• Promoting practitioner research through a social work teaching partnership

      Buck, Gillian; Whiteside, Nicola; Newman, Andrea; Jones, Helen; Stanley, Selwyn; Feather, Julie; Millard, Wayne; University of Chester; Cheshire and Merseyside Social Work Teaching Partnership; Liverpool John Moores University; Warrington Borough Council; Edge Hill University (Taylor and Francis, 2022-09-29)
      Research is critical for effective and innovative social work practice, yet social workers do not always have time to engage with research and there are limited accounts of how practitioners can undertake research in practical and meaningful terms (Mitchell, Lunt, and Shaw 2010). Using a reflective, storytelling methodology (Beresford 2016), which centres experiential knowledge, we describe how one regional social work teaching partnership nurtured practitioner research over a three-year period. We introduce a regionally administrated ‘hub’, that connected social workers and academics and supported the development of seventeen research teams. The studies that resulted, focused on a range of important issues including child protection, young people in transition to adult services, adults in community and residential settings, lived experience-led provision, and social work education. In terms of limitations, our reflections are descriptive and illuminative, rather than critical, our findings are also not representative but rather reflect a snapshot of practice. Despite limitations, this commentary reveals the feasibility and value of proactively nurturing practitioner research and offers a blueprint for cultivating similar initiatives in other regions.
    • How many practice hours are required to become a registered nurse?

      Garrow, Amanda; Roberts, Deborah; Kenny, Amanda; Leigh, Jackie; Borwell, Juliet; Knight, Kate H; Whaley, Victoria; Monks, Rob; Wright, Karen; University of Chester; Liverpool John Moores University; University of Bradford; La Trobe University; Edge Hill University; Health Education England (MA Healthcare, 2022-09-23)
      Globally, the number of nurse vacancies is high, and there has been much scrutiny on the preparation of the nursing workforce. The World Health Organization (2020) has called for an acceleration of nurse education to meet future demands. In the UK, nursing is at a critical juncture. Post-pandemic attrition rates are high and, despite ambitious government targets, recruitment is unable to meet demand. A Nursing and Midwifery Council (NMC) report (NMC, 2022a) demonstrated that almost half the number of graduate nurses joining the register for the first time (48% of 48 436) completed nurse education outside the UK. Of this group, 66% were educated in India or the Philippines. Nurse education in the UK is approved
    • Practicing lived experience leadership with love: Photovoice reflections of a community-led crime prevention project

      Buck, Gillian; Ryan, Kemi; Ryan, Natasha; University of Chester; Reformed, Liverpool (Oxford University Press, 2022-09-16)
      Lived experience leadership is part of a broader international trend toward service user involvement in public services yet little is known about services developed and delivered by people with lived experience of the criminal justice system. Our innovative study, coproduced by two formerly imprisoned community practitioners and an academic researcher, aims to amplify the voices of people delivering and using a lived experience-led crime prevention project. Using Photovoice methods, in which people use cameras to document their realities and advocate for change, we explore the potential of lived experience leadership to drive individual and social change. Some of the compelling images produced by the group are showcased, revealing how in contexts of suffering, social exclusion, and negative expectations, forms of inclusive, loving, hopeful community praxis can be impactful. We conclude that allegiances between community practitioners and social workers could begin to disrupt harmful and oppressive structures and create locally led, hope-filled service provision. To broker such allied practices, we include a self-audit for social and community workers, inviting reflections focused on this ambitious goal.
    • Social work students and dyslexia: outcomes from an empirical study and some implications for practice

      Gant, Valerie; Hewson, Michael; University of Chester (Taylor and Francis, 2022-09-07)
      Dyslexia is likely one of the most misunderstood conditions impacting on educational outcomes at all levels, in and across all practice and intellectual domains. This paper discusses a project carried out by two qualified social workers, one an academic involved in teaching and assessing social work students, the other a doctoral student with a formal diagnosis of dyslexia and dyspraxia. The research involved 9 social work students from 3 different universities who identified as having dyslexia. Semi structured interviews were held in order to identify challenges experienced by participants as well as any strategies they used to ameliorate them. The data from the interviews was coded and analysed, the findings indicated a range and variety of experiences. Participants described feeling anxious and questioned their ability to study social work, both in university and on placement. Feelings of exhaustion were noted, which indicated the need to examine and potentially to rebalance educators’ expectations across academic and practical roles, and to provide support for students to meet workload requirements particularly when on placement. Findings from the interviews were shared with academic staff and practice educators, additionally a ‘good practice’ guide was produced to support educators in placement as well as in universities
    • Psychological Therapies and Non-Suicidal Self Injury in LGBTIQ in Accident and Emergency Departments in the UK: A scoping review

      Broadway-Horner, Matthew; Kar, Anindya; Ventriglio, Antonio; Pemberton, Max; University of Chester; Advanced Neuropsychiatry Institute, Kolkata; Camden and Islington Foundation NHS Trust; University of Foggia (Taylor and Francis, 2022-08-25)
      Background: To identify psychological interventions that improve outcomes for those who overdose, especially amongst Lesbian, Gay, Bisexual, Transgender, Intersex and Questioning populations. Objective: To recognise and assess the results from all studies including randomised control trials that have studied the efficiency of psychiatric and psychological assessment of people who have depression that undergo Non-Suicidal Self Injury (NSSI) by self-poisoning, presenting to UK A & E Departments Method: A scoping review of all studies including randomised controlled trials of psychiatric and psychological therapy treatments. Studies were selected according to types of engagement and intervention received. All studies including Randomised Controlled Trials (RCTs) available in databases since 1998 in the Willey version of the Cochrane controlled trials register in 1998 till 2021, Psych INFO, Medline, Google Scholar and from manually searching of journals were included. Studies which included information on repetition of NSSI behaviour were also included. Altogether this amounts to 3,900 randomised study participants with outcome data. Results: 7 trials reported repetition of NSSI as an outcome measure which were classified into 4 categories. Problem solving therapy (PST) is indicated as a promising therapy and has shown to significantly reduce repetition in participants who NSSI by overdosing than patients in the control treatment groups consisting of standard after care. Conclusion: The data shows that Manualised Cognitive Therapy (MACT) psychological intervention was more effective than TAU after care. However, these differences are not statistically significant with p = 0.15; CI 0.61, 1.0 which crosses the line of no effect. And Psychodynamic Interpersonal Therapy (PIT) is more effective than standard treatment. Despite being only one study in this subgroup the analysis shows a statistically Significance with p = 0.009, CI0.08; 0.7
    • The Cost of Von Willebrand Disease in Europe: The CVESS Study

      Morgan, George; Brighton, Sarah; Laffan, Mike; Goudemand, Jenny; Franks, Bethany; Finnegan, Alan (SAGE Publications, 2022-08-17)
      Background: Von Willebrand disease (VWD) is one of the most common inherited bleeding disorders, imposing a substantial health impact and financial burden. The Cost of von Willebrand disease in Europe: A Socioeconomic Study (CVESS) characterises the socio-economic cost of VWD across Germany, Spain, Italy, France, and the UK. Methods: A retrospective, cross-sectional design captured 12 months of patient disease management, collected from August-December 2018, for 974 patients. This enabled estimation of direct medical, direct non-medical and indirect costs, utilising prevalence estimates to extrapolate to population level. Results: Total annual direct medical cost (including/excluding von Willebrand factor [VWF]) across all countries was the highest cost (€2 845 510 345/€444 446 023), followed by indirect costs (€367 330 271) and direct non-medical costs (€60 223 234). Differences were seen between countries: the UK had the highest direct medical costs excluding VWF (€159 791 064), Italy the highest direct-non medical (€26 564 496), and Germany the highest indirect cost burden (€197 036 052). Total direct medical costs per adult patient increased across VWD types with Type 1 having the lowest cost (€23 287) and Type 3 having the highest cost (€133 518). Conclusion: A substantial financial burden arises from the prevalence of VWD for the European healthcare systems considered.
    • Interactions between Vitamin D Genetic Risk and Dietary Factors on Metabolic Disease-Related Outcomes in Ghanaian Adults

      Alathari, Buthaina E.; Nyakotey, David A.; Bawah, Abdul-Malik; Lovegrove, Julie A.; Annan, Reginald A.; Ellahi, Basma; Vimaleswaran, Karani S.; University of Reading; The Public Authority for Applied Education and Training, Kuwait; Kwame Nkrumah University of Science and Technology; University of Auckland; University of Chester (MDPI, 2022-07-04)
      The Ghanaian population is experiencing an upsurge in obesity and type 2 diabetes (T2D) due to rapid urbanization. Besides dietary factors, vitamin D-related genetic determinants have also been shown to contribute to the development of obesity and T2D. Hence, we aimed to examine the interactions between dietary factors and vitamin D-related genetic variants on obesity and T2D related outcomes in a Ghanaian population. Three hundred and two healthy Ghanaian adults (25–60 years old) from Oforikrom, Municipality in Kumasi, Ghana were randomly recruited and had genetic tests, dietary consumption analysis, and anthropometric and biochemical measurements of glucose, HbA1c, insulin, cholesterol, and triglycerides taken. A significant interaction was identified between vitamin D-GRS and fiber intake (g/day) on BMI (pinteraction = 0.020) where those who were consuming low fiber (≤16.19 g/d) and carrying more than two risk alleles for vitamin D deficiency (p = 0.01) had a significantly higher BMI. In addition, an interaction between vitamin D-GRS and fat intake (g/day) on HbA1c (total fat, pinteraction = 0.029) was found, where participants who had a lower total fat intake (≤36.5 g/d), despite carrying more than two risk alleles, had significantly lower HbA1c (p = 0.049). In summary, our study has identified novel gene–diet interactions of vitamin D-GRS with dietary fiber and fat intakes on metabolic traits in Ghanaian adults.
    • Acceptability, usability and weight loss outcomes in a randomized cross-over study of commercially available portion size tools in an overweight South Asian community

      Ellahi, Basma; Aitken, Amanda; Dikmen, Derya; Erdogan, Bilge Seyhan; Makda, Munibah; Razaq, Rifat; University of Chester; Hacettepe University (MDPI, 2022-06-23)
      South Asian women living in the UK are particularly at high risk of obesity-related complications, such as type 2 diabetes and cardio-vascular disease. Exposure to large portion sizes is a risk factor for obesity. Specifically, designed tableware helps individuals to manage weight through controlling food portion sizes. Thirty-one (n=31) overweight or obese South Asian adult women participated in a randomised cross-over trial aimed to assess efficacy, acceptance and weight change for two guided/calibrated commercially available portion control tools (Utensil set and Crockery Set) used in free-living conditions. Data on acceptance, perceived changes in portion size, frequency, and meal type was collected using paper questionnaires and 3-day diet dairies. Scores describing acceptance, ease of use and perceived effectiveness were derived from five-point Likert scales from which binary indicators (high/low) were analysed for significance using multivariate variance analysis for repeated measurements. A reduction in BMI was observed at each point of measurement (p=0.007). For overall tool use, the crockery set scored higher in all areas of acceptance, ease of use, perceived efficacy for all comparisons. Self-selected portion sizes increased for salads and decreased for cooking oil and breakfast cereals with both tools. Further research to scale up and evaluate similar weight management interventions for this group are warranted.
    • Prisoners regulating prisons: voice, action, participation and riot

      Buck, Gillian; Tomczak, Philippa; University of Chester; University of Nottingham (Sage, 2022-06-16)
      Prisoners are a critical source of prison regulation around the world, but regulation by (rather than of) prisoners remains little analysed. In this article, we utilise the 1990 riots at HMP Strangeways (England), as a case study of prisoners (re)shaping imprisonment. We examine prisoners’ roles in these riots and subsequent cross-sectoral regulatory activities. We innovatively use the four-phase process of translation from actor-network theory to guide document analysis of i) Lord Woolf’s (1991) official inquiry into the riots and ii) the voluntary organisation Prison Reform Trust’s (2015) follow up report. We explore how participatory approaches could inform prison regulation through (former) prisoners partnering with external regulators throughout the processes of identifying problems and solutions to establish broader alliances seeking social change.
    • Sodium and potassium intakes assessed by 24-h urine among Moroccan University students in Casablanca, Morocco: Cross-sectional study

      Elarbaoui, Maria; Jafri, Ali; Elkardi, Younes; Makhlouki, Houria; Ellahi, Basma; Derouiche, Abdelfettah; Hassan II University of Casablanca; Mohammed VI University of Health Sciences; University of Chester (Elsevier, 2022-06-14)
      In Morocco, the high consumption of dietary sodium increases the risk of non-communicable diseases (NCDs) and predisposes to cardiovascular diseases (CVDs) and hypertension. This study aims to assess the dietary sodium and potassium intake in a random sample of Moroccan adult students as a benchmark informing a national strategy for reducing salt intake. This cross-sectional study was conducted with 103 adults aged 18 to 25 years recruited in Casablanca. The 24-hour urinary excretion was used to measure the sodium and potassium. Urine volume and creatinine excretion level were used to validate the completeness of the collected samples. The average urinary sodium excretion was 3.1 ± 0.1 g/day, 13.5% consumed less than 5g/day, while 69% consumed more than 5 g/day of which 17.5% consumed more than twice the recommendations. For the average urinary potassium excretion was 1.83 ± 0.06 g/day, and more than 98% of the students consumed less than the adequate intake. The Na/K ratio is significantly higher than the recommended amounts. The results of this pilot study show that the population studied has a high sodium intake and low potassium intake which does not meet World Health Organization (WHO) recommendations, which requires implementing an action plan to reduce salt intake.
    • Registered Nurses’ experiences of working within professional and contractual boundaries: A Grounded Theory study

      Templeman, Jenni; Barton, Janet; Devlin, Bernadette (University of Chester, 2022-06-01)
      Aligned to the Nursing and Midwifery Council’s (NMC) The Code (2018a) and other supporting regulatory documents, Registered Nurses (RNs) are accountable to the healthcare organisation through an employment contract and must work within the remit of professional standards and organisational policies. Falling below explicit professional and organisational standards has the potential for repercussions for the RN, the public and the organisation. This research explores RNs’ experiences of meeting the needs of the patient whilst fulfilling the requirements of The Code (NMC, 2018a) in conjunction with operational policies in a small District General Hospital within the British Isles. As far as can be ascertained, this study is the first to focus on the topic of interest. To explore this subject area and to have generated a substantive theory of Professional Liminality, a qualitative constructivist grounded theory approach situated in the interpretive research paradigm was espoused. Participants were purposefully and theoretically sampled to take part in this study. 12 face-to-face individual semi-structured interviews were conducted with experienced RNs. The interview guide evolved and lengthened over the data collection process in keeping with a grounded theory approach pertaining to emerging theoretical interests from the participants’ answers. The grounded theory principles of data collection techniques, constant comparative method of analysis to code data, construction of categories and the development of theoretical themes were adopted to produce a theory explaining the relationships between the emerging themes. Analysis of the findings uncovered three themes: Governance, Professional discrepancies, and Professional disquiet. These themes highlighted a dichotomy between professional and organisational expectations, significantly affecting RNs’ daily clinical practice, and are contextualised in the theoretical framework of professional liminality, representing the complexity of the findings. A new model, Rules versus Roles (RvR), is proposed as an approach to address and resolve the precarious professional liminal positions in which RNs find themselves. Whilst The Code (NMC, 2018a) and operational policy are both vital; they coexist paradoxically. This research indicates that they would benefit from complementing each other to affect an evolving and dynamic contemporary healthcare organisation.
    • Evaluation of Drinking Water Quality and Bacterial Antibiotic Sensitivity in Wells and Standpipes at Household Water Points in Freetown, Sierra Leone.

      Kamara, Dauda; orcid: 0000-0001-7750-8273; Bah, Doris; Sesay, Momodu; Maruta, Anna; orcid: 0000-0002-6417-7273; Sesay, Bockarie Pompey; Fofanah, Bobson Derrick; orcid: 0000-0003-3276-8949; Kamara, Ibrahim Franklyn; orcid: 0000-0003-1454-4650; Kanu, Joseph Sam; orcid: 0000-0003-0799-6907; Lakoh, Sulaiman; orcid: 0000-0002-7639-0004; Molleh, Bailah; et al. (2022-05-29)
      Water quality surveillance can help to reduce waterborne diseases. Despite better access to safe drinking water in Sierra Leone, about a third of the population (3 million people) drink water from unimproved sources. In this cross-sectional study, we collected water samples from 15 standpipes and 5 wells and measured the physicochemical and bacteriological water quality, and the antimicrobial sensitivity of <i>Escherichia coli</i> (<i>E. coli</i>) in two communities in Freetown, Sierra Leone in the dry and wet seasons in 2021. All water sources were contaminated with <i>E. coli</i>, and all five wells and 25% of standpipes had at least an intermediate risk level of <i>E. coli</i>. There was no antimicrobial resistance detected in the <i>E. coli</i> tested. The nitrate level exceeded the WHO's recommended standard (&gt;10 parts per million) in 60% of the wells and in less than 20% of the standpipes. The proportion of samples from standpipes with high levels of total dissolved solids (&gt;10 Nephelometric Turbidity Units) was much higher in the rainy season (73% vs. 7%). The level of water contamination is concerning. We suggest options to reduce <i>E. coli</i> contamination. Further research is required to identify where contamination of the water in standpipes is occurring.
    • Home‐based care nurses’ lived experiences and perceived competency needs: A phenomenological study

      Rusli, Khairul Dzakirin Bin; orcid: 0000-0002-8096-0006; Fen, Ong Shu; Speed, Shaun; Seah, Betsy; McKenna, Lisa; orcid: 0000-0002-0437-6449; Ying, Lau; orcid: 0000-0002-8289-3441; Ying, Liaw Sok; orcid: 0000-0002-8326-4049 (Wiley, 2022-05-22)
    • Editorial: COVID-19-Social Science Research During a Pandemic

      Ward, Paul R.; Bissell, Paul; Meyer, Samantha B.; Gesesew, Hailay A.; Januraga, Pande Putu; Chang, Dukjin; Lombi, Linda; Torrens University; University of Chester; University of Waterloo; Mekelle University; Udayana University Denpasar; Seoul National University; Catholic University of the Sacred Heart (Frontiers Media, 2022-05-09)
    • Examining patient and professional perspectives in the UK for gene therapy in haemophilia.

      Woollacott, Ione; Morgan, George; orcid: 0000-0003-2014-3415; Chowdary, Pratima; O'Hara, Jamie; Franks, Bethany; van Overbeeke, Eline; orcid: 0000-0003-0073-9350; Dunn, Nicola; Michelsen, Sissel; Huys, Isabelle; Martin, Antony; orcid: 0000-0003-4383-6038; et al. (2022-04-19)
      With the development of gene therapy for people with haemophilia (PWH), it is important to understand how people impacted by haemophilia (PIH) and clinicians prioritise haemophilia treatment attributes to support informed treatment decisions. To examine the treatment attribute preferences of PIH and clinical experts in the United Kingdom (UK) and to develop a profile of gene therapy characteristics fit for use in future discrete choice experiments (DCEs). Semi-structured interviews were conducted with PIH (n = 14) and clinical experts (n = 6) who ranked pre-defined treatment attributes by importance. Framework analysis was conducted to identify key themes and treatment attributes; points were allocated based on the rankings. Synthesis of results by a multidisciplinary group informed development of a profile of gene therapy characteristics for use in future research. Key themes identified by PIH and clinical experts included patient relevant features and the importance of 'informed decision making'. The six top-ranked treatment attributes were 'effect on factor level' (79 points), 'uncertainty regarding long-term risks' (57 points), 'impact on daily life' (41 points), 'frequency of monitoring' (33 points), 'impact on ability to participate in physical activity' (29 points), and 'uncertainty regarding long-term benefits' (28 points). The final treatment characteristics were categorised as therapeutic option, treatment effectiveness, safety concerns, impact on self-management and quality of life (role limitations). We identified several gene therapy characteristics important to PIH and clinicians in the UK. These characteristics will be used in a future DCE to further investigate patient preferences for gene therapy. [Abstract copyright: © 2022 John Wiley & Sons Ltd.]
    • Editorial: Coronavirus Disease (COVID-19): The Mental Health, Resilience, and Communication Resources for the Short- and Long-term Challenges Faced by Healthcare Workers

      Mitchell, Andrew E. P.; Galli, Federica; Keyworth, Chris; Vegni, Elena; Salas, Eduardo; University of Chester; Sapienza University of Rome; University of Leeds; University of Milan; Rice University (Frontiers Media, 2022-04-18)
      During the early phases of the COVID-19 pandemic, the world initially focused on measures to suppress COVID-19 transmission and protect their populations by developing vaccines and drug treatments for the most vulnerable and a host of social actions, including implementing social distancing, working from home, travel restrictions, lockdowns, and face coverings. Nearly 2 years after the initial outbreak, at the time of writing this editorial, and through research conducted as part of this Research Topic, it is clear that the mental health impacts of COVID-19 on healthcare workers (HCW) are significant. There is an urgent need to understand and address these impacts (Greenberg et al., 2020). This is particularly true given the World Health Organisation has outlined a series of mental health and psychosocial considerations aimed explicitly at HCWs (World Health Organisation, 2020). The present Research Topic on Coronavirus Disease (COVID-19) and HCWs has added to the scientific knowledge in several main areas, including barriers and enablers to healthcare delivery, understanding HCWs' mental health and well-being, resilience, coordination and communication within the workforce, and specific interventions to promote mental health and well-being.
    • Looking into the LGB affirmative therapies over the last fifty years – a mixed method review synthesis

      Broadway-Horner, Matthew; Kar, Anindya; University of Chester; Advanced Neuropsychiatry Institute, Kolkata (Taylor and Francis, 2022-04-04)
      In the past few decades, affirmative therapies for sexual minorities have burgeoned. These are appropriate therapies but often there is a lack of adequate research. We set out to study the research evidence available. For this mixed-methods review, we identified 15 studies looking into the experiences of lesbian, gay and bisexual people in psychological therapies. These included nine qualitative, five quantitative and one mixed-method study. The minority stress hypothesis may explain some of the major difficulties LGB individuals face. Studies showed computer-based therapies may reduce or even eliminate unhelpful responses on part of the therapist. Challenges related to confidentiality and privacy in this context remain. Therapists may focus on minority stress but other stressors and not just discrimination may contribute to various mental health problems and their clinical presence. And finally, divergent findings found internalized homophobia may best explain discrimination-based minority stress and that therapist self-disclosure of own sexuality produced better results than the therapists who did not self-disclose. These findings are discussed and future directions for research are identified.
    • Evidence-informed practice: simplifying and applying the concept for nursing students and academics

      Bettany-Saltikov, Josette; Van Schaik, Paul; McSherry, Robert; Kumah, Elizabeth; University of Chester; University of Teesside (MA Healthcare, 2022-03-25)
      Abstract Background: Nurses’ ability to effectively apply evidence into practice is a critical factor in the delivery of quality patient care. Evidence-Based Practice (EBP) is recognized as the gold standard for the delivery of safe and effective person-centred care. Yet, after several decades of its inception, nurses continue to encounter difficulties in implementing the concept. Existing models for implementing EBP offer stepwise approaches, nevertheless, certain factors, such as the context of care and its mechanistic nature act as barriers to the effective and consistent implementation of EBP. It is, therefore, imperative that a solution to solving the way in which evidence is applied into practice is found. Evidence-Informed Practice (EIP) is an evolving concept. In recent times, there has been a focus on EIP as an alternative to EBP. This has generated an international debate as to which of the two concepts better facilitate the application of evidence into practice. While several EBP models and educational interventions exist, there is limited research directed towards understanding the concept of EIP and how it facilitates the application of evidence into clinical nursing practice. Aim: This article aims at clarifying the concept of EIP and provides an integrated systems-based model of EIP in facilitating the application of evidence into clinical nursing practice. This is achieved through the application of two nursing case scenarios. Case scenario 1 is about caring for a high-dependent patient and case scenario 2 involves a patient with a low white blood cell count. Method: this article takes the reader through the various factors, elements, and associated systems and processes of the EIP model. Results: The case scenarios detail the various factors and elements of the EIP model and defines how it facilitates the application of evidence into clinical nursing practice. Conclusion: The EIP model provides a framework for nurses (indeed all healthcare practitioners) to deliver clinically effective care, and to be able to defend the processes used and the service provided by referring to reliable evidence. Revised
    • How Well Are Hand Hygiene Practices and Promotion Implemented in Sierra Leone? A Cross-Sectional Study in 13 Public Hospitals

      Lakoh, Sulaiman; Maruta, Anna; Kallon, Christiana; Deen, Gibrilla F.; Russell, James B. W.; Fofanah, Bobson D.; Kamara, Ibrahim F.; Kanu, Joseph S.; Kamara, Dauda; Molleh, Bailah; et al. (MDPI, 2022-03-23)
      Healthcare-associated infections (HAIs) result in millions of avoidable deaths or prolonged lengths of stay in hospitals and cause huge economic loss to health systems and communities. Primarily, HAIs spread through the hands of healthcare workers, so improving hand hygiene can reduce their spread. We evaluated hand hygiene practices and promotion across 13 public health hospitals (six secondary and seven tertiary hospitals) in the Western Area of Sierra Leone in a cross-sectional study using the WHO hand hygiene self-Assessment framework in May 2021. The mean score for all hospitals was 273 ± 46, indicating an intermediate level of hand hygiene. Nine hospitals achieved an intermediate level and four a basic level. More secondary hospitals 5 (83%) were at the intermediate level, compared to tertiary hospitals 4 (57%). Tertiary hospitals were poorly rated in the reminders in workplace and institutional safety climate domains but excelled in training and education. Lack of budgets to support hand hygiene implementation is a priority gap underlying this poor performance. These gaps hinder hand hygiene practice and promotion, contributing to the continued spread of HAIs. Enhancing the distribution of hand hygiene resources and encouraging an embedded culture of hand hygiene practice in hospitals will reduce HAIs.