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Title: Hand hygiene in primary schools : evaluating the effects of an educational intervention
Author: Nicholson, Alexandra Louise
ISNI:       0000 0004 5923 1014
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2014
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Appropriate hand washing is an effective and cost-effective means of reducing the spread of infectious illness. It is therefore important to encourage and sustain good hygiene habits in the young, who are often implicated in the spread of common infections. Educational interventions are often used to promote hand washing in the school setting, however current evidence on the extent to which such interventions produce behaviour change is mixed, and in general of poor quality. The Hand Washing Trial, a well-designed pragmatic cluster randomised controlled trial, sought to test the effectiveness of an educational resource promoting hand washing in primary schools. Effectiveness of the Hands up for Max!resource was evaluated using pupil and staff absence as a proxy measure for spread of infection. 178 schools in the South West of England were recruited to the trial and randomised to receive Hands up for Max! or continue as usual. Intervention schools received the resource in the autumn 2009 and all schools were followed up until summer 2010. 24 schools also took part in a sub-study exploring absence related specifically to infectious illness captured in absence forms, and hand hygiene knowledge, attitudes, and behaviour recorded in a self-reported questionnaire developed and validated within this doctorate. The trial findings suggest that the Hands up for Max! resource was not effective at reducing pupil or staff absence, or the spread of common infections such as respiratory and gastrointestinal illnesses. After psychometric testing and exploratory factor analysis three factors were identified within the developed questionnaire relating to (i) when, how and why hand washing is engaged in (ii) role modelling of hand washing and (iii) facilitators and barriers to hand washing. A comparison of scores for these three factors between trial arms suggested that whilst there was no effect on absence, pupils in intervention schools observed and promoted hand washing behaviour more, than control schools. Insights from a process evaluation, embedded in the trial, suggested that a more holistic approach to hand washing behaviour change is needed addressing standards of facilities, time, and social norms, alongside health education. Appropriate hand hygiene in schools is an important public health issue, but encouraging and sustaining such behaviour remains a challenge. Such a challenge may be best met with comprehensive thinking about the appropriate messages to"impart and how to facilitate such messages being acted upon.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available