Promoting FPE Adherence Among Home Care Workers: Key Factors and Strategies

An older woman is in her home with the home care worker.

(Adobe Stock 601869653 by Chanelle Malambo/peopleimages.com)

The SARS-CoV-2 pandemic led to a dramatic increase in the use of facial protective equipment (FPE), such as respiratory and eye protection. Studies in institutional health care settings have linked consistent FPE use to reduced transmission rates and milder illness. However, little research has examined FPE adherence in home care environments, where the occupational context differs significantly from hospitals or long-term care facilities.

A recent study, “Factors Influencing Self-Reported Facial-Protective Equipment Adherence Among Home Care Nurses and Personal Support Workers: A Multisite Cross-Sectional Study,” published in the American Journal of Infection, researched individual, environmental, and organizational factors influencing adherence.

Home care providers, including personal support workers (PSWs) and nurses, deliver essential services to clients, often older adults with complex medical needs, in their homes or communal living environments. PSWs account for approximately 80% of home care services in Ontario, Canada. These workers face unique challenges, such as working alone, limited supply access, and navigating client home environments. These differences make promoting FPE adherence in-home care distinct from institutional settings.

“With few studies specifically exploring FPE use among home care PSWs and nurses, home care leaders have limited sector-specific evidence to inform their efforts to promote FPE use,” the authors wrote. “The objective of this study was to conduct a large-scale investigation across multiple home care agencies to elucidate factors that may not have been visible from the single-site study’s smaller sample. Findings generated within the context of the SARS-CoV-2 pandemic can provide valuable insights into promoting FPE adherence in-home care for future infectious disease epidemics or pandemics when long-term, repeated use is again required.”

A cross-sectional electronic survey was distributed to PSWs and nurses from 3 large not-for-profit home care agencies in Ontario, Canada. The agencies provided care in urban, suburban, and rural settings and had infrastructure for research engagement.

A survey conducted among 1,108 home care providers from three large, non-profit agencies in Ontario examined FPE adherence during the SARS-CoV-2 pandemic. The results revealed an overall adherence rate of 63.4%, with respiratory protection adherence (95.8%) significantly higher than eye protection adherence (63.9%). The findings suggest that respiratory protection measures, like surgical masks or N95 respirators, were more consistently used than eye protection, similar to trends reported in hospital-based studies.

Multiple factors influenced FPE adherence. First, gender and ethnicity played notable roles. Men were less likely to be fully adherent to FPE guidelines compared to women, while Caribbean providers were more likely to adhere compared to their White counterparts. These findings underscore the need for more tailored interventions addressing gender and ethnicity in adherence training.

Educational background also mattered. Nurses with a 2-year diploma reported lower adherence rates than PSWs and nurses with a 4-year degree. This points to the potential value of integrating higher education into home care training programs to improve FPE usage.

Another critical finding was the relationship between mental health and adherence. Providers who reported adverse mental health effects due to occupational exposure were less likely to adhere to FPE protocols. This suggests that mental well-being, particularly during a pandemic, plays a significant role in worker safety behaviors.

“A novel finding from this study was an association between lower adherence and negative mental health effects following occupational exposure to an infectious respiratory disease. This association between mental health and FPE adherence may be explained in part by the degree of burnout respondents may have experienced,” the authors wrote.

Environmental factors also contributed to adherence. Workers who used communal transportation reported lower adherence, possibly because they perceived higher exposure risks in public transit, prompting them to take breaks during client visits.

Finally, organizational support and access to FPE were key factors in promoting adherence. Workers who reported having convenient access to FPE and received comprehensive training were significantly more likely to follow safety protocols. This highlights the importance of ensuring home care agencies strengthen their supply chains and provide adequate training and support to their workers.

The study can be found here.