Thesis (Ph.D.)--Chulalongkorn University, 2009

Background: Limited studies illustrated the effect of intensive education on hand washing behaviors in Thai households. We examined the effect of intensive hand washing education on self-reported frequency (FHW) and measured-quality of hand washing (QHW) as well as determined the change of score on instruments designed to measure knowledge, attitude and practice (KAP) of hand washing relevant to influenza. Methods: We provided intensive hand washing education in households between April 2007 and July 2009 as a component of a household-randomized control trial of interventions to reduce influenza transmission. We assessed behaviors among members of households (aged > 7 years) with a confirmed influenza infected child enrolled in control (group 1) and hand washing (group 2) arms. Group 1 received routine health education on home visit day 0/1. Group 2 received 30 minutes education on influenza, benefits of hand washing, individual hand washing training and supplies on home visit day 0/1, 3 and 7 and was asked to record frequency of hand washing daily. We compared FHW at 7 days post-education between groups, using self-reported diary and compared QHW between groups by observation. We also compared change of FHW, QHW, KAP and hand washing procedure on 4 practices that include i) use of soap, ii) technique of cleaning area of hands, iii) use of clean towel/paper for drying hands and iv) duration between pre and 90 days post-education in group 2. Results: On day 7, group 1 (n[subscript 1] =135) reported 3.9 hand washing episodes/day, while group 2 (n[subscript 2] =140) reported 5.7 hand washing episodes/day (p<.001), Group 1 (n1=164) obtained a 3.2 quality score, while group 2 (n[subscript 2] =166) obtained a 6.4 quality score (p<.001). Pre and 90 days post-education, FHW improved by 2 episodes/day and QHW increased by 3 scores. Hand washing procedure was improved (p<.001) in particular duration of washing hands increased from 26 to 59 seconds per episode (p<.001). Knowledge of influenza and hand washing following coughing/sneezing showed improvement (p<.001) but the attitude towards the severity of influenza remained unchanged. Conclusions: Intensive home-based education significantly improved the frequency, quality and knowledge of hand washing in preventing respiratory infection during the 90 days. However, the attitude modification may require an intensified approach with a longer intervention