Effectiveness of a continuous handwashing education program with multiple activities at a Japanese kindergarten school.

Formation of proper handwashing techniques and habits from childhood is important for disease prevention. However, there are few studies that comprehensively and longitudinally evaluate the effectiveness of handwashing education for kindergarteners. This study aims to evaluate the effectiveness of continuous handwashing education using multiple activities to improve handwashing practices and skills among first- to third-grade students at a kindergarten in central Japan. A quasi-experimental one group pre- and post-test design was used. The education program consisted of three activities: (i) a 1-day teaching session by a researcher in January 2021, (ii) a 1-month follow-up activity led by kindergarten teachers and (iii) a 1-month follow-up activity led by parents at home, both occurring from late January to late February 2021. The study used questionnaires and handwashing skill experiments to investigate the kindergarteners' handwashing practices and comprehensive handwashing skills (handwashing steps, handwashing time, rinsing time and areas of the hands left unwashed) before and after Activities 1, 2 and 3. Data were obtained from 56 kindergarteners (64.4%). Second and third graders showed a significant improvement in their handwashing practices after coughing or sneezing. With the exception of rinsing time, handwashing skills significantly improved in all grades after the 1-day teaching session. After 1-month follow-up activities, the number of areas left unwashed by first graders significantly decreased, and the score for handwashing steps significantly improved. This study indicated that continuous handwashing education is partially effective at improving and maintaining handwashing practices and skills, except for rinsing time, among kindergarteners of all grades.