Evaluation of Social-Cognitive Determinants of Patients’ Hand Hygiene Decisions and the Role of Mental Health in a Cross-Sectional and a Longitudinal Study of German Patients

Patients’ effective hand hygiene helps to reduce healthcare-associated infections and prevents the spread of nosocomial infections and communicable diseases, such as COVID-19. Accordingly, this study aimed to describe effective hand hygiene decisions based on the Health Action Process Approach (HAPA) and whether this pattern is invariant for mental health. Data were collected cross-sectionally from patients who had previously been admitted to a hospital (Nstudy 1 = 279; study 1) and longitudinally from psychosomatic rehabilitation patients (Nstudy 1 = 1073; study 2). The fit of the HAPA framework and changes in hand hygiene decisions regarding compliance, social-cognitive variables of the HAPA, and mental health status were examined. The results revealed that the trimmed HAPA framework fitted the data well (χ2 = 27.1, df = 12, p < 0.01, CMIN/df = 2.26, CFI = 0.97, RMSEA = 0.08). According to multi-group structural equation modeling, the HAPA model with hand hygiene behavior was found to be invariant regarding mental health. To conclude, the trimmed HAPA framework was revealed to be a generic framework for explaining social-cognitive processes relating to hand hygiene decisions. Therefore, helping individuals to perform hand hygiene recommendations requires intention formation and bridging the intention–behavior gap. This can be undertaken by promoting planning and self-efficacy. All processes appear generic to participants with and without mental health challenges.