Changes in knowledge, beliefs, and perceptions throughout a multifaceted behavioral program aimed at preventing ventilator-associated pneumonia

Prevention of ventilator-associated pneumonia (VAP) requires a complex approach that should include factors affecting healthcare workers' (HCWs) behavior. This study attempted to assess change of individual factors throughout a multifaceted program focusing on VAP prevention. The prevention program involved all HCWs in a 20-bed medical intensive care unit (ICU) and included a multidisciplinary task force, an educational session, direct observations and performance feedback, technical improvements, and reminders. Knowledge, beliefs, and perceptions (cognitive factors) were assessed with a test and a self-reporting questionnaire based on social-cognitive theories. They were completed before and 1 and 12 months after the educational session. Of the 100 HCWs initially evaluated, 84 were present 1 year later. Overall, individual factors (knowledge and cognitive factors) changed positively and significantly, immediately after the educational session. Five cognitive factors were significantly associated with knowledge: perceived susceptibility, seriousness, knowledge, benefits, and self-efficacy (P < 0.05). The other factors, i.e., perceived barriers, subjective and behavioral norm, intention to perform action, and motivation, were not. The positive cognitive change was significantly reinforced at 1 year. Three distinct cognitive profiles derived from answers to the baseline questionnaire were individualized. The positive impact of our behavioral approach was highest for the HCW group with the lowest baseline cognitive profiles. Behavior changed gradually throughout the program and was especially pronounced for HCWs with the lowest baseline cognitive profiles.