Implementation of an educational intervention to improve hand washing in primary schools: process evaluation within a randomised controlled trial.
BACKGROUND
Process evaluations are useful for understanding how interventions are implemented in trial settings. This is important for interpreting main trial results and indicating how the intervention might function beyond the trial. The purpose of this study was to examine the reach, dose, fidelity, acceptability, and sustainability of the implementation of an educational hand washing intervention in primary schools, and to explore views regarding acceptability and sustainability of the intervention.


METHODS
Process evaluation within a cluster randomised controlled trial, including focus groups with pupils aged 6 to 11, semi-structured interviews with teachers and external staff who coordinated the intervention delivery, and school reports and direct observations of the intervention delivery.


RESULTS
The educational package was delivered in 61.4% of schools (85.2% of intervention schools, 37.8% of control schools following completion of the trial). Teachers and pupils reacted positively to the intervention, although concerns were raised about the age-appropriateness of the resources. Teachers adapted the resources to suit their school setting and pupils. Staff coordinating the intervention delivery had limited capacity to follow up and respond to schools.


CONCLUSIONS
The hand washing intervention was acceptable to schools, but its reach outside of a randomised trial, evidenced in the low proportion of schools in the control arm who received it after the trial had ended, suggests that the model of delivery may not be sustainable.


BACKGROUND
ISRCTN: ISRCTN93576146.
School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, United Kingdom. catherine.chittleborough@adelaide.edu.au
Catherine R
CR
Chittleborough
Alexandra L
AL
Nicholson
Elaine
E
Young
Sarah
S
Bell
Rona
R
Campbell
D000041:Absenteeism; D002648:Child; D004739:England; D005240:Feasibility Studies; D017144:Focus Groups; D005500:Follow-Up Studies; D006235:Hand Disinfection / Q000592:standards*; D006266:Health Education / Q000458:organization & administration*; D006801:Humans; D016730:Program Development; D015397:Program Evaluation; D036301:Qualitative Research; D012572:School Health Services / Q000458:organization & administration*; D012574:Schools