VHA Research

Safer Teams

Determinants of nurse’s and personal support worker’s adherence to facial protective equipment in a community setting during the COVID-19 pandemic: A pilot study; 2021

What’s the challenge?

Facial protective equipment (FPE) is a critical barrier to COVID-19 transmission, but compliance with FPE recommendations has been historically low, even amongst health care workers. Previous literature focuses on institution-based health care sectors and suggests that organizational and environmental factors influence FPE compliance. Less is known about FPE compliance in the home care sector, where important differences can impact infection prevention and control (e.g. supply access). This study analyzes factors of influence on home care worker FPE compliance during the COVID-19 pandemic. Results provides vital information for designing effective health and safety initiatives of heightened importance during the pandemic.

What are we doing?

A literature review assessed publications from 2005 – 2020 for FPE compliance in health care settings. Nurses and PSWs employed by VHA Home HealthCare (N=199) from January 27 – February 10, 2021 completed a web-based survey adapted from the Facial Protection Questionnaire used in previous studies. The new homecare-focused, COVID-19-specific version of the FPQ (FPQ-HC-C19) was a 5-part, 66-item questionnaire, measuring demographics and work patterns, individual factors, compliance with recommended use of FPE, environmental factors, and organizational factors. Descriptive statistics, tests of significance, and logistic regression were conducted for each variable separated by FPE compliance.

What have we found?

Previous literature suggests that healthcare workers’ FPE compliance could be increased by improving FPE access, training, perceived efficacy, and comfort, and organizational support for health and safety. This study found higher rates of FPE compliance (70.85%) than previously reported. Regression results suggest that not always FPE compliant participants (29.15%) were significantly more likely to have lower perceived FPE efficacy, lower knowledge of recommended FPE use, lower perception of risk at work, and higher personal barriers for face shields. Fogging of glasses or face shields from wearing a mask (74.4%) or face shield (70.9%) increased job difficulty for many participants.

What's next?

In contrast to previous findings, organizational and environmental barriers did not emerge as significant predictors of FPE compliance in this study. Results suggest that when these organizational and environmental standards are largely met, as was the case with this sample, individual factors become significant predictors of FPE compliance. Policies and initiatives addressing perceived FPE efficacy, knowledge of recommended FPE use, perception of at-work risk, and personal barriers to FPE would be expected to significantly effect FPE compliance in the home care sector. Additionally, utilizing materials that reduce visibility issues while wearing FPE would decrease personal barriers to FPE use.

Project partners

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Project Funders

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Project Contact

Emily C King, PhD
Manager, Research Operations
VHA Home HealthCare