The effect of a handwashing intervention on preschool educator beliefs, attitudes, knowledge and self-efficacy

L. Rosen*, D. Zucker, D. Brody, D. Engelhard, O. Manor

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


This paper describes the effect of a preschool hygiene intervention program on psychosocial measures of educators regarding handwashing and communicable pediatric disease. A cluster-randomized trial, with randomization at the level of the preschool, was run in 40 Jerusalem preschool classrooms. Eighty preschool educators participated. The program used a multipronged approach which included elements aimed at staff, children, parents, school nurses and the classroom environment. Frontal lectures by medical, epidemiological and educational experts, along with printed materials and experiential learning, were provided to staff. Responses from a validated survey instrument were used to build four scales for each respondent regarding beliefs, attitudes, self-efficacy and knowledge. The scales were built on a Likert-type 1-7 scale (1 = minimum, 7 = maximum). The effect of the intervention was tested using mixed model analysis of variance. Response was received from 92.5% of educators. Educators believed that handwashing could affect health (mean = 5.5, SD = 1.1), had high levels of self-efficacy (mean = 6.1, SD = 0.9) and had positive attitudes toward handwashing (mean = 5.7, SD = 1.2). Knowledge was affected by the intervention (intervention: mean = 6.2, SD = 0.7; control: mean = 5.8, SD = 0.8). The combination of positive attitudes toward handwashing among educators and the program's effectiveness in imparting knowledge helped to create a sustained social norm of handwashing among many children in disparate locations.

Original languageAmerican English
Pages (from-to)686-698
Number of pages13
JournalHealth Education Research
Issue number4
StatePublished - Aug 2009

Bibliographical note

Funding Information:
Chief Scientist’s Office, Israel Ministry of Health; Health Promotion Granting Unit, Associate Director General, Ministry of Health; National Institute for Health Services Research Doctoral Stipend (m-2-02); Grant for outstanding doctoral work from Municipality of Jerusalem.


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