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Author: Sassenrath, C. / Diefenbacher, S. / Siegel, A. / Keller, J. (2015) Source: Sassenrath, C. et al., Psychology & Health 2016, Vol. 31, No. 2


Sassenrath, C. / Diefenbacher, S. / Siegel, A. / Keller, J. (2015)

A person-oriented approach to hand hygiene behaviour: emotional empathy fosters hand hygiene practice

Background: Although hand hygiene – when performed as indicated – can effectively prevent infection, compliance rates are still low. In their study, Sassenrath et al. examined the influence of emotional empathy on compliance: they investigated whether there is a link between empathy and hand hygiene behaviour and whether an empathy-based intervention improves hand hygiene.

Methods: Sassenrath et al. conducted a three-part study.

Part 1: In the first part, they evaluated the link between empathy as individual variable and the average self-reported hand hygiene frequency. For this, 62 healthcare workers of a German hospital filled in a two-part questionnaire: on the basis of the Mehrabian and Epstein emotional empathy scale, the empathy of the health care workers was determined. Afterwards, the personal hand hygiene behaviour was assessed by the day reconstruction method (DRM).

Part 2: In the second study part, the causal effect of empathy on hand hygiene behaviour was assessed. 150 study participants were divided into a control and empathy group and received a text on the situation of a patient potentially suffering from HIV to manipulate the empathy. Afterwards, the empathy group was instructed to concentrate on the situation and emotions of the patient, the control group’s focus was on the factual information given in the text. Then, the participants were asked to perform six typical activities in the kitchen of a nursing home, for example, washing plates and preparing differing meals. Additionally, the participants’ attention was called to the fact that hand hygiene is important during these activities. During the entire experiment, disinfectant dispensers were in the direct view of the test subjects. It was observed how many participants disinfected their hands at least once.

Part 3: In the third study part, the effect of an empathy-based intervention was evaluated. A control phase of seven weeks was succeeded by an intervention phase of four weeks. During the latter, empathy-inducing images showing consoling gestures were hung up in well-visible locations in a ward (empathy ward), including in the nurses’ room. Another ward (control ward) was equipped with neutral images of the hospital. The images’ effect was validated in a test beforehand.

The hand hygiene behaviour of the healthcare workers was determined on the basis of the daily disinfection frequency and the absolute consumption of disinfectants. The change in hand hygiene behaviour during the intervention phase in the wards was then compared.


Part 1: The evaluation of the questionnaires showed that empathy can significantly predict the self-reported hygiene behaviour: the higher the self-assessed empathy, the higher the reported number of hand disinfection procedures in relevant situations.

Part 2: The results of the second study part confirm the thesis that empathy promotes the hand hygiene frequency. The test subjects of the empathy group disinfected their hands significantly more often (60 %) than the participants of the control group (43 %).

Part 3: The third study part showed that the empathy-based intervention had a positive influence on the hand hygiene: compared to the control group, the number of hand disinfection procedures in the empathy ward increased significantly.

Conclusions: Sassenrath et al. proved a link between empathy and hand hygiene behaviour. Moreover, empathy-based interventions can promote hand hygiene. The study results provide new ideas for the design of interventions that eventually shall improve safety and quality of health care, the authors summarised.

Sassenrath, C. et al., Psychology & Health 2016, Vol. 31, No. 2

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