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Hand Hygiene Roles, Challenges, and Intervention Feedback from School Staff: A Qualitative Analysis, Belize, 2022–2023

Author

Listed:
  • Anh N. Ly

    (Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA)

  • Christina Craig

    (Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA)

  • Dian Maheia

    (Belize Ministry of Education, Culture, Science, and Technology, Belmopan, Belize)

  • Yolanda Gongora

    (Belize Ministry of Education, Culture, Science, and Technology, Belmopan, Belize)

  • Vickie Romero

    (Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA)

  • Rosalva Blanco

    (Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA)

  • Allison Lino

    (Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA)

  • Kelsey McDavid

    (Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA)

  • Allison Stewart

    (Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention—Central America Region, Guatemala City 01004, Guatemala)

  • Victoria Trinies

    (Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA)

  • Alexandra Medley

    (Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA)

  • Francis Morey

    (Belize Ministry of Health and Wellness, Belmopan, Belize)

  • Russell Manzanero

    (Belize Ministry of Health and Wellness, Belmopan, Belize)

  • Matthew Lozier

    (Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
    United States Public Health Service, Silver Springs, MD 20201, USA
    These authors contributed equally to this work.)

  • Kristy O. Murray

    (Department of Pediatrics, National School of Tropical Medicine, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX 77030, USA
    School of Medicine and Children’s Healthcare of Atlanta, Emory University, Atlanta, GA 30322, USA
    These authors contributed equally to this work.)

Abstract

Hand hygiene (HH) in school settings can reduce the spread of infectious diseases and student absenteeism due to illness. During the COVID-19 pandemic, the World Health Organization recommended HH as a public health measure to prevent disease transmission. Understanding school staff’s experiences with school-based programs is important for future program development and improvement. As part of a mixed-methods study, we conducted in-depth interviews in March 2022 with school administrators and teachers at 12 primary schools in Belize, selected based on high gaps in HH resources, to understand HH responsibilities, supplies, and challenges. An intervention was implemented to increase HH knowledge and practices among students, which included environmental nudges, supplemental provision of soap, and HH lesson implementation. Follow-up interviews were conducted in June 2023 among school administrators to garner feedback on the intervention. School staff described roles in teaching and managing HH supplies at both timepoints. The environmental nudges and HH lessons were perceived as helpful, but there were gaps remaining in HH practices, which may be partially influenced by practices and beliefs outside of school. Procurement of HH supplies remained a challenge at some schools due to financial constraints. The feedback from school staff will be valuable for the implementation of future hand hygiene programs in schools.

Suggested Citation

  • Anh N. Ly & Christina Craig & Dian Maheia & Yolanda Gongora & Vickie Romero & Rosalva Blanco & Allison Lino & Kelsey McDavid & Allison Stewart & Victoria Trinies & Alexandra Medley & Francis Morey & R, 2025. "Hand Hygiene Roles, Challenges, and Intervention Feedback from School Staff: A Qualitative Analysis, Belize, 2022–2023," IJERPH, MDPI, vol. 22(6), pages 1-12, May.
    • Handle: RePEc:gam:jijerp:v:22:y:2025:i:6:p:835-:d:1664936
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    References listed on IDEAS

    as
    1. Celia McMichael, 2019. "Water, Sanitation and Hygiene (WASH) in Schools in Low-Income Countries: A Review of Evidence of Impact," IJERPH, MDPI, vol. 16(3), pages 1-21, January.
    2. Anna N. Chard & Matthew C. Freeman, 2018. "Design, Intervention Fidelity, and Behavioral Outcomes of a School-Based Water, Sanitation, and Hygiene Cluster-Randomized Trial in Laos," IJERPH, MDPI, vol. 15(4), pages 1-17, March.
    3. Robert Dreibelbis & Anne Kroeger & Kamal Hossain & Mohini Venkatesh & Pavani K. Ram, 2016. "Behavior Change without Behavior Change Communication: Nudging Handwashing among Primary School Students in Bangladesh," IJERPH, MDPI, vol. 13(1), pages 1-7, January.
    4. Balwani Chingatichifwe Mbakaya & Paul H. Lee & Regina L. T. Lee, 2017. "Hand Hygiene Intervention Strategies to Reduce Diarrhoea and Respiratory Infections among Schoolchildren in Developing Countries: A Systematic Review," IJERPH, MDPI, vol. 14(4), pages 1-14, April.
    5. Anh N. Ly & Kelsey McDavid & Christina Craig & Dian Maheia & Yolanda Gongora & Alexandra Medley & Francis Morey & Russell Manzanero & Gerhaldine Morazan & Allison Lino & Vickie Romero & Rosalva Blanco, 2024. "Water, Sanitation, and Hygiene Infrastructure and Resources in Schools in Belize during the COVID-19 Pandemic, 2021–2023," IJERPH, MDPI, vol. 21(4), pages 1-10, April.
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