Effect of a theory-based hand hygiene educational intervention for enhancing behavioural outcomes in Ghanaian schools: a cluster-randomised controlled trial
- 9 Downloads
The study sought to determine whether a hand hygiene educational intervention underpinned by educational and psychosocial theories is effective in enhancing behavioural intention and proper handwashing practices among school children.
The study was a cluster-randomised controlled trial, with schools constituting the clusters. At baseline, 717 pupils organised in four clusters were recruited. Techniques for data collection included a structured observation. The Student’s t test was used for data analysis.
At follow-up, a statistically significant difference was observed between the study arms with regard to intention to wash hands with soap [after toilet use (p = 0.032, d = 0.5); before meals (p = 0.020, d = 0.2)]. Similarly, a statistically significant difference was identified between the study arms with regard to the practice of handwashing with soap (HWWS) [after toilet use (p = 0.005); before meals (p = 0.012)].
A theory-driven hand hygiene educational intervention involving school children can have a medium to a very large effect size, with respect to the practice of HWWS, and a low to a medium effect size with respect to behavioural intention.
KeywordsHand hygiene Education School Theory based Intention Practice
Funding was provided by Danida Fellowship Centre (DK) and KNUST (fbsu2-1A1).
Compliance with ethical standards
Conflict of interest
The authors declare that there is no conflict of interest.
In order to ensure that standard research protocols have been adhered to right from the design stage of the research, the research proposal was submitted to the Committee on Human Research (CHRPE), Publications and Ethics of the Kwame Nkrumah University of Science and Technology for review and subsequently ethical clearance was granted unconditionally.
The study sought for assent from eligible pupils, and subsequently a written informed consent from parents or guardians.
- Bennet P, Murphy S (1997) Psychology and health promotion. Open University Press, BuckinghamGoogle Scholar
- Bloom BS, Engelhart MD, Furst EJ, Hill WH, Krathwohl DR (1956) Taxonomy of educational objectives, handbook I: the cognitive domain. David McKay Co Inc., New YorkGoogle Scholar
- Campbell M, Walters S (2014) How to design, analyse and report CRTs in medicine and health related research. Wiley, LondonGoogle Scholar
- Cottrell R, McKenzie J (2011) Health promotion and education research methods: using the five-chapter thesis/dissertation model, 2nd edn. Jones and Bartlett Publishers, TorontoGoogle Scholar
- Dreibelbis R, Winch PJ, Leontsini E, Hulland KRS, Ram PK, Unicomb L, Luby SP (2013) The integrated behavioural model for water, sanitation, and hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC Public Health 13(1):1CrossRefGoogle Scholar
- Ejemot-Nwadiaro RI, Ehiri JE, Meremikwu MM, Critchley JA (2015) Hand washing promotion for preventing diarrhoea (review). Cochrane Database Syst Rev Art. No.: CD004265. https://doi.org/10.1002/14651858.CD004265.pub2
- Eshetu G (2013) Involving children for handwashing behavior change. Anchor Academic Publishing, HamburgGoogle Scholar
- European Medicines Agency (2003) Points to consider on adjustment for baseline covariates. EMEA, LondonGoogle Scholar
- Mellard D (2010) Fidelity of implementation within a response to intervention (RtI) framework: tools for schools. In: National center on response to intervention webinar. https://webnew.ped.state.nm.us/wp-content/uploads/2018/03/Fidelity-of-Implementation-guidev5-1.pdf. Accessed 11 Sept 2017
- Thabane L (2004) Sample size determination in clinical trials. https://fammedmcmaster.ca/research/files/sample-size-calculations. Accessed 16 July 2016
- UNICEF (2008) More than soap and water: taking handwashing with soap to scale: UNICEF handwashing training module. http://globalhandwashing.org/wp-content/uploads/2015/03/HWWS-More-Than-Soap-and-Water_Training-Module.pdf. Accessed 8 July 2016
- UNICEF (2015) Advancing WASH in schools monitoring. UNICEF Press, New YorkGoogle Scholar