Kitsanapun Apaporn, Yamarat Khemika
College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand.
J Multidiscip Healthc. 2019 Jul 9;12:533-541. doi: 10.2147/JMDH.S203825. eCollection 2019.
This quasi-experimental study sought to assess the effectiveness of a multidisciplinary intervention called "Germ-Free Hands" to improve the hand hygiene practices of students attending Thailand's Sirindhorn College of Public Health (SCPH).
The intervention was developed and implemented at SCPH and incorporated education, training, a workshop, and performance feedback. The intervention targeted behavioral antecedents specified by the Health Belief Model (HBM) and the Theory of Planned Behavior (TPB). Handwashing determinants (knowledge, beliefs, attitudes, subjective norms, perceived behavioral control, and intentions) and hand hygiene behaviors were assessed at baseline, immediately post-intervention, and 3 months post-intervention for the intervention group at (=60) at the Suphanburi campus of SCPH and a matched control group (=60) of students at the Ubonratchathani campus. Data analysis included descriptive statistics, independent samples -tests, two-way measures of analysis of variance, and a generalized estimating equation to compare handwashing practices by self-reports between two groups.
The "Germ-Free Hands" intervention produced significant improvements in the intervention group's handwashing knowledge, behavioral and control beliefs, subjective norm scores, intentions, and behaviors, as compared to the control group. However, the intervention had no significant impact on normative beliefs, attitudes, or perceived behavioral control. Reported improvements also decreased 3 months post-intervention, and the number of bacterial colonies on students' hands increased over the course of the study.
This study adds to the evidence that multidisciplinary interventions can be effective at improving handwashing rates. However, education and training must be continuous, rather than delivered as a one-time program, in order to have sustained results. Participants may also require more in-depth instruction in correct handwashing and drying techniques to remove bacteria effectively and prevent recolonization.
本准实验研究旨在评估一项名为“无菌之手”的多学科干预措施对泰国诗琳通公共卫生学院（SCPH）学生手部卫生习惯的改善效果。
该干预措施在SCPH制定并实施，包括教育、培训、研讨会和绩效反馈。干预措施针对健康信念模型（HBM）和计划行为理论（TPB）所确定的行为前置因素。在SCPH素攀武里校区对干预组（n = 60）和乌汶叻差他尼校区的匹配对照组（n = 60）学生进行基线、干预后即刻和干预后3个月的洗手决定因素（知识、信念、态度、主观规范、感知行为控制和意图）及手部卫生行为评估。数据分析包括描述性统计、独立样本t检验、双向方差分析以及广义估计方程，以比较两组自我报告的洗手习惯。
与对照组相比，“无菌之手”干预措施使干预组的洗手知识、行为和控制信念、主观规范得分、意图及行为有显著改善。然而，该干预措施对规范信念、态度或感知行为控制没有显著影响。干预后3个月报告的改善情况也有所下降，且在研究过程中，学生手上的细菌菌落数量有所增加。
本研究进一步证明多学科干预措施可有效提高洗手率。然而，教育和培训必须持续进行，而非一次性项目，才能取得持续效果。参与者可能还需要更深入的正确洗手和干燥技术指导，以有效去除细菌并防止重新定植。
