Factors influencing hand washing behaviour in primary schools: process evaluation within a randomized controlled trial
Open accessAbstract
This article explores factors that may influence hand washing behaviour among pupils and staff in primary schools. A qualitative process evaluation within a cluster randomized controlled trial included pupil focus groups (n = 16, aged 6-11 years), semi-structured interviews (n = 16 teachers) and observations of hand washing facilities (n = 57). Pupils and staff in intervention and control schools demonstrated a similar level of understanding of how, when and why they should wash their hands. Lack of time, poor adult modelling of regular hand washing and unattractive facilities were seen as important barriers to regular hand washing. Reminders and explanations for the importance of hand hygiene were thought to have a positive impact. Influencing individual choices about hand washing through education and information may be necessary, but not sufficient, for initiating and maintaining good hand washing practices. Structural factors, including having time to wash hands using accessible, clean facilities, and being encouraged through the existence of hand washing opportunities in the daily routine and hand washing being viewed as the social norm, will also influence hand washing behaviour. The effectiveness of educational interventions at improving hand hygiene in primary schools may be improved by changing priorities of staff and increasing accessibility to quality facilities.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Studies assessing the impact of hygiene behaviour change interventions on hand washing practice demonstrate that presence of infrastructure alone is unlikely to sustainably improve hygiene behaviours.
“Studies assessing the impact of hygiene behaviour change interventions on hand washing practice demonstrate that presence of infrastructure alone is unlikely to sustainably improve hygiene behaviours [31,32]”
From Menstrual hygiene management and school absenteeism among adolescent students in Indonesia: evidence from a cross-sectional school-based survey (2018) · cites this paper as [32]
The Discussion (page not available) says facilities matter alongside time, reminders, adult modelling and daily routines, supporting the idea that facilities are not the only influence on hand washing. But this qualitative process evaluation does not demonstrate that infrastructure alone fails to produce sustainable improvement; its explicit insufficiency finding concerns education alone. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Using thematic analysis in psychology
Braun, V., & Clarke, V. (2006) · Qualitative Research in Psychology · doi:10.1191/1478088706qp063oa · Cited by 194,414 · see citing works
Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis
Aiello, A. E., Coulborn, R. M., Perez, V., & Larson, E. L. (2008) · American Journal of Public Health · doi:10.2105/ajph.2007.124610 · Cited by 796 · see citing works
Talaat, M., Afifi, S., Dueger, E., El-Ashry, N., Marfin, A., Kandeel, A., Mohareb, E., & El-Sayed, N. (2011) · Emerging Infectious Diseases · doi:10.3201/eid1704.101353 · Cited by 238 · see citing works
Flagged first, then by citations
Research works printed but not linked: 16
- [1]Goldmann DA Transmission of viral respiratory infections in the home Pediatr Infect Dis J 2000 19 S97 102 11052396
- [7]Rabie T Curtis V Handwashing and risk of respiratory infections: a quantitative systematic review Trop Med Int Health 2006 11 258 267 16553905 PMC7169664
- [8]Curtis V Cairncross S Effect of washing hands with soap on diarrhoea risk in the community: a systematic review Lancet Infect Dis 2003 3 275 281 12726975
- [10]Kimel L Handwashing education can decrease illness absenteeism J Sch Nurs 1996 12 14 8 8704381
- [11]Master D Hess Longe S Dickson H Scheduled hand washing in an elementary school population Fam Med 1997 29 336 9 9165286
- [13]Early E Battle K Cantwell E English J Lavin JE Larson E Effect of several interventions on the frequency of handwashing among elementary public school children Am J Infect Control 1998 26 263 269 9638290
- [15]Giddens A The constitution of society: outline of the theory of structuration 1984 Polity Press Cambridge
- [16]Bourdieu P Wacquant LJD An invitation to reflexive sociology 1992 University of Chicago Press Chicago
- [18]Driessnack M Children’s drawings as facilitators of communication: a meta-analysis J Pediatr Nurs 2005 20 415 23 16298282
- [19]Backett-Milburn K McKie L A critical appraisal of the draw and write technique Health Educ Res 1999 14 387 98 10539229
- [23]Miles MB Huberman AM Qualitative data analysis. An expanded sourcebook 1994 Sage London 2nd edition
- [24]Rosen L Zucker D Brody D Engelhard D Meir M Manor O Enabling hygienic behavior among preschoolers: Improving environmental conditions through a multi-faceted intervention Am J Health Promot 2011 25 248 256 21361810
- [25]Curtis V Talking dirty: how to save a million lives Int J Environ Health Res 2003 13 S73 S79 12775382
- [26]Schmidt W-P Wloch C Biran A Curtis V Mangtani P Formative research on the feasibility of hygiene interventions for influenza control in UK primary schools BMC Public Health 2009 9 390 19832971 PMC2770489
- [27]Kennedy C Kools S Krueger R Methodological considerations in children’s focus groups Nurs Res 2001 50 184 7 11393641
- [29]Oakley A Strange V Bonnell C Allen E Stephenson J Process evaluation in randomised controlled trials of complex interventions BMJ 2006 332 413 416 16484270 PMC1370978
Cited by
Sorted by citations
Davis, J., Macintyre, A., Odagiri, M., Suriastini, W., Cordova, A., Huggett, C., Agius, P. A., Budiyani, A. E., Quillet, C., Cronin, A. A., et al. (2018) · Tropical Medicine & International Health · doi:10.1111/tmi.13159 · Cited by 200 · see citing works
- Authors
- Chittleborough, C. R., Nicholson, A. L., Basker, E., Bell, S., & Campbell, R.
- Affiliations
- University of Bristol (GB)
- Corresponding author
- Chittleborough, C. R.
- Venue
- Health Education Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-05-22
- Volume
- 27
- Issue
- 6
- Pages
- 1055-1068
- ISSN
- 0268-1153 (ISSN-L)
- 1465-3648
- PMC
- PMC3797645
- OpenAlex
- W2127841077
- Cited by
- 87
- References
- 3
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 10 · 2022: 13 · 2021: 9 · 2020: 9 · 2019: 7 · 2018: 7 · 2017: 5 · 2016: 2 · 2015: 7 · 2014: 3 · 2013: 2
- FWCI
- 9.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Health Education Research (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- Wellcome Trust (WT087640MA)
- United Kingdom Clinical Research Collaboration
- Cancer Research UK
- National Institute for Health and Care Research (PB-PG-1207-15212)
- British Heart Foundation
- Medical Research Council (WT087640MA)
- Economic and Social Research Council (RES-590-28-0005, ES/G007543/1)
- National Health and Medical Research Council (570120)
- Research for Patient Benefit Programme
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement
- Topics
- Health Sciences › Health Professions › Speech and Hearing › School Health and Nursing Education
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- hand hygiene, elementary school, school staff, pupils, handwashing facilities, reminders, social norms, educational intervention, infection control
- MeSH terms
- Child, Faculty, Female, Hand Disinfection, Health Promotion, Humans, Health Knowledge, Attitudes, Practice, Male, Schools, Students, Focus Groups, Qualitative Research, Hand Hygiene
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
