Enabling hygienic behavior among preschoolers: improving environmental conditions through a multifaceted intervention

Abstract

Purpose: Environmental conditions often serve as critical enabling factors for health promotion. This article describes the effect of a preschool hygiene intervention program on classroom environmental conditions.

Design: Cluster randomized trial, with randomization at the level of the preschool.

Setting: State-run preschools in Jerusalem.

Subjects: Forty secular and religious Jerusalem preschools (including 1029 children).

Intervention: A multidisciplinary hygiene intervention that included changes to the preschool environment.

Measures: Presence of soap, soap dispenser, paper towel, paper towel dispenser, cloth towels, communal cup, or personal cups.

Analysis: Generalized estimating equations and Fisher's exact test were used to estimate the effect of the intervention program on environmental conditions.

Results: Information was obtained from most (97.9%) visits. Baseline environmental hygienic conditions were poor. Relative to the control group, the following environmental conditions were better in the intervention group after program implementation: soap (odds ratio [OR] = 14.7; p < .01), paper towels (OR = 13.5; p < .01), communal cups (OR = .05; p < .01), soap dispensers (secular preschools only, p < .01), individual cups (secular, p < .01; religious, OR = 18.7; p < .02).

Conclusions: Environmental hygiene in the Israeli preschools studied was deficient at baseline but amenable to change. Improvement in environmental conditions was a necessary enabling factor for the changes in hand-washing behavior that were observed among the children. Sustained environmental change is possible in the preschool environment.