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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 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.

Multimodal hand hygiene programs are well-established in hospitals across the United Arab Emirates (UAE), yet sustaining hand hygiene compliance is challenging. Religious and cultural beliefs are considered to be behaviour domains that influence hand hygiene behaviour, yet the influence of these beliefs upon hand hygiene have not been examined in the UAE. This thesis reports on a study of religious and cultural beliefs influencing hand hygiene behaviours, and the effect of a Modified Mafraq Hand Hygiene Program on HCWs’ compliance and beliefs about alcohol-based hand rub (ABHR) use. This study was conducted in two phases at the Mafraq Hospital, UAE. Phase 1 comprised two parts. Phase 1A used interviews with Islamic scholars and HCWs to explore how participants’ (i) behavioural, normative, control, and (ii) religious and cultural beliefs influenced hand hygiene. Phase 1B involved an online cross-sectional survey utilising an existing instrument based on the Theory of Planned Behaviour (TPB) model, which was adapted to include items on religious and cultural beliefs derived from phase 1A, to determine if it was predictive of hand hygiene behaviour. Phase 2 used a cohort design to examine the effect of a Modified Mafraq Hand Hygiene Program on HCWs’ hand hygiene compliance, and religious beliefs about ABHR use. Six themes related to standard TPB variables and six themes related to religious and cultural beliefs emerged from phase 1A. In phase 1B, the strongest predictors of alcohol-based hand rubbing were cultural beliefs and attitudes. Phase 2 of the study found that the intervention group had higher mean compliance with ABHR use post-intervention, and higher mean compliance with overt ABHR use than the control group. The intervention group had more positive religious beliefs about ABHR use than the control group. Addressing determinants related to religious and cultural beliefs is an important strategy to improve compliance with ABHR use. Introducing religion-relevant, culturally-specific interventions can positively influence compliance with, and beliefs related to, ABHR use. This study is the first of its kind. Future studies exploring ABHR use using a TPB model with integrated religious and cultural beliefs could improve and sustain hand hygiene compliance in other contexts.