The Effect of the Theory of Planned Behaviour Based Hand Hygiene Intervention Program on Primary School Students' Health Outcomes and Absenteeism in School

The most common infections in schools are acute respiratory infections (colds, pharyngitis, influenza and others) and diarrheal diseases. Acute respiratory infections are a major cause of morbidity and mortality in children and a major public health problem in both developed and developing countries. The incidence of these infections may also be an important cause of school absenteeism, leading to negative outcomes in both education and health.

Improving water, sanitation and hygiene in schools is an important intervention for the healthy development of children. WHO states that handwashing a well-known primary infection control measure, is the most important hygiene measure to prevent the spread of infection when handwashing is done with soap and water. It was found that well-structured and applied handwashing techniques were useful in reducing the incidence of gastro-intestinal and respiratory infections in school children; handwashing with soap reduces respiratory infections in children by 16% - 25%.

In children, unlike adults, it is more likely to give positive behavior because negative hygiene habits are less established and do not have stereotyped and difficult to change habits. Since behavioral choices that determine lifestyle are made in childhood, it is important that health education in hand hygiene be implemented as early as possible to improve healthy behaviors. In this context, schools are important structures for information and behavior change about water, sanitation and hygiene interventions. Hand hygiene initiatives in the school provide multiple gains by enabling children to become hygienic ambassadors in their own homes and gaining the skills they can sustain during the adult period.

Planned Behavior Theory (PBT) states that intention is the main precursor of behavior.

According to the theory, intention is guided by three independent variables (perceived behavior control, attitudes and subjective norms), and intention formation leads to the development of behavior. In a systematic review of 30 studies using PBT in various health interventions, two thirds of studies reported effective behavior change. The theory has been used in a study to improve hand hygiene behavior in health workers, but it has not been used in the literature to improve hygiene behaviors in children.