Understanding consumer perspectives on healthcare-associated infection risk, institutional trust, and prevention responsibility: a Q-methodology study

Abstract

Abstract Background: Healthcare-associated infections (HAIs) are a major source of preventable harm, yet their risk remains largely invisible to patients. Infection prevention and control strategies focus primarily on system-level processes, minimal attention has been given to how consumer conceptualize risk, institutional trust, and their role in prevention. Understanding these perspectives is important for designing effective, consumer-informed infection prevention and control (IPC) strategies. Methods: We conducted a Q-methodology study to identify shared viewpoints among Australian healthcare consumers aged over 18 years. Participants completed an online survey which included demographic questions, 5-point Likert scale items (Strongly Agree to Strongly Disagree), and Q-sort statements (n = 44) relating to HAIs, IPC initiatives, trust, and responsibility. Factor analysis using principal components and varimax rotation identified patterns of shared perspectives. Results: A total of 405 surveys were analyzed. Three distinct viewpoints were identified: (1) heightened anxiety and vigilance (n = 148; 37%); (2) trusting and reassurance-oriented (n = 84; 21%); and (3) concerned but balanced (n = 73; 18%). Across viewpoints there was universal agreement that antimicrobial resistance is a concern, HAIs significantly impact recovery, and patients should be informed if they acquire a HAI. Conclusion: Consumer perceptions of HAI risk were heterogenous and shaped by experience and trust. The identification of three viewpoints suggest that a one-size-fits-all approach to IPC communication and engagement are unlikely to be effective, highlighting the need for tailored, transparent, and consumer-informed strategies to support more responsive IPC policy and practice.