How does school based hand-washing promotion program affect the handwashing behavior of students at the urban slums in Puducherry, South India? Mixed method design

Abstract

Background: Handwashing is vital to prevent infections, especially among children of an urban slum. The handwashing habit needs to be inculcated at an early age. Objectives: The objectives of this study is (1) to determine the effect of a school-based handwashing promotion program on the knowledge and practice of handwashing among students of age 11–18 years and (2) to explore the facilitating and hindering factor for the behavior change. Materials and Methods: It is a sequential explanatory mixed method study done in two schools in an urban slum of Puducherry. The students’ baseline knowledge and practice of handwashing were assessed using a self-administered questionnaire and observation checklist. During the school-based handwashing promotion week, the students had interactive health education sessions and poster/ essay/elocution competitions. The posters made by the students were displaced in classrooms. Two weeks later, post-test was conducted. Two group interviews were done among the students. Change in knowledge and practice was compared using Chi-square test. Manual content analysis of the transcripts of the group interview was done. Results: Around 194 students were involved in the study. With the intervention, knowledge of students improved, particularly the correct duration of handwashing and the role of hand drying. The students learned the six steps of handwashing. After the observation of the handwashing promotion week, the number of students who used soap for washing hands, especially before eating and after using the toilet, increased. Health talk by the health professionals and active involvement of students facilitated the behavior change. Poorly maintained wash area, peer pressure, and misconceptions hindered the behavior change. Conclusion: Intensive health education program with active involvement of students and reinforcement are essential for behavior change.