Health Education Research Advance Access originally published online on March 24, 2009
Health Education Research 2009 24(4):686-698; doi:10.1093/her/cyp004
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The effect of a handwashing intervention on preschool educator beliefs, attitudes, knowledge and self-efficacy
,*
1 Department of Health Promotion, School of Public Health, Tel Aviv University, Ramat Aviv 6998, Israel
2 Department of Statistics, Hebrew University, Jerusalem 91905, Israel
3 Academic Dean, Efrata Teacher's College, Jerusalem 91102, Israel
4 Hadassah University Hospital, Ein-Kerem, PO Box 12000, Jerusalem 91120, Israel
5 School of Public Health, Hebrew University, Jerusalem 91120, Israel
* Correspondence to: L. Rosen. E-mail: rosenl{at}post.tau.ac.il
This paper describes the effect of a preschool hygiene intervention program on psychosocial measures of educators regarding handwashing and communicable pediatric disease. A cluster-randomized trial, with randomization at the level of the preschool, was run in 40 Jerusalem preschool classrooms. Eighty preschool educators participated. The program used a multipronged approach which included elements aimed at staff, children, parents, school nurses and the classroom environment. Frontal lectures by medical, epidemiological and educational experts, along with printed materials and experiential learning, were provided to staff. Responses from a validated survey instrument were used to build four scales for each respondent regarding beliefs, attitudes, self-efficacy and knowledge. The scales were built on a Likert-type 1–7 scale (1 = minimum, 7 = maximum). The effect of the intervention was tested using mixed model analysis of variance. Response was received from 92.5% of educators. Educators believed that handwashing could affect health (mean = 5.5, SD = 1.1), had high levels of self-efficacy (mean = 6.1, SD = 0.9) and had positive attitudes toward handwashing (mean = 5.7, SD = 1.2). Knowledge was affected by the intervention (intervention: mean = 6.2, SD = 0.7; control: mean = 5.8, SD = 0.8). The combination of positive attitudes toward handwashing among educators and the program's effectiveness in imparting knowledge helped to create a sustained social norm of handwashing among many children in disparate locations.
This work was conducted while at the Hebrew University School of Public Health. Received on October 20, 2007; accepted on January 14, 2009