Hand Hygiene Intervention Program on Primary School Students' Health Outcomes and Absenteeism in School

The Effect of the Theory of Planned Behaviour Based Hand Hygiene Intervention Program on Primary School Students' Health Outcomes and Absenteeism in School

The most common infections in schools are acute respiratory infections (colds, pharyngitis, influenza and others) and diarrheal diseases. The incidence of these infections may also be an important cause of school absenteeism, leading to negative outcomes in both education and health.

WHO states that handwashing a well-known primary infection control measure, is the most important hygiene measure to prevent the spread of infection when handwashing is done with soap and water. Since behavioral choices that determine lifestyle are made in childhood, it is important that health education in hand hygiene be implemented as early as possible to improve healthy behaviors. In this context, schools are important structures for information and behavior change about water, sanitation and hygiene interventions.

Planned Behavior Theory (PBT) states that intention is the main precursor of behavior. According to the theory, intention is guided by three independent variables (perceived behavior control, attitudes and subjective norms), and intention formation leads to the development of behavior. The theory has been used in a study to improve hand hygiene behavior in health workers, but it has not been used in the literature to improve hygiene behaviors in children.

Researches indicate that students who do not attend school frequently or for a long time have difficulty in mastering the subject described in the lesson and that school absenteeism is an issue that should be emphasized in education. Therefore, hand hygiene has a simultaneous effect that improves both education and health and contributes to a safe and healthy learning environment. The aim of this research is; To test the effect of hand hygiene intervention program based on Planned Behavior Theory on students' health outcomes and school absenteeism.

Study Overview

• Status: Completed
• Conditions: Absenteeism; Hand Hygiene; Respiratory Tract; Infection, Upper (Acute)
• Intervention / Treatment: Behavioral: Hand hygiene intervention program developed according to planned behavior theory; Behavioral: Classical hand hygiene education

Detailed Description

The most common infections in schools are acute respiratory infections (colds, pharyngitis, influenza and others) and diarrheal diseases. Acute respiratory infections are a major cause of morbidity and mortality in children and a major public health problem in both developed and developing countries. The incidence of these infections may also be an important cause of school absenteeism, leading to negative outcomes in both education and health.

Improving water, sanitation and hygiene in schools is an important intervention for the healthy development of children. WHO states that handwashing a well-known primary infection control measure, is the most important hygiene measure to prevent the spread of infection when handwashing is done with soap and water. It was found that well-structured and applied handwashing techniques were useful in reducing the incidence of gastro-intestinal and respiratory infections in school children; handwashing with soap reduces respiratory infections in children by 16% - 25%.

In children, unlike adults, it is more likely to give positive behavior because negative hygiene habits are less established and do not have stereotyped and difficult to change habits. Since behavioral choices that determine lifestyle are made in childhood, it is important that health education in hand hygiene be implemented as early as possible to improve healthy behaviors. In this context, schools are important structures for information and behavior change about water, sanitation and hygiene interventions. Hand hygiene initiatives in the school provide multiple gains by enabling children to become hygienic ambassadors in their own homes and gaining the skills they can sustain during the adult period.

Planned Behavior Theory (PBT) states that intention is the main precursor of behavior.

According to the theory, intention is guided by three independent variables (perceived behavior control, attitudes and subjective norms), and intention formation leads to the development of behavior. In a systematic review of 30 studies using PBT in various health interventions, two thirds of studies reported effective behavior change. The theory has been used in a study to improve hand hygiene behavior in health workers, but it has not been used in the literature to improve hygiene behaviors in children.

Researches indicate that students who do not attend school frequently or for a long time have difficulty in mastering the subject described in the lesson and that school absenteeism is an issue that should be emphasized in education. Therefore, hand hygiene has a simultaneous effect that improves both education and health and contributes to a safe and healthy learning environment. The aim of this research is; To test the effect of hand hygiene intervention program based on Planned Behavior Theory on students' health outcomes and school absenteeism.

• Study Type: Interventional
• Enrollment (Actual): 159
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Cigli
    • İzmir, Cigli, Turkey, 35620
      • Gülçin Uyanık

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 7 years to 11 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• primary school student (especially third and fourth class student)

Exclusion Criteria:

• people with chronic disease

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: first group; Hand hygiene intervention program prepared by using planned behavior theory will be applied to the students in this group.	Behavioral: Hand hygiene intervention program developed according to planned behavior theory; The perception of the importance of hand hygiene with expression of damages of microorganisms (stories about illnesses etc.). Visually assisted hand hygiene training experiments to ensure the visibility of microorganisms in the environment. Demonstration and application of the correct hand washing technique with music. All applications will take place in three lessons (120-minute).
Active Comparator: second group; Students in this group will be given classic hand hygiene training	Behavioral: Classical hand hygiene education; expression of hand hygiene with verbal presentation method in a 40-minute lecture

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Group A Streptekok infections in rapid antigen test	Children with symptoms of infection will be referred to the family physician to have a rapid antigen test and to report the result to the researcher.	Total 20 weeks
Incidence of symptoms of acute upper respiratory tract infection	Ten identified upper respiratory tract symptoms (fever, sore throat, runny nose, etc.) will be recorded weekly by family of children. The researcher will receive symptom information from the family via weekly sms	Total 20 weeks
school absenteeism	The number of days the child does not attend school due to illness and the percentage of absenteeism	Total 20 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pollution rate of hands	Glogerm gel applied hands will shine areas containing microorganisms. Contamination rate will be calculated by taking the photo of the hands and performing brightness analysis in adobe photoshop program.	From date of randomization until the date of first documented progression assessed up to 7 months

Collaborators and Investigators

• Sponsor: Izmir Katip Celebi University
• Investigators: Study Director: Şafak Dağhan, Ege University, Nursing Faculty

Publications and helpful links

General Publications

• Tai JW, Mok ES, Ching PT, Seto WH, Pittet D. Nurses and physicians' perceptions of the importance and impact of healthcare-associated infections and hand hygiene: a multi-center exploratory study in Hong Kong. Infection. 2009 Aug;37(4):320-33. doi: 10.1007/s15010-009-8245-x. Epub 2009 Jul 27.

Study record dates

Study Major Dates

• Study Start (Actual): September 9, 2019
• Primary Completion (Actual): June 29, 2020
• Study Completion (Actual): June 29, 2020

Study Registration Dates

• First Submitted: December 21, 2019
• First Submitted That Met QC Criteria: February 11, 2020
• First Posted (Actual): February 13, 2020

Study Record Updates

• Last Update Posted (Actual): July 29, 2020
• Last Update Submitted That Met QC Criteria: July 28, 2020
• Last Verified: July 1, 2020

More Information

Terms related to this study

• Keywords: Health education; Theory of planned behavior; Primary schools
• Additional Relevant MeSH Terms: Infections; Respiratory Tract Diseases; Respiratory Tract Infections
• Other Study ID Numbers: 509055

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No