Children and Handwashing: Developing a Resource to Promote Health and Well-Being in Low and Middle Income Countries

Objective: Using a participatory action research (PAR) model, this paper reports on findings from a mixed-methods study which aimed to discover whether specifically developed health education resources (A Germ's Journey) aid children's understanding of health-hygiene principles, and how these findings can inform the future development of culturally relevant resources to teach children in low- and middle-income countries about the association between bacteria, handwashing and disease. Design: Educational health-hygiene workshops were conducted at 13 case study sites (n = 651) in collaboration with local organisations in Ahmedabad, India. During Phase 1 of the study, children's and teacher--trainer workshops were conducted using UK resources. Following suggestions from local teachers, a Gujarati book was co-created and in Phase 2, workshops (using the Gujarati book) were delivered. Methods: Data were collected from children using quasi-experimental methods, using pre-workshop questions, follow-up questions, observations and baseline and post-workshop assessments. Data were collected from teachers using questionnaires. Results: Following teacher-trainer workshops during Phase 1 of the study, 100% of teachers stated that they would use the resources with their pupils in the future. Two months after participating in the workshops, 60%-73% of children knew how germs can cause illness, and 76%-80% knew how to remove germs from hands. When assessed during Phase 2 of the study, 54% of children scored higher after the intervention, showing an increased understanding of microbiology after using the resources. Conclusion: The results indicate that children had an improved understanding of the causes of bacterial disease and the health implications of not using adequate health-hygiene practices. Recommendations for the future development of resources include the use of a PAR model of research, co-creation with end users, and working alongside local organisations and participants in order to access 'hard-to-reach' areas.