Abstract
Children attending kindergarten are at high risk for contracting infections, for which hand hygiene (HH) has been recognized as the most cost-effective prevention measure globally. Kindergarten teachers’ HH behavior plays a vital role in encouraging favorable hygiene techniques and environment. This study aims to evaluate the effectiveness of a multimodal intervention at changing kindergarten teachers’ HH behavior and social cognitive factors that influences HH behavior in China. The intervention named “Clean Hands, Happy Life” includes HH products with refills, reminders and cues for action, a kick-off event with awards, and training programs. We evaluated the intervention using a self-administrative questionnaire with a stratified random sample of 12 kindergartens. Two surveys was completed by 176 teachers at baseline and 185 after the 6-month intervention. Compared with the baseline scores, there was a significant improvement in the overall self-reported HH compliance of teachers (9.38 vs. 9.68 out of 10, p = 0.006), as well as teachers’ perceived disease susceptibility, disease severity and behavioral control after the intervention (p<0.05). We found that teachers’ HH compliance was likely to be higher among those who have better HH guideline awareness (β = 0.48, p<0.01) and perceived behavioral control (β = 0.26, p = 0.01), which explained 24.2% of the variance of self-reported compliance of teachers at baseline. The assessed intervention may provide Chinese kindergarten teachers with behavioral skills and cognitions that associated with the compliance of HH behavior. We thus recommend future intervention studies consider our HH behavior change techniques, address multiple social cognitive determinants of HH behavior and include the change of targeted influences in the impact evaluation.
Highlights
Children attending kindergartens or child care centers are more susceptible to infectious diseases than children who are cared for in their own homes [1]
Little variation was found among self-reported hand hygiene (HH) compliance in specific activities after the intervention (IDQ = 0), with the exception of hand washing after coughing in the hands and/or sneezing (IQR = 1)
This study reveals that there were significant improvements in self-reported HH compliance and in the cognitive determinants–namely, perceived disease susceptibility, severity and behavioral control–for kindergarten teachers after 6-month implementation of the intervention “Clean Hands, Happy Life” at their workplace
Summary
Children attending kindergartens or child care centers are more susceptible to infectious diseases than children who are cared for in their own homes [1]. Children attending kindergartens in China generally fall into the range of age between 3 and 6 years old–an age group that is highly susceptible to hand, foot and mouth disease (HFMD). Hand washing is regarded as a cost-effective and simple measure in the prevention of infectious diseases worldwide [5]. Previous studies showed that hand washing with soap reduced diarrheal diseases by 42–47% [6], and reduced the incidence of pneumonia among children under 5 years by 50% [7]. Practicing good hand hygiene among teachers has been recognized as an important measure that decreases the risk of becoming infected with the viruses that cause HFMD at schools [9], and is regulated by China’s national guideline on public health response for HFMD prevention and outbreak in schools, including kindergartens [10]. Several interventions aiming at increasing compliance with hand-washing guidelines have shown varying levels of effectiveness [12]
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