Enabling hygienic behavior among preschoolers: Improving environmental conditions through a multifaceted intervention

Purpose. Environmental conditions often serve as critical enabling factors for health promotion. This article describes the effect of a preschool hygiene intervention program on classroom environmental conditions. Design. Cluster randomized trial, with randomization at the level of the preschool. Setting. State-run preschools in Jerusalem. Subjects. Forty secular and religious Jerusalem preschools (including 1029 children). Intervention. A multidisciplinary hygiene intervention that included changes to the preschool environment. Measures. Presence of soap, soap dispenser, paper towel, paper towel dispenser, cloth towels, communal cup, or personal cups. Analysis. Generalized estimating equations and Fisher's exact test were used to estimate the effect of the intervention program on environmental conditions. Results. Information was obtained from most (97.9%) visits. Baseline environmental hygienic conditionswere poor.Relative to the control group, the following environmental conditions were better in the intervention group after program implementation: soap (odds ratio [OR] = 14.7; p < .01), paper towels (OR = 13.5; p,.01), communal cups (OR = .05; p,.01), soap dispensers (secular preschools only, p < .01), individual cups (secular, p < .01; religious, OR = 18.7; p < .02). Conclusions. Environmental hygiene in the Israeli preschools studied was deficient at baseline but amenable to change. Improvement in environmental conditions was a necessary enabling factor for the changes in hand-washing behavior that were observed among the children. Sustained environmental change is possible in the preschool environment.