INTRODUCTION:

Hands are capable of a wide variety of functions, including gross and fine motor movements. Gross motor movements allow us to pick up large objects or perform heavy labour. Fine motor movements enable us to perform delicate tasks, such as holding small objects or performing detailed work¹. As we perform these tasks we are at more risk of carrying micro- organisms in our hands.

They are capable of a wide variety of functions like touching, grasping, holding, manipulating and performing daily activities and more. Good hand hygiene is one of the most critical control strategies in outbreak management. It is well-documented that the most important measure for preventing the spread of pathogens is effective hand washing. Germs are found everywhere and are the cause for the sickness of the people.

Children are one third of our population and all of our future. In order to develop a healthy society, it is important that we have healthy children¹¹. Children undergo a dynamic period of the physical, mental, emotional, and social changes¹². Health status of the children of a nation is highly reliable index of the health of its population¹³. Nutrition and activity levels have a key impact on children’s health and wellbeing¹⁴. A majority of Indian population resides in rural area, of which more than 40% constitute children¹⁵. Hand hygiene is a milestone of infectious disease control, and promotion of improved hand hygiene has been recognized as an important public health measure¹⁶. According to NACO Guideline effective timings of hand washing with soap and water is 20 sec¹⁷. Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior¹⁸. Although hand washing is very simple and basic procedure to perform in daily life¹⁹. Children learn a lot from school environment and more from experience²⁰. Hand washing has always been one of most effective ways of keeping diseases at bay. It is a simple act that pays in dividends when it comes to keeping ourselves healthy and safe.

OBJECTIVES:

1. To assess the knowledge of school children regarding importance of hand washing with soap and water in selected rural and urban schools of Shimla.

2. To compare the knowledge regarding importance of hand washing with soap and water among school children in selected rural and urban schools of Shimla.

3. To determine the association of level of knowledge regarding importance of hand washing with soap and water among school children with selected demographical variables.

HYPOTHESIS:

H₁: There will be a significant knowledge regarding importance of hand washing with soap and water among school children in selected rural and urban schools of Shimla.

H₂: There will be a significant association between level of knowledge regarding importance of hand washing with soap and water among school children with selected demographical variables.

MATERIALS AND METHODS:

Research design:

The research design used for this study was Comparative Research Design.

Research setting:

The study was conducted in Government Senior Secondary School, Boileaugunj (Urban) and Government Senior Secondary School of Mashobra (Rural) H.P.

Selection of the study subjects:

Target population: In present research project, the target population were school children of 6^th to 8^th standard.

Accessible population:

School children those were studied in 6^thto 8^th standard in Government Senior Secondary School, Boileaugunj (Urban) and Government Senior Secondary School of Mashobra (Rural) H.P. Those who were fulfilling the inclusion criteria.

Sampling technique and Sample size:

The sampling technique was stratified random sampling technique and sample size was 60 school children, 30 each from selected urban and rural school.

Inclusion criteria:

1. School children who were in 6^th to 8^th class

2. School children who were willing to participate in the study.

3. School children who were present at the time of data collection.

Exclusion criteria:

1. School children who were not willing to participate in the study.

Description of the tool:

Data collection was planned through the structured questionnaire as on knowledge regarding importance of hand washing with soap and water. The tool was developed after extensive review of literature, expert opinion and researcher own experience. A structured teaching programme was planned after consultation with experts to increase the knowledge of school children regarding hand hygiene with soap and water. The structured tool was divided into two sections:

Section A: This part consists of personal information (demographic variables) of the participants such as age in year, class, gender, religion, parent’s education, parent’s occupation, family income, type of family, number of siblings, source of information, domicile.

Section B: The tool consisted of 30 multiple choice questions related to hand washing with soap and water.

Data collection procedure:

The data collection procedure was carried out in the month of January, 2021. Purpose of the study was explained to the school authorities and permission were taken to conduct the research study. Total 60 sample 30 from rural and 30 from urban school were selected for the data collection. Before data collection informed consent was taken from the schoolchildren. Data was collected in two phases.

Phase I: The data was collected from both rural and urban school children. Before data collection researcher introduced herself, explained the purpose of the study, clarified questions and took consent from the individual subjects. The data was collected by providing them with structured questionnaire. After that structured teaching programme was provided to the school children regarding importance of hand washing with soap and water.

Phase II: After collection of the data in phase II post- test of the school children was taken to assess the effectiveness of structured teaching programme. After completion of the data collection all the subjects were thanked for the participation and assured to keep confidentiality.

RESULTS AND DISCUSSION:

Section I: Findings related to demographic variables of subjects

Table No.1: Frequency and percentage distribution of Demographic variables. N=30

Section-1 Socio Demographic Data		Rural	Rural	Urban	Urban
Section-1 Socio Demographic Data		(f)	f (%)	(f)	f (%)
	11 – 12	9	30.00%	5	16.70%
	>12 – 13	8	26.70%	15	50.00%
Age(yrs)	>13 – 14	13	43.30%	10	33.30%
	> 14	0	0.00%	0	0.00%
	Male	14	46.70%	9	30.00%
Gender	Female	16	53.30%	21	70.00%
	6th	8	26.70%	5	16.70%
Class	7th	9	30.00%	15	50.00%
	8th	13	43.30%	10	33.30%
	No formal education	0	0.00%	0	0.00%
	Matric	4	13.30%	0	0.00%
Education of father	10 + 2	16	53.30%	9	30.00%
	Graduate	9	30.00%	16	53.30%
	Postgraduate	1	3.30%	5	16.70%
	Government Employee	12	40.00%	17	56.70%
	Private Employee	14	46.70%	11	36.70%
Occupation of father	Self Employee	4	13.30%	2	6.70%
	No formal education	2	6.70%	1	3.30%
	Matric	19	63.30%	10	33.30%
Education of mother	10 + 2	9	30.00%	17	56.70%
	Graduate	0	0.00%	2	6.70%
	Postgraduate	0	0.00%	0	0.00%
	Government Employee	1	3.30%	1	3.30%
	Private Employee	3	10.00%	9	30.00%
Occupation of mother	Self Employee	6	20.00%	6	20.00%
	Home maker	20	66.70%	14	46.70%
Monthly income	Less than 10,000	1	3.30%	0	0.00%
	10,001 – 20,000	14	46.70%	5	16.70%
	20,001 – 50,000	14	46.70%	25	83.30%
	More than 50,000	1	3.30%	0	0.00%
	Nuclear	13	43.30%	22	73.30%
	Joint	15	50.00%	8	26.70%
Type of family	Extended	1	3.30%	0	0.00%
	Single parent	1	3.30%	0	0.00%
	One	2	6.70%	4	13.30%
No. of sibblings	Two	22	73.30%	22	73.30%
	Three	6	20.00%	4	13.30%
	Four and above	0	0.00%	0	0.00%
	Television	9	30.00%	6	20.00%
Source of information	Internet	4	13.30%	4	13.30%
	School	17	56.70%	20	66.70%
	Others	0	0.00%	0	0.00%
	Hindu	30	100.00%	30	100.00%
	Muslim	0	0.00%	0	0.00%
Religion	Sikh	0	0.00%	0	0.00%
	Christian	0	0.00%	0	0.00%
	Rural	30	100.00%	0	0.00%
Domicile	Urban	0	0.00%	30	100.00%

Section-II: Findings related to the level of knowledge regarding importance of hand washing with soap and water among school children in selected rural and urban schools of Shimla.

Table No.2: Assessment of pre-test and post- test knowledge score among rural and urban school children. N = 30

Assessment of Knowledge Score
	Rural				Urban
Score Level	Pretest		Posttest		Pretest		Posttest
	(f)	(f%)	(f)	(f%)	(f)	(f%)	(f)	(f%)
Excellent (25-30)	0	0%	9	30%	0	0%	14	46.7%
Very Good (19-24)	4	13.3%	21	70%	5	16.7%	15	50%
Good (13-18)	16	53.3%	0	0%	20	66.7%	1	3.3%
Average (7-12)	10	33.3%	0	0%	5	16.7%	0	0%
Poor (0-6)	0	0%	0	0%	0	0%	0	0%

Section- III: Findings related to comparison of knowledge regarding importance of hand washing with soap and water among school children in selected rural and urban schools of Shimla.

Table No.3: Comparison of knowledge score of rural and urban school children regarding importance of hand washing with soap and water. N = 30+30

Knowledge Score					Paired ‘T’ Test
	PRE-TEST		POST TEST
Group	Mean	SD	Mean	SD	df	t	p value	Result
Rural group	15.27	3.778	23.43	1.906	29	0.325	12.947	Significant
Urban group	15.567	3.370	24.17	2.135	29	1.403	15.941	Significant

The table no. 3 shows the effectiveness of structured teaching programme as results were significant in both the groups urban and rural.

Section – IV: Findings related to the association of level of knowledge regarding importance of hand washing with soap and water with selected demographic variables:

The study revealed that there was significant association between the post test knowledge score level and demographic variables such as age (in years), (p value 0.005, df 4) and class (p value 0.005, df 4). There was no significance association between the level of scores and other demographic variables.

DISCUSSION:

Discussion on the findings were arranged in the order of the objective of the study. First objective was to assess the knowledge regarding importance of hand washing with soap and water among school children. The study results revealed that in pre-test of rural group (33.3%) had average knowledge, (53.3%) had good knowledge and (13.3%) had very good knowledge, whereas in pre-test of urban group (16.7%) had average knowledge, (66.7%) had good knowledge and (16.7%) had very good knowledge. Hence it was concluded that in pre-test knowledge of school children was average in both rural and urban group. A Similar study was conducted by Manandhar P, et al (2017) showed that all the students had some knowledge about hand washing technique before meal and after defecation. But only 8.5% students at school and 47% students at home regularly washed hand with soap and water.

Second objective was to compare the knowledge regarding importance of hand washing with soap and water among school children. The study results revealed the significant results on comparison within the group with paired ‘t’ test in which, in rural group ‘t’ value was 12.947 at df 29 which was significant at p <0.01 level of significance whereas in urban group ‘t’ value was 15.941 at df 29 which was significant at p <0.01 level of significance. A similar study was conducted by Priyanka Dekate, Archana Mourya (2017) to compare the knowledge and attitude towards hand washing technique among school children in urban and rural area. Study concluded that there was significant difference was found in knowledge and attitude score between urban and rural school children towards hand washing technique.

Third objective of the study was to determine the association of level of knowledge with selected demographic variables: The study results revealed that in rural group pre-test knowledge score significantly associated with age (in years) and class which was significant at p ≤0.05 level of significance and in rural group there lies no significant association between post- test knowledge score and selected demographic variables. In urban group pre-test knowledge score was significantly associated with age (in years), class and monthly income which was significant at p ≤0.05 level of significance and in urban group post-test knowledge score was significantly associated with age (in years) and class which was significant at p ≤0.05 level of significance. It can be said that age, class and monthly income is associated with level of knowledge. A similar study was conducted by Alula Seyum Buda, Dejene Ermias Mekengo et. al (2018) to assess knowledge, attitude and practice of hand washing and associated factors among primary school children in Hosanna town, Ethiopia. Study revealed that knowledge of students is affected by grade of students (95%) and area of residence (95%). Study concluded that maternal educational status, area of residence. Age, sex, and grade of students are factors that affect knowledge, attitude and practice of school children towards hand washing with soap.

CONCLUSION:

On the basis of total mean score findings of the study reveals that knowledge of school children both in rural and urban schools prior to the structured teaching programme was inadequate after the teaching students gain knowledge and awareness regarding importance of hand washing with soap and water. It is important to develop health habits among children as we all know he who has health has hope, and he who has hope has everything.

NURSING IMPLICATIONS:

The implications have been written under the following headings, nursing education, nursing practice, nursing administration and nursing research.

Nursing Education:

This study can be used as an evidence for students to show effectiveness of structured teaching programme to improve school children’s knowledge regarding importance of hand washing with soap and water. Nursing curriculum is responsible for preparing future nurses with emphasis on curative, preventive and promotive health practices and hand washing with soap and water is one of the most important aspect for the promotion of health and prevention of illness among human beings.

Nursing Practice:

Nurses comprise the largest workforce in any health care setting. Nurses as resource persons working in hospital and community settings should impart education especially on prevention and promotional aspects. Nurses need to impart health education to family members including children regarding “Importance of hand washing with soap and water” in order to reduce the economical burden of family due to illness and also to increase attendance of school children. It can be included in the health educational programme, which should be carried out in high schools, colleges, and in community.

Nursing Administration:

Nurse administrators are key person to plan, organize and conduct educational programs. Nurse administrator’s support is necessary to conduct and evaluate health education programs. The nurse administrator should formulate policies, protocols, guidelines and systems of care in collaboration with the multi- disciplinary team. Nurse administrators in the hospitals, in the community can organize in-service education for nurses and health awareness camps for the community about hand washing techniques, need, importance and steps. Adequate information materials regarding steps of hand washing, resources should be available to all nurses, health personnel and to the public.

Nursing Research:

The findings of the study helps to expand scientific body of professional knowledge upon which further research can be conducted. These helps to provide evidence for future practices to be followed both in hospitals as well as in community areas to promotion of health, prevention of illness. Large scale studies can be conducted in consideration of other contributing variables. The study will be a motivation for budding researchers to conduct similar studies on a large scale. The study will be a references for research scholars.

RECOMMENDATIONS:

On the basis of the findings of the study, it is recommended that:

1. A similar study can be performed for primary school children.

2. A similar study can be conducted in other community area.

3. Study can be done on a large sample for the generalization.

4. Interventional study can be done in different setting.

5. Study can be done using alternative method of sample selection technique.

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Received on 11.10.2022 Modified on 21.06.2023

Int. J. Nur. Edu. and Research. 2023; 11(4):315-320.

DOI: 10.52711/2454-2660.2023.00071