A powerful theoretical framework for changing hand hygiene behavior of healthcare professionals is the Stages of Change theory. Developed by Prochaska et al. (1994), this theory facilitates educators’ identification of the stage which the participants are in. It also assists them in transitioning through other stages to reach the actual behavior change and the stage of maintenance. Two complimentary theories to augment the SOC model are self-efficacy theory developed by Bandura (1997) and expectancy-value theory, developed by Rotter (1982) and later by Weiner (1992).
The Stages of Change theory (Prochaska et al., 1994) provides characteristics of particular stages as well as guidance as to how effectively help the study participants grow aware of the need to change, then contemplate and prepare for the change, as well as act and maintain this change. In the first, precontemplation stage, participants are generally unaware of the need to alter the behavior through rationalization or avoidance. Next, in the contemplation stage, the participants recognize the need to change yet they are still stuck. Further, in the preparation stage, the participants plan the change and get ready for it take place in the near future. In the action stage, the participants start by taking small steps while they rely on social support and rewards. Finally, in the maintenance stage, the participants get committed to hand hygiene and do not need external rewards any longer (Trunnell & White, 2005).

To augment the transition from preparation to action, two additional theories may also be used. The self-efficacy theory is based on the assumption that the participants’ self-efficacy beliefs significantly increase the likelihood of further performance and persistence. Three of the four modalities should be present: stepwise performance (PE), then seeing this done by others (VL), emotional arousal (EA), and verbal persuasion (VP). As for the expectancy-value theory, it assumes that increases in behavior will take place if it is be valued or viewed as important as well as the participants clearly realize the link between their performance and the outcome that is expected.

References
• Bandura, A. (1997). Self-efficacy. New York: W. H. Freeman.
• Prochaska, J., Norcross, J., & Diclemente, C. (1994). Changing for good. New York: Avon
  Books.
  Rotter, J. (1982). Social learning theory. In N. T. Feather (Ed.) Expectations and actions:
  Expectancy-value models in psychology (pp. 421-260). Hillsdale, NJ: Erlbaum.
• Trunnell, E. & White, G. (2005). Using behavior change theories to enhance hand hygiene
  behavior. Education for Health, 18 (1), 80-84.
• Weiner, B. (1992). Human motivation. Newbury Park, NJ: Sage.