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Year : 2013  |  Volume : 57  |  Issue : 2  |  Page : 109-112  

Impact of a school-based hand washing promotion program on knowledge and hand washing behavior of girl students in a middle school of Delhi

1 Senior Resident, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
2 Director Professor, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
3 SMO, Urban Health Center Gokulpuri, New Delhi, India
4 Director Professor & Head, Department of Community Medicine, Maulana Azad Medical College, New Delhi, India

Date of Web Publication15-Jul-2013

Correspondence Address:
Ankur Garg
Senior Resident, WZ-1043, Rani Bagh, New Delhi - 110 034
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Source of Support: Indian Public Health Association Garg et al: Hand washing promotion program among school children in Delhi, Conflict of Interest: None

DOI: 10.4103/0019-557X.115009

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The intervention study was conducted in a school of New Delhi to assess the effect of a school based hand-washing promotion program on knowledge and hand-washing behavior among school children and extent of information sharing with parents. Intervention was carried out on randomly selected 300 students (100 each from 6th class to 8th class) with 281 students being part of the final analysis. Tools of the study were hand-washing questionnaire and household survey performa; essay, poster, slogan writing competition; classroom interactions. Data were analyzed in the SPSS 16.0 software and Mcnemar test and Student paired t-test were used. After the program, 95% felt that hand should be washed frequently. Overall, there was a significant improvement in the knowledge regarding hand-washing and frequency of hand-washing practices after the intervention. 42% children shared this information with their parents. The intervention proved effective in improving awareness and highlights the potential of school for hand-washing promotion activities.

Keywords: Hand washing, Intervention, Practice, Technique

How to cite this article:
Garg A, Taneja DK, Badhan SK, Ingle GK. Impact of a school-based hand washing promotion program on knowledge and hand washing behavior of girl students in a middle school of Delhi. Indian J Public Health 2013;57:109-12

How to cite this URL:
Garg A, Taneja DK, Badhan SK, Ingle GK. Impact of a school-based hand washing promotion program on knowledge and hand washing behavior of girl students in a middle school of Delhi. Indian J Public Health [serial online] 2013 [cited 2023 Mar 23];57:109-12. Available from:

Hand-washing has been accepted as an effective measure to prevent the transmission of many infectious diseases with a recent meta-analysis showing a 31% reduction in gastrointestinal infections and 21% reduction in respiratory illness through proper hand-washing practices. [1] Simple hand-washing practices in the community could save a million lives annually. [2]

However, health behaviors like hand-washing are difficult to incorporate and change. Parents usually teach their children regarding the importance of hand-washing very early in childhood, but reinforcement often decreases in school children. [3] Researchers have measured substantial changes in hand-washing behavior among children after a preschool-based hand-washing promotion programme. [4] Moreover, school children can be important behavior change agents in the community and schools and with the help of other students introduce and maintain changes in the school environment. [5],[6] In the household settings, they communicate health messages and introduce relevant health practices to help their parents/siblings improve their knowledge and change their behavior through participation. [5],[6]

However, despite the overwhelming evidence in its favor, attaining high levels of hand-washing practices in various settings remains an elusive goal. The present study aimed to assess the effect of a school based hand-washing promotion program on the knowledge and hand-washing behavior among school children and the extent to which children shared this information with their parents/siblings.

This intervention study was conducted among students of Sarvodaya Kanya Vidyalaya, an MCD girl's senior secondary school located in C block, Gokulpuri, which is a resettlement colony of Delhi. The study was conducted during the months of April and May 2010 after obtaining due permission from the school authority. There were a total of 570 students enrolled in the 6 th to 8 th class of the school. A total of 300 students (100 each from 6 th to 8 th class) were administered the pretest. A total of 17 students each were randomly selected from sections A, B, C, D of each class and 16 students each from sections E and F. The students were selected in all three grades according to their classroom roll numbers using a random number table. However, 19 students were not available during the post-test. In all, 281 students were included in the final analysis 96, 95 and 90 students from class 6 th to 8 th respectively.

A pre-designed semi-structured self-administered questionnaire was distributed to the children as pretest to collect the required baseline information. It assessed the knowledge and practices of students with regard to hand-washing on domains like impact of hand-washing on health, diseases transmitted through unclean hands, hand-washing material, duration and technique, critical hand-washing times, actual hand-washing practices and source of information.

A multifaceted approach was adopted for intervention. The goal of intervention was to improve hand hygiene with main emphasis being on hand-washing with soap before meals and after toilet use. The students were sensitized regarding the importance of hand-washing and when to wash hands through interactive sessions by a doctor and school teacher in each class. Students were also instructed in hand-washing technique. To encourage student participation in the program an essay, poster and slogan writing competition was organized among students focusing on the theme of the role of hand-washing in prevention of diseases. In all 205 entries were received in different events. The students also performed a skit on the role of hand washing in prevention of swine flu. The winners of these events were awarded individual prizes. The students took a pledge to wash their hands regularly using soap and motivate their relatives and friends to do the same. The following day some key messages were reinforced in each of the classes. The students were asked to share this information with their parents, siblings and friends.

The knowledge and practices with respect to crucial times of hand washing was assessed on a four point scale focusing on four crucial aspects of hand-washing: before eating, after visiting the toilet, before preparing/handling food and after handling something dirty. Each of these responses was given a score of one with a maximum score being four.

The knowledge regarding diseases transmitted through unclean hands was measured on a nine point scale including diseases: diarrhea, pneumonia, common cold, swine flu, worm infestation, conjunctivitis, pyoderma, jaundice and typhoid. Each of these was assigned a score of one with the maximum score being nine.

Post-intervention assessment: After a week, post-intervention test was done to assess the change in students' knowledge. Subsequently, 3 days later, 100 households were visited for the household survey. While selecting the households for household survey, equal representation was given to students from 6 th to 8 th class. We selected 50 student households from each of the three classes 6 th , 7 th and 8 th . The selection was carried out using a random number table after allotting a serial number to each student's performa selected in the study from respective classes (6 th , 7 th and 8 th ). The personal details collected from students in the baseline questionnaire helped to link them to their respective households during the household survey. Extra households were chosen to account for locked house/unavailability/mother's refusal to participate in survey. We interviewed households until the required sample was achieved in each respective class. In all we surveyed 34, 33 and 33 households of students from class 6 th to 8 th respectively. During the household survey, the mothers of children were interviewed to assess the extent information sharing with students' families. Design of the intervention is depicted in [Figure 1].

Data were analyzed in the SPSS 16.0 software. Mcnemar and Student paired t-test were used to compare the pre-test and post-test responses.

Participants were girls with age between 10 years and 16 years (mean-11.87). Majority 149 (53%) girls belonged to age 12-13 years and only 25 (9%) were 14 years and above. After the program, 268 (95%) felt that hands should be washed frequently in comparison to 216 (76%) before it, 279 (99%) came to know that hands should be washed using a soap. 191 (68%) came to know of the correct technique of hand-washing [Table 1]. With respect to the knowledge regarding crucial times of hand-washing, mean score of 1.5 at baseline improved to 2.29 after the intervention (P < 0.001) and mean score for knowledge regarding diseases transmitted through unclean hands improved from 3.14 to 5.2 after the intervention (P < 0.001). Overall, there was a significant increase in the knowledge regarding the importance and technique of hand-washing from pre-intervention to post-intervention.

There was a significant improvement in students' hand-washing practices after the program. Mean score with respect to students' hand-washing practices at crucial times during the last 24 h improved from 1.17 before the intervention to 1.67 after it (P < 0.001). With respect to soap usage, the present study found that 211 (75%) used soap for hand-washing at the baseline which improved significantly following intervention to 279 (99%) (P < 0.001).

Out of the 100 households surveyed, 42% of the children who attended the program shared the hand-washing information with their parents. Out of these 42 children, majority had informed their parents regarding crucial hand-washing times 38 (90.4%) and use of soap 41 (97.6%), but only 18 (42.8%) children discussed about hand-washing technique and 19 (45.2%) about the diseases transmitted through unclean hands. Overall there was transfer of knowledge from pupils to parents after the program.
Figure 1: The design of the intervention study

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Table 1: Awareness among school children regarding the importance and technique of hand washing before and after intervention (n=281)

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The goal of this school based intervention program was to improve hand hygiene among the school children with the main emphasis being on hand-washing with soap before eating and after toilet use.

There was a significant improvement in the overall knowledge with respect to the importance of hand-washing, diseases transmitted through contaminated hands and technique of hand-washing after the educational intervention. The program also showed a positive effect on the hand washing practices among the school children during last 24 h with significant improvement in soap usage by children. Studies in India and abroad have also demonstrated similar improvements in students' knowledge and practices with regard to hand-washing. [4],[7],[8]

Knowledge regarding some issues like duration of hand-washing and non-superiority of antibacterial soap over ordinary soap didn't show much improvement and perhaps needs more reinforcing efforts.

School children have the potential for transmitting their newly acquired knowledge to their parents and studies have demonstrated significant transfer of information relating to health concepts. [6],[7],[9] In Western Kenya, 25% parents changed their hand-washing practices because of their children after a school based hand-washing program. [7] As revealed by the household survey, 42% of the children in our study discussed and shared the information provided in school with their parents focusing on the most crucial aspects that is timing and material to be used for hand-washing.

The intervention proved effective in improving awareness among school children regarding hand-washing and that the school children can effectively communicate health information to their families. This highlights the potential of school as a promising venue for hand-washing promotion activities and lay foundations for behavior change in long-term.

Limitations of the study included that the observations were based on self-reported data by the students; the findings of the study were for girl students of government school in a resettlement colony and the study design did not include any controls.

   Acknowledgments Top

Authors deeply acknowledge the support rendered by the Vice Principle and staff, SKV Gokulpuri as well as the Indian Public Health Association for their whole hearted support in organizing the program.

   References Top

1.Aiello AE, Coulborn RM, Perez V, Larson EL. Effect of hand hygiene on infectious disease risk in the community setting: A meta-analysis. Am J Public Health 2008;98:1372-81.  Back to cited text no. 1
2.Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: A systematic review. Lancet Infect Dis 2003;3:275-81.  Back to cited text no. 2
3.Guinan ME, McGuckin-Guinan M, Sevareid A. Who washes hands after using the bathroom? Am J Infect Control 1997;25:424-5.  Back to cited text no. 3
4.Rosen L, Manor O, Engelhard D, Brody D, Rosen B, Peleg H, et al. Can a handwashing intervention make a difference? Results from a randomized controlled trial in Jerusalem preschools. Prev Med 2006;42:27-32.  Back to cited text no. 4
5.Rohde JE, Sadjimin T. Elementary-school pupils as health educators: Role of school health programmes in primary health-care. Lancet 1980;1:1350-2.  Back to cited text no. 5
6.Onyango-Ouma W, Aagaard-Hansen J, Jensen BB. The potential of schoolchildren as health change agents in rural western Kenya. Soc Sci Med 2005;61:1711-22.  Back to cited text no. 6
7.O'Reilly CE, Freeman MC, Ravani M, Migele J, Mwaki A, Ayalo M, et al. The impact of a school-based safe water and hygiene programme on knowledge and practices of students and their parents: Nyanza Province, western Kenya, 2006. Epidemiol Infect 2008;136:80-91.  Back to cited text no. 7
8.Tragler A. Health education in school children. Indian Pediatr 1991;28:541-4.  Back to cited text no. 8
9.Bhore PD, Bhore CP, Powar S, Nade AL, Kartikeyan S, Chaturvedi RM. Child-to-parent education: A pilot study. Indian J Lepr 1992;64:51-7.  Back to cited text no. 9


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