Correlates of School Children’s Handwashing: A Study in Tibetan Primary Schools

Chang Sun, Qingzhi Wang, Sasmita Poudel Adhikari, Ruixue Ye, Sha Meng, Yuju Wu, Yuping Mao, Hein Raat and Huan Zhou
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Chang Sun: Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, Chengdu 610041, China
Qingzhi Wang: Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, Chengdu 610041, China
Sasmita Poudel Adhikari: Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, Chengdu 610041, China
Ruixue Ye: Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, Chengdu 610041, China
Sha Meng: Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, Chengdu 610041, China
Yuju Wu: Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, Chengdu 610041, China
Yuping Mao: Department of Communication Studies, California State University, Long Beach, CA 90802, USA
Hein Raat: Department of Public Health, Erasmus MC—University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
Huan Zhou: Department of Health and Social Behavior Science, West China School of Public Health, Sichuan University, Chengdu 610041, China

IJERPH, 2019, vol. 16, issue 17, 1-12

Abstract: Hand hygiene, including handwashing by children, has been reported to contribute to the prevention of various infectious conditions. This study aims to explore the correlates of handwashing behavior among 1690 fourth to sixth grade primary school students in 19 Tibetan primary schools (Golog, Qinghai, China). The theory of reasoned action (TRA) was applied. Data was collected by questionnaire. Structural equation modeling (SEM) analysis showed that students’ attitude (β = 0.22, 95% CI 0.13–0.31) and subjective norms in terms of compliance to teachers’, parents’ and peers’ suggestions to wash hands (β = 0.09, 95% CI 0.01–0.18) were directly associated with students’ handwashing behavior. Students’ knowledge (β = 0.04, 95% CI 0.03–0.07) had an indirect association with handwashing behavior, mediated by students’ attitudes and subjective norms. Subjective norms (β = 0.12, 95% CI 0.07–0.17) were also indirectly correlated with handwashing through students’ attitudes. Therefore, our study supported the theory of reasoned action through our findings that students’ attitude and knowledge, and also attitudes from teachers, parents and peers were correlated with student handwashing behavior. Students reported higher level of compliance to teachers than to their parents and classmates. Based on this information, we recommend teacher-involved participatory hygiene education to promote students’ handwashing behaviors in areas at high risk for infectious diseases that can be prevented by handwashing.

Keywords: handwashing behavior; school children; rural areas; the Tibetan nationality; theory of reasoned action; structural equation model (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2019
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