Open Access Research article

Implementation of an educational intervention to improve hand washing in primary schools: process evaluation within a randomised controlled trial

Catherine R Chittleborough12*, Alexandra L Nicholson1, Elaine Young1, Sarah Bell1 and Rona Campbell1

Author affiliations

1 School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol BS8 2PS, United Kingdom

2 School of Population Health, University of Adelaide, 178 North Terrace, South Australia 5005, Australia

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Citation and License

BMC Public Health 2013, 13:757  doi:10.1186/1471-2458-13-757

Published: 15 August 2013



Process evaluations are useful for understanding how interventions are implemented in trial settings. This is important for interpreting main trial results and indicating how the intervention might function beyond the trial. The purpose of this study was to examine the reach, dose, fidelity, acceptability, and sustainability of the implementation of an educational hand washing intervention in primary schools, and to explore views regarding acceptability and sustainability of the intervention.


Process evaluation within a cluster randomised controlled trial, including focus groups with pupils aged 6 to 11, semi-structured interviews with teachers and external staff who coordinated the intervention delivery, and school reports and direct observations of the intervention delivery.


The educational package was delivered in 61.4% of schools (85.2% of intervention schools, 37.8% of control schools following completion of the trial). Teachers and pupils reacted positively to the intervention, although concerns were raised about the age-appropriateness of the resources. Teachers adapted the resources to suit their school setting and pupils. Staff coordinating the intervention delivery had limited capacity to follow up and respond to schools.


The hand washing intervention was acceptable to schools, but its reach outside of a randomised trial, evidenced in the low proportion of schools in the control arm who received it after the trial had ended, suggests that the model of delivery may not be sustainable.

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Hand washing; Primary school; Process evaluation; Educational intervention