Effect of a theory-based hand hygiene educational intervention for enhancing behavioural outcomes in Ghanaian schools: a cluster-randomised controlled trial

  • Emmanuel Appiah-BrempongEmail author
  • Samuel Newton
  • Muriel J. Harris
  • Gabriel Gulis
Original article



The study sought to determine whether a hand hygiene educational intervention underpinned by educational and psychosocial theories is effective in enhancing behavioural intention and proper handwashing practices among school children.


The study was a cluster-randomised controlled trial, with schools constituting the clusters. At baseline, 717 pupils organised in four clusters were recruited. Techniques for data collection included a structured observation. The Student’s t test was used for data analysis.


At follow-up, a statistically significant difference was observed between the study arms with regard to intention to wash hands with soap [after toilet use (p = 0.032, d = 0.5); before meals (p = 0.020, d = 0.2)]. Similarly, a statistically significant difference was identified between the study arms with regard to the practice of handwashing with soap (HWWS) [after toilet use (p = 0.005); before meals (p = 0.012)].


A theory-driven hand hygiene educational intervention involving school children can have a medium to a very large effect size, with respect to the practice of HWWS, and a low to a medium effect size with respect to behavioural intention.


Hand hygiene Education School Theory based Intention Practice 



Funding was provided by Danida Fellowship Centre (DK) and KNUST (fbsu2-1A1).

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

In order to ensure that standard research protocols have been adhered to right from the design stage of the research, the research proposal was submitted to the Committee on Human Research (CHRPE), Publications and Ethics of the Kwame Nkrumah University of Science and Technology for review and subsequently ethical clearance was granted unconditionally.

Informed consent

The study sought for assent from eligible pupils, and subsequently a written informed consent from parents or guardians.


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Copyright information

© Swiss School of Public Health (SSPH+) 2019

Authors and Affiliations

  1. 1.Department of Health Promotion and Disability StudiesKwame Nkrumah University of Science and Technology (KNUST)KumasiGhana
  2. 2.Department of Global and International HealthKwame Nkrumah University of Science and Technology (KNUST)KumasiGhana
  3. 3.Department of Health Promotion and Behavioral SciencesUniversity of LouisvilleLouisvilleUSA
  4. 4.Unit for Health Promotion ResearchUniversity of Southern Denmark (SDU)EsbjergDenmark

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