Background: The critical need for early adoption of WASH strategies as effective preventive health behaviour could not be stressed enough. Hand washing with soap at specific times is the simplest protection against communicable diseases. To this effect Government of India and UNICEF have identified school sanitation as a key area of collaboration, recognising that improved hygiene practices and a clean school environment are contributory factors to ensuring that children can enjoy an acceptable standard of health. Several hygiene and sanitation brands have taken this up as their corporate social responsibility agenda. Yet children in school going age continue to suffer from diarrhoea and other preventable illnesses.
Objective: The intent of the study was to spot barriers to hand washing among children while simultaneously recognising the influencing factors to build the solutions narrative for effective WASH strategies. The study had two-fold objectives: a) To identify the barriers coming in the way of children learning the habit of hand washing; and b) to identify source of information & influence among children on the subject of hand washing.
Methods: The school based cross-sectional, mixed method study was carried out in five randomly selected rural government primary schools from Ballabhgarh block of Faridabad district in the state of Haryana, India. A pre-designed, pre-tested structured questionnaire was administered to 106 class V students after taking due permissions, consent and ethical clearances.
Results: The most common barrier to hand washing was surprisingly not lack of access or availability, it was children’s attitude towards hand washing. Majority (>91%) children had very low illness threat perception and hence were not keen on washing hands. The invisibility of germs came out as one the biggest barriers (46%) that was preventing children from practicing regular hand washing. The study also found that family, teachers & peers were the most important sources of influence on children and not any media channel. In fact, peers were found to play a unique role as 72%children said that they would wash hands if their friends were washing hands. This finding has strategic implications for future behaviour change interventions making a case for peer to peer behaviour modelling.
Conclusion: While the advantages of leveraging digital technologies in field of health cannot be stressed enough, this study indicates that the human channel of communication is still the most relevant when it comes to public health in rural heartlands. Despite 100% penetration of mobile phones and significant presence of television, it is parents, teachers and peers that still are the most trusted sources of information and influence for children as found in this study. This learning has wider implications for designing effective WASH strategies in future. Additionally, children’s need of visible proof of germs and associated casual attitude towards illness threat is a hitherto unidentified barrier to hand washing. We need more studies and community interventions to overcome this barrier in order to convince kids to wash hands regularly.