title: Process evaluation of a multi-component intervention to reduce infectious diseases and improve hygiene and well-being among school children: the Hi Five study.
abstract: The Hi Five study was a three-armed cluster randomized controlled trial designed to reduce infections and improve hygiene and well-being among pupils. Participating schools (n = 43) were randomized into either control (n = 15) or one of two intervention groups (n = 28). The intervention consisted of three components: (i) a curriculum (ii) mandatory daily hand washing before lunch (iii) extra cleaning of school toilets. The aim of this study was to evaluate the implementation and to identify challenges to program implementation. Several data sources were used, including observations of school toilets, semi-structured interviews with school coordinators (n = 4), focus groups with pupils (n = 6) and teachers (n = 5), and questionnaires among pupils (n = 5440), teachers (n = 387) and school coordinators (n = 28). This study indicates that the curriculum was successfully implemented at most schools, and that teachers and pupils reacted positively to this part of the intervention. However, daily hand washing before lunch seems to be difficult to implement. Overall, the implementation process was affected by several factors such as poor sanitary facilities, lack of time and prioritization and objections against the increasing tendency to place the responsibility for child-rearing tasks on schools. This study reveals the strong and weak parts of the Hi Five study and can guide program improvement.
authors.affiliation: Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, DK-1353 Copenhagen K, Denmark and The National Board of Social Services, Office of Children and Families, DK-1119 Copenhagen K, Denmark catb@niph.dk.
authors.forename: C T
authors.initials: CT
authors.lastname: Bonnesen
authors.affiliation: Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, DK-1353 Copenhagen K, Denmark and The National Board of Social Services, Office of Children and Families, DK-1119 Copenhagen K, Denmark.
authors.forename: R
authors.initials: R
authors.lastname: Plauborg
authors.affiliation: Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, DK-1353 Copenhagen K, Denmark and The National Board of Social Services, Office of Children and Families, DK-1119 Copenhagen K, Denmark.
authors.forename: A M
authors.initials: AM
authors.lastname: Denbæk
authors.affiliation: Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, DK-1353 Copenhagen K, Denmark and The National Board of Social Services, Office of Children and Families, DK-1119 Copenhagen K, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Due
authors.affiliation: Centre for Intervention Research in Health Promotion and Disease Prevention, National Institute of Public Health, University of Southern Denmark, DK-1353 Copenhagen K, Denmark and The National Board of Social Services, Office of Children and Families, DK-1119 Copenhagen K, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Johansen
mesh_terms: D000293:Adolescent; D002648:Child; D016000:Cluster Analysis; D003140:Communicable Disease Control / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006266:Health Education; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D006920:Hygiene; D007407:Interviews as Topic; D008297:Male; D010549:Personal Satisfaction; D015397:Program Evaluation; D012572:School Health Services; D000070777:School Teachers; D012574:Schools; D011795:Surveys and Questionnaires