Implementation of an educational intervention to improve hand washing in primary schools: process evaluation within a randomised controlled trial

BMC Public Health

Rona Campbell²  Sarah Bell²  Elaine Young²  Alexandra L Nicholson²  Catherine R Chittleborough¹ 

[1] School of Population Health, University of Adelaide, 178 North Terrace, South Australia 5005, Australia;School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, United Kingdom

关键词: Educational intervention;    Process evaluation;    Primary school;    Hand washing;   

Others  :  1161925
DOI  :  10.1186/1471-2458-13-757

 received in 2013-02-06, accepted in 2013-07-31,  发布年份 2013

【 摘 要 】

Background

Process evaluations are useful for understanding how interventions are implemented in trial settings. This is important for interpreting main trial results and indicating how the intervention might function beyond the trial. The purpose of this study was to examine the reach, dose, fidelity, acceptability, and sustainability of the implementation of an educational hand washing intervention in primary schools, and to explore views regarding acceptability and sustainability of the intervention.

Methods

Process evaluation within a cluster randomised controlled trial, including focus groups with pupils aged 6 to 11, semi-structured interviews with teachers and external staff who coordinated the intervention delivery, and school reports and direct observations of the intervention delivery.

Results

The educational package was delivered in 61.4% of schools (85.2% of intervention schools, 37.8% of control schools following completion of the trial). Teachers and pupils reacted positively to the intervention, although concerns were raised about the age-appropriateness of the resources. Teachers adapted the resources to suit their school setting and pupils. Staff coordinating the intervention delivery had limited capacity to follow up and respond to schools.

Conclusions

The hand washing intervention was acceptable to schools, but its reach outside of a randomised trial, evidenced in the low proportion of schools in the control arm who received it after the trial had ended, suggests that the model of delivery may not be sustainable.

Trial registration

ISRCTN: ISRCTN93576146

【 授权许可】

   
2013 Chittleborough et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Durlak JA, DuPre EP: Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol 2008, 41:327-350.
• [2]Lendrum A, Humphrey N: The importance of studying the implementation of interventions in school settings. Oxf Rev Educ 2012, 38:635-652.
• [3]Oakley A, Strange V, Bonell C, Allen E, Stephenson J: Process evaluation in randomised controlled trials of complex interventions. BMJ 2006, 332:413-416.
• [4]Dusenbury L, Brannigan R, Falco M, Hansen WB: A review of research on fidelity of implementation: implications for drug abuse prevention in school settings. Health Educ Res 2003, 18:237-256.
• [5]Holliday J, Audrey S, Moore L, Parry-Langdon N, Campbell R: High fidelity? How should we consider variations in the delivery of school-based health promotion interventions? Health Educ J 2009, 68:44-62.
• [6]Young DR, Steckler A, Cohen S, Pratt C, Felton G, Moe SG, Pickrel J, Johnson CC, Grieser M, Lytle LA, Lee J-S, Raburn B: Process evaluation results from a school- and community-linked intervention: the Trial of Activity for Adolescent Girls (TAAG). Health Educ Res 2008, 23:976-986.
• [7]Goldmann DA: Transmission of viral respiratory infections in the home. Pediatr Infect Dis J 2000, 19:S97-S102.
• [8]Talaat M, Afifi S, Dueger E, El-Ashry N, Marfin A, Kandeel A, Mohareb E, El-Sayed N: Effects of hand hygiene campaigns on incidence of laboratory-confirmed influenza and absenteeism in schoolchildren, Cairo, Egypt. Emerg Infect Dis 2011, 17:619-625.
• [9]Kimel LS: Handwashing education can decrease illness absenteeism. J Sch Nurs 1996, 12:14-16. 18
• [10]Master D: Hess Longe SH, Dickson H: Scheduled hand washing in an elementary school population. Fam Med 1997, 29:336-339.
• [11]Baxter A, Cleary V: Hand hygiene in local primary school children — an infection control and health promotion initiative. Br J Infect Control 2002, 3:14-17.
• [12]Early E, Battle K, Cantwell E, English J, Lavin JAE, Larson E: Effect of several interventions on the frequency of handwashing among elementary public school children. Am J Infect Control 1998, 26:263-269.
• [13]Rabie T, Curtis V: Handwashing and risk of respiratory infections: a quantitative systematic review. Trop Med Int Health 2006, 11:258-267.
• [14]Jefferson T, Foxlee R, Del Mar C, Dooley L, Ferroni E, Hewak B, Prabhala A, Nair S, Rivetti A: Physical interventions to interrupt or reduce the spread of respiratory viruses: systematic review. BMJ 2008, 336:77.
• [15]Freeman MC, Greene LE, Dreibelbis R, Saboori S, Muga R, Brumback B, Rheingans R: Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial. Trop Med Int Health 2012, 17:380-391.
• [16]Steckler A, Linnan L: Process evaluation for public health interventions and research: an overview. In Process evaluation for public health interventions and research. 1st edition. Edited by Steckler A, Linnan L. San Francisco: Jossey-Bass; 2002.
• [17]Chittleborough CR, Nicholson AL, Basker E, Bell S, Campbell R: Factors influencing hand washing behaviour in primary schools: process evaluation within a randomized controlled trial. Health Educ Res 2012, 27:1055-1068.
• [18]Morgan M, Gibbs S, Maxwell K, Britten N: Hearing children’s voices: methodological issues in conducting focus groups with children aged 7–11 years. Qual Res 2002, 2:5-20.
• [19]Docherty S, Sandelowski M: Focus on qualitative methods: Interviewing children. Res Nurs Health 1999, 22:177-185.
• [20]Kirk S: Methodological and ethical issues in conducting qualitative research with children and young people: A literature review. Int J Nurs Stud 2007, 44:1250-1260.
• [21]Kennedy C, Kools S, Krueger R: Methodological Considerations in Children’s Focus Groups. Nurs Res 2001, 50:184-187.
• [22]Heary CM, Hennessy E: The Use of Focus Group Interviews in Pediatric Health Care Research. J Pediatr Psychol 2002, 27:47-57.
• [23]Ritchie J, Spencer L, O’Connor W: Carrying out qualitative analysis. In Qualitative research practice A guide for social science students and researchers. 1st edition. Edited by Ritchie J, Lewis J. London: Sage; 2003.
• [24]Attride-Stirling J: Thematic networks: an analytic tool for qualitative research. Qual Res 2001, 1:385-405.
• [25]Braun V, Clarke V: Using thematic analysis in psychology. Qual Res Psychol 2006, 3:77-101.
• [26]Miles M, Huberman A: Qualitative data analysis. An expanded sourcebook. 2nd edition. London: Sage; 1994.
• [27]Lee H, Contento IR, Koch P: Using a Systematic Conceptual Model for a Process Evaluation of a Middle School Obesity Risk-Reduction Nutrition Curriculum Intervention: Choice, Control & Change. J Nutr Educ Behav 2013, 45:126-136.
• [28]Wilson DK, Griffin S, Saunders RP, Kitzman-Ulrich H, Meyers DC, Mansard L: Using process evaluation for program improvement in dose, fidelity and reach: the ACT trial experience. Int J Behav Nutr Phys Act 2009, 6:1-10. BioMed Central Full Text
• [29]Roland M, Torgerson DJ: Understanding controlled trials: What are pragmatic trials? BMJ 1998, 316:285.
• [30]Blakely C, Mayer J, Gottschalk R, Schmitt N, Davidson W, Roitman D, Emshoff J: The fidelity-adaptation debate: Implications for the implementation of public sector social programs. Am J Community Psychol 1987, 15:253-268.
• [31]Munro A, Bloor M: Process evaluation: the new miracle ingredient in public health research? Qual Res 2010, 10:699-713.
• [32]The Global Public Private Partnership for Handwashing: The Handwashing Handbook. A guide for developing a hygiene promotion program to increase handwashing with soap. Washington DC: The World Bank; 2005.
• [33]World Health Organization: WHO’s Global School Health Initiative. Health-promoting schools. Geneva: World Health Organization; 1998.
• [34]Tang K-C, Nutbeam D, Aldinger C, St Leger L, Bundy D, Hoffmann AM, Yankah E, McCall D, Buijs G, Arnaout S, Morales S, Robinson F, Torranin C, Drake L, Abolfotouh M, Whitman CV, Meresman S, Odete C, Joukhadar A-H, Avison C, Wright C, Huerta F, Munodawafa D, Nyamwaya D, Heckert K: Schools for health, education and development: a call for action. Health Promot Int 2009, 24:68-77.