Effectiveness of behaviour change techniques in improving children's hand hygiene to reduce illness-related absence in educational settings in high-income countries: a systematic review.

Problem

Respiratory tract (RT) and gastrointestinal (GI) infections are highly infectious, spreading quickly between children. Guidelines recommend that children should wash their hands regularly in educational settings to reduce spread of infection. NICE recommend that educational settings implement the following actions to support effective handwashing: action planning, information about social and environmental consequences, demonstration of the behaviour, and adding objects to the environment. However, the evidence for these particular techniques in supporting effective handwashing is unclear.

Approach

We are conducting a systematic review and behaviour change techniques analysis. Our primary outcome is to find out which behaviour change techniques are used in hand hygiene interventions in educational settings. Our secondary outcome is to identify which BCTs, or groups of BCTs, may be effective at improving the hand hygiene of children in educational settings. This will be measured through incidence of school absence due to respiratory tract and gastrointestinal infection.We searched MEDLINE, EMBASE, social science & science citation indexes, CINAHL, Cochrane Library, Education resource information centre and British education index to identify relevant literature. We included randomised controlled trials of hand hygiene interventions (including cluster controlled trials) which were conducted in schools, or other educational settings, in high income countries (according to the World Bank classification). Our population of interest were 3-11 year old school children and, where possible, the staff who work with them. Studies where there was not overlap with the specified age range were excluded. A group of primary teachers reviewed our search terms, and advised on our application of behaviour change techniques to educational settings.

Findings

We have completed searches and BCTv1 coding. Searches showed 11 eligible papers, from nine studies. Behaviour change techniques taxonomy (v1) coding showed that 18 BCTS were used. Studies used between 6 and 11 BCTs. Instruction on how to perform the behaviour was used most frequently (9 studies) whilst action planning and credible source were each used in 8 studies. Our next step is to extract and synthesise these data. Aggregate data will be used to quantitatively assess the difference that each intervention type made to incidence of infection related school absence. If studies are sufficiently homogeneous, we will carry out a meta-analysis, using random effects models.

Consequences

Respiratory tract infections (RTIs) gastrointestinal (GI) infections are a common cause for medical attendance, particularly in children. Physical interventions, like handwashing, are recommended to reduce transmission. However, there is little evidence in how to motivate handwashing behaviours in children in educational settings. Once completed, our review has potential to offer an evidence-base of effective practice to support crucial hand-washing behaviours to limit disease transmission in educational settings.