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. 2025 Mar 7;22(3):394.
doi: 10.3390/ijerph22030394.

Trends in the Use of Non-Pharmaceutical Interventions in Schools During the COVID-19 Pandemic, February 2021 to December 2023: A Mixed Methods Study

Nicole M Robertson  1 , Kailey Fischer  1 , Iris Gutmanis  1 , Veronica Zhu  1 , Ccs-Working Group, Brenda L Coleman  1   2
Affiliations

Trends in the Use of Non-Pharmaceutical Interventions in Schools During the COVID-19 Pandemic, February 2021 to December 2023: A Mixed Methods Study

Nicole M Robertson et al. Int J Environ Res Public Health. .

Abstract

The use of non-pharmaceutical interventions (NPIs) was imperative to avoid prolonged school closures during the COVID-19 pandemic. The purpose of this study was to understand the levels of adherence to and attitudes towards NPIs from February 2021 to December 2023 in schools in Ontario, Canada. Participants reported how frequently they, their coworkers, and their students used five NPIs: hand hygiene, covering coughs, staying home when ill, wearing a mask, and physically distancing. Open text comments provided participants with the option to provide additional details. Our mixed methods approach incorporated a series of descriptive statistics calculated at consecutive time points and thematic analysis. Participants reported higher adherence to NPIs than their coworkers and students, with less than perfect adherence that declined over time. Six themes emerged from the qualitative analysis on NPI use in schools: (1) the influence of time; (2) managing competing priorities; (3) a lack of enabling factors; (4) a lack of reinforcing factors; (5) the responsive use of NPIs; and (6) an emotional toll. To reduce the transmission of future communicable diseases and resultant staff and student sick days, ongoing commitment to hand hygiene, covering coughs, and staying home when ill is required.

Keywords: COVID-19; education worker; hand hygiene; masking; mixed methods; non-pharmaceutical interventions.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study, in the collection, analyses, or interpretation of data, in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Wears a mask in others’ presence while at work, as reported by Ontario education workers for themselves, their coworkers, and their students; COVID-19 Cohort Study for Teachers and Education Workers (February 2021 to December 2023). The vertical bars indicate 95% confidence intervals.
Figure 2
Figure 2
Covers coughs while at work, as reported by Ontario education workers for themselves, their coworkers, and their students; COVID-19 Cohort Study for Teachers and Education Workers (February 2021 to December 2023). The bars indicate 95% confidence intervals.
Figure 3
Figure 3
Washes hands thoroughly and regularly while at work, as reported by Ontario education workers for themselves, their coworkers, and their students; COVID-19 Cohort Study for Teachers and Education Workers (February 2021 to December 2023). The bars indicate 95% confidence intervals.
Figure 4
Figure 4
Physically distances from others while at work, as reported by Ontario education workers for themselves, their coworkers, and their students; COVID-19 Cohort Study for Teachers and Education Workers (February 2021 to December 2023). The bars indicate 95% confidence intervals. A specific distance was not included in the question.
Figure 5
Figure 5
Stays home from work when they have symptoms, even if they are mild, as reported by Ontario education workers for themselves, their coworkers, and their students; COVID-19 Cohort Study for Teachers and Education Workers (February 2021 to December 2023). The bars indicate 95% confidence intervals.
Figure 6
Figure 6
Thematic map with six themes and their subthemes; COVID-19 Cohort Study for Teachers and Education Workers; Ontario, Canada; February 2021 to December 2023.
See this image and copyright information in PMC

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