A multimodal intervention to improve hand hygiene compliance via social cognitive influences among kindergarten teachers in China

PLoS One. 2019 May 14;14(5):e0215824. doi: 10.1371/journal.pone.0215824. eCollection 2019.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Child
  • China
  • Cognition*
  • Female
  • Guideline Adherence / statistics & numerical data*
  • Hand Hygiene*
  • Humans
  • Interpersonal Relations*
  • Male
  • School Teachers / psychology*
  • Self Report
  • Surveys and Questionnaires

Grants and funding

The study was made possible with support from the Health and Family Planning Commission of Shenzhen Municipality in China (Grant number: 201602001) to JC, and the Department of Public Health, Erasmus University Medical Center Rotterdam in the Netherlands (Grant number: 20150401) to VE. The specific roles of these authors are articulated in the 'author contributions' section. The funders played no role in the study design, data analysis, or preparation of the manuscript.