|Components of the intervention observed in the four intervention schools participating in the direct observation|
|Component||Observation notes||Number of classes using component||Duration for teaching component Range, minutes|
|KS1 N=4||KS2 N=4|
|DVD or CD-ROM animation||All schools used the animation. In two schools it was shown as part of whole school assemblies. In one school it was shown to separate KS1 and KS2 assemblies and combined with a demonstration of how to wash hands according to the DVD instructions, with input from pupils. At another school the DVD was shown to individual classes in combination with other intervention lessons. The instructions in the DVD were used by one KS1 teacher as a vehicle for teaching time connecting words such as “first”, “then” and “next” in a grammar lesson.||4||4||10 to 25|
|‘What are germs?’ lesson||At one school this lesson was only used for KS2, not KS1. The colouring germ character worksheets were used in KS1 classes. Time spent on the content of this lesson ranged from 8 minutes in a class where it was combined with the ‘Healthy hands, healthy school’ lesson, to 75 minutes in a KS2 class where the pupils were interested and engaged. Three KS2 classes designed their own germ, as suggested in the lesson plan. One KS2 class also used the germ character colouring worksheets designed for KS1.||3||4||8 to 75|
|‘Healthy hands, healthy school’ lesson||All KS1 classes used the glitter activity. One KS1 teacher used the glitter activity as a science experiment. The KS2 teacher who did not use this lesson explained that they used the ‘What are germs?’ lesson, and left the glitter lesson to the younger pupils. In one KS2 class the activity was scaled down due to limited time, so that only 6 pupils demonstrated the glitter activity rather than the whole class.||4||3||11 to 60|
|Posters||Posters were used in all schools, displayed near sinks, on bathroom walls and classroom doors. One KS1 class cut out pictures from photocopied posters and pasted them to make their own hand washing instruction pictures. Another KS1 class used the poster to review correct hand washing technique. Posters at one school were laminated to enable them to be displayed for a longer period of time.||4||4||-|
|Stickers||Stickers were used at all schools, sometimes distributed to all pupils after watching the animation, or provided as a reward for correct hand washing technique.||4||4||-|
|Fun facts||Additional background information about hand washing and germs were used in lessons by two KS2 teachers.||0||2||-|
Note. KS1 Key Stage 1, KS2 Key Stage 2, The homework worksheets, art competition and game were not observed in process evaluation schools.
Chittleborough et al.
Chittleborough et al. BMC Public Health 2013 13:757 doi:10.1186/1471-2458-13-757