Hand Hygiene Roles, Challenges, and Intervention Feedback from School Staff: A Qualitative Analysis, Belize, 2022–2023

Anh N. Ly, Christina Craig, Dian Maheia, Yolanda Gongora, Vickie Romero, Rosalva Blanco, Allison Lino, Kelsey McDavid, Allison Stewart, Victoria Trinies, Alexandra Medley, Francis Morey, Russell Manzanero, Matthew Lozier and Kristy O. Murray ()
Additional contact information
Anh N. Ly: Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
Christina Craig: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
Dian Maheia: Belize Ministry of Education, Culture, Science, and Technology, Belmopan, Belize
Yolanda Gongora: Belize Ministry of Education, Culture, Science, and Technology, Belmopan, Belize
Vickie Romero: Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
Rosalva Blanco: Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
Allison Lino: Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
Kelsey McDavid: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
Allison Stewart: Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention—Central America Region, Guatemala City 01004, Guatemala
Victoria Trinies: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
Alexandra Medley: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
Francis Morey: Belize Ministry of Health and Wellness, Belmopan, Belize
Russell Manzanero: Belize Ministry of Health and Wellness, Belmopan, Belize
Matthew Lozier: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
Kristy O. Murray: Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA

IJERPH, 2025, vol. 22, issue 6, 1-12

Abstract: Hand hygiene (HH) in school settings can reduce the spread of infectious diseases and student absenteeism due to illness. During the COVID-19 pandemic, the World Health Organization recommended HH as a public health measure to prevent disease transmission. Understanding school staff’s experiences with school-based programs is important for future program development and improvement. As part of a mixed-methods study, we conducted in-depth interviews in March 2022 with school administrators and teachers at 12 primary schools in Belize, selected based on high gaps in HH resources, to understand HH responsibilities, supplies, and challenges. An intervention was implemented to increase HH knowledge and practices among students, which included environmental nudges, supplemental provision of soap, and HH lesson implementation. Follow-up interviews were conducted in June 2023 among school administrators to garner feedback on the intervention. School staff described roles in teaching and managing HH supplies at both timepoints. The environmental nudges and HH lessons were perceived as helpful, but there were gaps remaining in HH practices, which may be partially influenced by practices and beliefs outside of school. Procurement of HH supplies remained a challenge at some schools due to financial constraints. The feedback from school staff will be valuable for the implementation of future hand hygiene programs in schools.

Keywords: hand hygiene; behavior change; COVID-19; Belize; Central America; WASH in schools (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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