Impact of Hand Rub Placement on Patient Trust and Disease Stigma

NCT07552792 | Not Yet Recruiting

• 6 other identifiers: KY2025-137124ZR1407800C2025212HSWH202403HSWH202505HSWH202513
• Study Type: interventional
• Target: 250
• Locations: 0 countries
• Sites: N/A

Brief Summary

This study aims to investigate how the physical placement of hand sanitizer in consultation rooms affects patient trust and feelings of disease stigma. While hand hygiene is an essential infection control measure in healthcare, performing it immediately in front of patients with visible, non-communicable conditions (such as psoriasis) might inadvertently make patients feel rejected or stigmatized.This study uses a randomized controlled design to evaluate if a simple environmental modification-changing the spatial location of the hand sanitizer-can naturally nudge physicians to alter their hand hygiene timing without compromising safety. Researchers will discreetly observe the hand hygiene behavior of outpatient dermatologists and ask participating psoriasis patients to complete a brief, anonymous questionnaire regarding their trust in the physician, feelings of stigma, and overall satisfaction with the consultation. The goal is to provide evidence for patient-centered hospital space designs that protect patient psychological well-being while maintaining hygiene standards.

Conditions

Noncommunicable Disease; Psoriasis

Outcome Measures

Primary Outcomes (3)

• Proportion of Invisible Hand Hygiene Events

  Hand hygiene behavior was observed and categorized into "visible hand hygiene" (immediate post-contact cleansing before patient departure) and "invisible hand hygiene" (cleansing after patient departure). A positive outcome is defined as handwashing occurring after the patient leaves (invisible hand hygiene). The outcome is reported as the proportion of consultations where invisible hand hygiene occurred.

  Assessed during the outpatient consultation (average 10-15 minutes per consultation).

• Patient Trust in Physician Scale (TPS) Score

  Patient trust was measured using the 10-item Trust in Physician Scale (TPS), a validated tool using a 5-point Likert scale to assess trust in the physician's competence, communication, and prioritization of patient interests. Results are expressed as percentages of total possible scores (range 0-100%). Higher scores indicate a higher level of trust in the physician.

  Assessed immediately after the outpatient consultation.

• Feelings of Stigma Questionnaire (FSQ) Score

  Perceived disease stigma was measured using the 28-item modified Feelings of Stigma Questionnaire (FSQ), which uses a 6-point scale to assess subjective experiences of stigma across domains including self-stigma, social exclusion, privacy management, and emotional impact. Results are expressed as percentages of total possible scores (range 0-100%). Higher scores indicate higher levels of perceived disease stigma.

  Assessed immediately after the outpatient consultation.

Secondary Outcomes (1)

• Patient Satisfaction Score

  Assessed immediately after the outpatient consultation.

Study Arms (2)

Distant Placement Group

EXPERIMENTAL

In this experimental arm, the hand rub dispenser is placed at a distant position, greater than 1 meter (approx. 3.3 feet) away from the physician (e.g., on a sink), before the outpatient consultation begins.

Other: Distant placement of hand rub

Conventional Placement Group

ACTIVE COMPARATOR

In this active comparator arm, the hand rub dispenser is placed in the conventional position, less than or equal to 0.3 meters (approx. 1 foot) away from the physician (e.g., to the left of the computer), before the outpatient consultation begins.

Other: Conventional placement of hand rub

Interventions

Distant placement of hand rub OTHER

The alcohol-based hand rub dispenser is relocated to a distant position in the consultation room, greater than 1 meter (approx. 3.3 feet) away from the physician (e.g., on a sink). This environmental modification is designed to prompt physicians to perform hand hygiene after the patient departs ("invisible hand hygiene"), aiming to improve patient trust and reduce perceived disease-related stigma.

Distant Placement Group

Conventional placement of hand rub OTHER

The alcohol-based hand rub dispenser is placed in the conventional, standard position in the consultation room, which is less than or equal to 0.3 meters (approx. 1 foot) away from the physician (e.g., to the left of the computer). This facilitates standard hand hygiene immediately after patient contact ("visible hand hygiene").

Conventional Placement Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• For Patients:
• Aged 18 years or older.
• Diagnosed with psoriasis and receiving treatment at the designated psoriasis specialty outpatient clinic during the study period.
• Legally capable of signing the informed consent form and cognitively able to understand and complete the questionnaire (independently or with assistance from family members).
• For Physicians:
• Hold a registered practicing qualification in the Dermatology Department of Huashan Hospital Pudong Branch and are qualified for independent outpatient consultations.
• Scheduled to continuously undertake outpatient work in the designated consultation rooms during the study period.
• Voluntarily sign the informed consent form for behavioral observation.

You may not qualify if:

• For Patients:
• Severe visual, hearing, or speech impairments leading to basic doctor-patient communication barriers.
• Diagnosed with psychiatric disorders (e.g., schizophrenia, severe depression) that, as assessed by a specialist, may interfere with the authenticity of the questionnaire responses.
• Presenting with a clinical state requiring emergency treatment during the visit, such as acute infection of skin lesions or generalized pustules.
• For Physicians:
• Non-permanent practicing staff of the hospital, such as visiting physicians or rotating medical students.
• Unable to independently perform hand hygiene procedures due to physical/limb dysfunction.

Sponsors & Collaborators

• Huashan Hospital: lead

Related Publications (9)

• Ginsburg IH, Link BG. Feelings of stigmatization in patients with psoriasis. J Am Acad Dermatol. 1989 Jan;20(1):53-63. doi: 10.1016/s0190-9622(89)70007-4.

  PMID: 2913081 BACKGROUND

• Anderson LA, Dedrick RF. Development of the Trust in Physician scale: a measure to assess interpersonal trust in patient-physician relationships. Psychol Rep. 1990 Dec;67(3 Pt 2):1091-100. doi: 10.2466/pr0.1990.67.3f.1091.

  PMID: 2084735 BACKGROUND

• Reid H, Smith R, Williamson W, Baldock J, Caterson J, Kluzek S, Jones N, Copeland R. Use of the behaviour change wheel to improve everyday person-centred conversations on physical activity across healthcare. BMC Public Health. 2022 Sep 20;22(1):1784. doi: 10.1186/s12889-022-14178-6.

  PMID: 36127688 BACKGROUND

• Speight J, Holmes-Truscott E, Garza M, Scibilia R, Wagner S, Kato A, Pedrero V, Deschenes S, Guzman SJ, Joiner KL, Liu S, Willaing I, Babbott KM, Cleal B, Dickinson JK, Halliday JA, Morrissey EC, Nefs G, O'Donnell S, Serlachius A, Winterdijk P, Alzubaidi H, Arifin B, Cambron-Kopco L, Santa Ana C, Davidsen E, de Groot M, de Wit M, Deroze P, Haack S, Holt RIG, Jensen W, Khunti K, Kragelund Nielsen K, Lathia T, Lee CJ, McNulty B, Naranjo D, Pearl RL, Prinjha S, Puhl RM, Sabidi A, Selvan C, Sethi J, Seyam M, Sturt J, Subramaniam M, Terkildsen Maindal H, Valentine V, Vallis M, Skinner TC. Bringing an end to diabetes stigma and discrimination: an international consensus statement on evidence and recommendations. Lancet Diabetes Endocrinol. 2024 Jan;12(1):61-82. doi: 10.1016/S2213-8587(23)00347-9.

  PMID: 38128969 BACKGROUND

• Sant'Anna A, Vilhelmsson A, Wolf A. Nudging healthcare professionals in clinical settings: a scoping review of the literature. BMC Health Serv Res. 2021 Jun 2;21(1):543. doi: 10.1186/s12913-021-06496-z.

  PMID: 34078358 BACKGROUND

• Iyer R, Park D, Kim J, Newman C, Young A, Sumarsono A. Effect of chair placement on physicians' behavior and patients' satisfaction: randomized deception trial. BMJ. 2023 Dec 15;383:e076309. doi: 10.1136/bmj-2023-076309.

  PMID: 38101923 BACKGROUND

• Anderson J, Fenton K. HIV related stigma: a dangerous roadblock. BMJ. 2022 Dec 12;379:o2989. doi: 10.1136/bmj.o2989. No abstract available.

  PMID: 36523179 BACKGROUND

• Kahn MW. Etiquette-based medicine. N Engl J Med. 2008 May 8;358(19):1988-9. doi: 10.1056/NEJMp0801863. No abstract available.

  PMID: 18463374 BACKGROUND

• Puhl R, Suh Y. Health Consequences of Weight Stigma: Implications for Obesity Prevention and Treatment. Curr Obes Rep. 2015 Jun;4(2):182-90. doi: 10.1007/s13679-015-0153-z.

  PMID: 26627213 BACKGROUND

MeSH Terms

Conditions

Noncommunicable Diseases; Psoriasis

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms; Skin Diseases, Papulosquamous; Skin Diseases; Skin and Connective Tissue Diseases

Central Study Contacts

Juan Du, MD

CONTACT

+86-13601821207; dujuan@huashan.org.cn

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Associate Chief Physician, Associate Professor

Study Record Dates

• First Submitted: April 20, 2026
• First Posted: April 27, 2026
• Study Start: May 1, 2026
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): June 1, 2026
• Last Updated: April 27, 2026

Record last verified: 2026-04

Data Sharing

• IPD Sharing: Will not share