The influence of religious and cultural beliefs on hand hygiene behaviour in the United Arab Emirates

Background: Behavioural theory is crucial to develop effective hand hygiene interventions. While studies have explored the behavioural determinants of hand hygiene in healthcare workers (HCWs) using the Theory of Planned Behaviour (TPB), none of these have incorporated religious and cultural beliefs about hand hygiene behaviour. This study aimed to explore HCWs' and Islamic scholars’ perceptions of the religious and cultural beliefs influencing hand hygiene behaviours in the United Arab Emirates. Methods: A mixed methods design employed interviews with Islamic scholars, nurses, doctors and allied health professionals, followed by survey. Results: Six themes related to standard TPB variables and six themes related to religious and cultural beliefs emerged. 349 participants (26.1%) responded to the survey: 171 (49%), 111 (31.8%) and 67 (19.2%) were from nurses, doctors and allied health professionals respectively. Direct logistic regression revealed the strongest predictors of alcohol-based hand rubbing were cultural beliefs (OR = 1.15; p < 0.001), followed by attitudes (OR = 0.87; p < 0.001), when controlling for other factors in the model. Conclusion: Addressing determinants related to cultural beliefs and attitudes and exploring alcohol-based hand rub use using a TPB model with integrated cultural beliefs is an important strategy to improve compliance with alcohol-based hand rubbing behaviour.