Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Glob Health Sci Pract. 2023 Feb 28;11(1). doi: 10.9745/GHSP-D-22-00231.
Increasing handwashing with soap (HWWS) among older children (aged 5-14 years) can achieve a substantial public health impact. However, HWWS interventions targeting older children have had mixed success. Recent research has attempted to quantitatively identify effective intervention techniques; however, success is likely also influenced by the wider context of implementation. We explore nongovernmental organization (NGO) practitioners' perspectives on the challenges and solutions to HWWS interventions targeting older children to enhance understanding of what is required, beyond intervention content, for them to be effective.
We conducted in-depth, semistructured interviews in April-November 2020 with 25 practitioners employed across 11 NGOs and involved in HWWS interventions targeting older children in development and humanitarian settings. We used purposive and snowball sampling to recruit participants in roles at the global, national/regional, and local levels. Interviews were audio-recorded, transcribed, and thematically analyzed to identify challenges and solutions to HWWS interventions targeting older children. Results were organized according to program development cycle stages.
Twelve themes relating to perceived challenges emerged: (1) lack of prioritization, (2) funding inconsistency, (3) insufficient formative research, (4) demand on resources, (5) unengaging intervention content, (6) non-enabling physical environments, (7) availability of skilled implementers, (8) reaching out-of-school children, (9) community mistrust, (10) lack of coordination, (11) lack of evaluation rigor, and (12) failure to assign older children's HWWS as a primary outcome in evaluations of hygiene interventions. Recommended solutions were at the intervention, organization, and sector levels.
Intervention design and delivery are important for the success of HWWS interventions for older children, but contextual factors, such as the availability of human and material resources and the level of coordination within and beyond the NGO sector, should also be considered. NGOs need to prioritize HWWS promotion among older children and support programs accordingly.
增加 5-14 岁大龄儿童（儿童）的用肥皂洗手（HWWS）频率，可以产生重大的公共卫生影响。然而，针对大龄儿童的 HWWS 干预措施效果参差不齐。最近的研究试图定量识别有效的干预技术；然而，成功也可能受到实施范围更广的因素影响。我们探讨了非政府组织（NGO）从业者对大龄儿童 HWWS 干预措施所面临的挑战和解决方案的看法，以增进对除干预内容以外，大龄儿童 HWWS 干预措施取得成功所需条件的理解。
我们于 2020 年 4 月至 11 月，对 11 个 NGO 中从事针对发展中和人道主义环境中大龄儿童 HWWS 干预措施的 25 名从业者进行了深入的半结构式访谈。我们采用了目的性和滚雪球抽样方法，招募了在全球、国家/地区和地方各级从业的参与者。访谈内容被录音、转录，并进行了主题分析，以确定针对大龄儿童 HWWS 干预措施所面临的挑战和解决方案。结果根据方案开发周期阶段进行了组织。
出现了 12 个与 HWWS 干预措施相关的挑战主题：（1）缺乏优先级，（2）资金不稳定，（3）基础研究不足，（4）资源需求，（5）干预内容缺乏吸引力，（6）缺乏有利的物质环境，（7）熟练实施者的可用性，（8）难以接触校外儿童，（9）社区不信任，（10）缺乏协调，（11）评估不严谨，以及（12）未能将大龄儿童 HWWS 作为卫生干预措施评估的主要结果。推荐的解决方案涉及干预措施、组织和部门层面。
HWWS 干预措施的设计和实施对大龄儿童 HWWS 的成功很重要，但也应考虑到背景因素，如人力和物质资源的可用性以及 NGO 部门内外的协调程度。非政府组织需要优先考虑大龄儿童的 HWWS 促进工作，并相应地提供支持。
