Abstract
Hand hygiene, including handwashing by children, has been reported to contribute to the prevention of various infectious conditions. This study aims to explore the correlates of handwashing behavior among 1690 fourth to sixth grade primary school students in 19 Tibetan primary schools (Golog, Qinghai, China). The theory of reasoned action (TRA) was applied. Data was collected by questionnaire. Structural equation modeling (SEM) analysis showed that students’ attitude (β = 0.22, 95% CI 0.13–0.31) and subjective norms in terms of compliance to teachers’, parents’ and peers’ suggestions to wash hands (β = 0.09, 95% CI 0.01–0.18) were directly associated with students’ handwashing behavior. Students’ knowledge (β = 0.04, 95% CI 0.03–0.07) had an indirect association with handwashing behavior, mediated by students’ attitudes and subjective norms. Subjective norms (β = 0.12, 95% CI 0.07–0.17) were also indirectly correlated with handwashing through students’ attitudes. Therefore, our study supported the theory of reasoned action through our findings that students’ attitude and knowledge, and also attitudes from teachers, parents and peers were correlated with student handwashing behavior. Students reported higher level of compliance to teachers than to their parents and classmates. Based on this information, we recommend teacher-involved participatory hygiene education to promote students’ handwashing behaviors in areas at high risk for infectious diseases that can be prevented by handwashing.
Highlights
Hand hygiene has been recommended as an important way of keeping individuals from diseases such as foodborne parasitic infections [1,2,3]
On-site observations revealed that all schools in this study had toilets as well as tap water and soap for handwashing
The model fitness was within the acceptable ranges, namely, the normed chi–square (χ2 /df = 4.432), goodness-of-fit index (GFI = 0.965), comparative fit index (CFI = 0.952), normed fit index (NFI = 0.961) as well as root mean square error of approximation (RMSEA = 0.045)
Summary
Hand hygiene has been recommended as an important way of keeping individuals from diseases such as foodborne parasitic infections [1,2,3]. Systematic reviews of nonexperimental and experimental studies related to handwashing have supported the importance of handwashing as a relevant infection control measure [2,4]. The important role of handwashing and health education was highlighted in promoting adequate handwashing, as a relevant contribution to breaking the transmission cycle of distinct infections (e.g., alveolar echinococcosis, cystic echinococcosis) [5]. Handwashing is a simple and efficient method for reducing the risk of infectious diseases, studies have shown the relatively low adherence to the recommended handwashing; the reported. Public Health 2019, 16, 3217; doi:10.3390/ijerph16173217 www.mdpi.com/journal/ijerph
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