital, and university hospital. The nature of sampling was appropriate since the researchers were able to find all critical study groups for the research, which include physicians, nurses, and medical students, improving the richness of the study. The sample size was adequate, and saturation was achieved since all participants were homogeneous based on their profession and hospital. |
| Data collection | The method used to collect data was effective, and two methods of data collection were used mainly through focus group interviews and face to face interviews. The researchers asked the right questions, which were categorized into three: attitudes, subjective norms, and perceived behavioral control. The data were recorded using a voice recorder a later were fully transcribed. The data collected were sufficient and very useful since the focus group allowed for free expression; hence different perspectives were collected, and the face to face interviews allowed for adequate contact with participants. |
| Procedures | The article clearly outlines the data collection and recording procedures and is appropriate for the research design. Yes, data was collected in a way that minimized bias, the focus group allowed for the inclusion of opinion of all participants. Also, for physicians, data was collected through interviews because of their fixed schedules that could not allow for the focus group session. The staffs were adequately trained and used the structured interviewed guides and were also assigned, assistants. |
| Enhancement of trustworthiness | The authors used the structured interview guide that had the Theory of Planned Behavior, which enabled them to structure questions that would yield honest replies from the participants, therefore, improve the integrity of the research. The authors clearly explain how the model works, and the model was sufficient for the integrity of the research. The researchers documented the question that they asked the participants, and the question quality of the questions can be assessed. The data can be transferred because it clearly and describes in detail every aspect of the study from participants to findings. |
Results Data analysis | The article briefly describes the data analysis technique using the seventh version of Nvivo software, which is designed to analyze qualitative data. The analysis yielded the required data, which were ascribed codes, and code-specific reports were obtained to identify common themes and primary points. The procedure analysis did not show any sign of bias since the contextual analysis was conducted independently by two researchers and disputes resolved by another researcher. |
| Findings | Yes, the findings were adequately summarized with various supportive excerpts. The author adequately abstracted the themes in the data with each of the participants stressing the importance of hand hygiene and acknowledging that culture and norms influence the habit of hand hygiene. Yes, the analysis yielded the influence of behavior on poor hand hygiene practices. For instance, medical students pointed out that they follow the habit of their superiors who do not practice hand hygiene compliance. |
| Theoretical integration | The analysis yields a pattern that logically brings out the causes of poor hand hygiene practices and that it is a behavioral problem, for example, physicians do not believe washing hands reduce cross-infection while nurses believe washing hands reduce cross-infection. Hence, personal beliefs are important, and norms followed in hospitals, especially be senior hospital staff is essential when it comes to hand hygiene compliance. The article does not use any figures or maps to summarize the findings. |
Discussion Interpretation of the findings | The results of the study were analyzed from a social perspective whereby hand hygiene among health workers is driven only by self-protection and the urge to carry out cleaning only after a task that is perceived as dirty. The findings were discussed in the context of other studies; for example, the researchers mention a study by Whitby et al. Yes, the discussion was consistent with the limitation of the study. For an instant, the small number of physicians interviewed because focus groups were impossible for this group of participants, which led to the generation of two forms of qualitative data, one from individual interviews and the other from focus groups. |
| Implications/recommendations | The authors state that the findings are only useful on preliminary determination of probable elements influencing hand hygiene adherence, and the identified factors can be further analyzed in quantitative studies. |
General Issues Presentation | The article is written correctly, using words that are easy to understand, and it has no grammatical errors. The methods used and findings are appropriately discussed in detail, and it is easy to understand and follow. However, the article seems too brief in certain areas, such as in the analysis section. Also, the researchers could have used graphs or maps in the research, especially in the results section. |
| Researcher credibility | Yes, the design of the study and the methods of data collection used by the authors give credibility to the survey given it was a qualitative based study. In the discussion, the authors indicate the limitations of the study, which eliminates any thoughts of bias from the reader. |
| Summary assessment | The researchers discuss the measures to improve the quality of the study, such as involving participants from different healthcare institutions. The researchers used the Theory of Planned Behavior to interview participants and get the required information in a complete and non-biased way. The quality improvement technique that could have been used is reflexivity to ensure the participants are transparent during the interviews. The study and the findings are trustworthy, and I have confidence in the findings of the study. Yes, the study clearly shows the impact of behavior on hand hygiene and the role senior hospital staff play when it comes to being role models to the junior employees regarding hand hygiene practices, which is essential in nursing. |
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