Nutr Res Pract.  2012 Apr;6(2):169-174.

The effects of food safety education on adolescents' hand hygiene behavior: an analysis of stages of change

• Kim EJ
• Pai AJ
• Kang NE
• Kim WK
• Kim YS
• Moon HK
• Ha AW

Abstract

The hand hygiene behavior of 400 middle school students (grades 1-3) in Seoul and Gyeonggi-Do was studied to determine how stages of change were affected by food safety education, focusing on hand hygiene and general food safety. Subjects were 51.3% male and 44.3% of study subjects were first graders of middle school. Approximately 40% of subjects were at the stage of action, 42.7% were at the stage of contemplation, and 16.4% were at pre-contemplation. The most important factor that influenced proper hand washing was self efficacy (P < 0.001). Proper hand washing was also correlated significantly with positive belief (P < 0.01) and stages of change (P < 0.01). After food safety education by high-school mentors, middle-school students who were in the stages of pre-contemplation (11.1%) and contemplation (88.9%) showed significant progression toward the action stage (P < 0.001). Proper hand washing (P < 0.01) and food safety knowledge (P < 0.05) were also significantly increased after educational intervention.

Keyword

Hand-washing; middle school students; behavior; self-efficacy; stages of change

MeSH Terms

Food Safety
Hand
Hand Disinfection
Hand Hygiene
Humans
Male
Mentors
Self Efficacy

Reference

1. Roberts L, Smith W, Jorm L, Patel M, Douglas RM, McGilchrist C. Effect of infection control measures on the frequency of upper respiratory infection in child care: a randomized, controlled trial. Pediatrics. 2000. 105:738–742.

2. Niffenegger JP. Proper handwashing promotes wellness in child care. J Pediatr Health Care. 1997. 11:26–31.

3. Master D, Hess Longe SH, Dickson H. Scheduled hand washing in an elementary school population. Fam Med. 1997. 29:336–339.

4. Ryan MA, Christian RS, Wohlrabe J. Handwashing and respiratory illness among young adults in military training. Am J Prev Med. 2001. 21:79–83.

5. Curtis V, Cairncross S. Effect of washing hands with soap on diarrhoea risk in the community: a systematic review. Lancet Infect Dis. 2003. 3:275–281.

6. Luby SP, Agboatwalla M, Painter J, Altaf A, Billhimer WL, Hoekstra RM. Effect of intensive handwashing promotion on childhood diarrhea in high-risk communities in Pakistan: a randomized controlled trial. JAMA. 2004. 291:2547–2554.

7. Contento IR. Nutrition education: linking research, theory, and practice. Asia Pac J Clin Nutr. 2008. 17:Suppl 1. 176–179.

8. Janz NK, Champion VL, Strecher VJ. Glanz K, Lewis FM, Rimer BK, editors. The health belief model. Health Behavior and Health Education: Theory, Research, and Practice. 2002. 3rd ed. Hoboken, NJ: John Wiley & Sons, Inc.;45–66.

9. Prochaska JO, Redding CA, Evers KE. Glanz K, Lewis FM, Rimer BK, editors. The transtheoretical model and stages of change. Health Behavior and Health Education: Theory, Research, and Practice. 2002. 3rd ed. Hoboken, NJ: John Wiley & Sons, Inc.;99–120.

10. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983. 51:390–395.

11. Greene GW, Fey-Yensan N, Padula C, Rossi S, Rossi JS, Clark PG. Differences in psychosocial variables by stage of change for fruits and vegetables in older adults. J Am Diet Assoc. 2004. 104:1236–1243.

12. Foerster SB, Kizer KW, Disogra LK, Bal DG, Krieg BF, Bunch KL. California's "5 a day--for better health!" campaign: an innovative population-based effort to effect large-scale dietary change. Am J Prev Med. 1995. 11:124–131.

13. Steptoe A, Perkins-Porras L, Rink E, Hilton S, Cappuccio FP. Psychological and social predictors of changes in fruit and vegetable consumption over 12 months following behavioral and nutrition education counseling. Health Psychol. 2004. 23:574–581.

14. Wolf RL, Lepore SJ, Vandergrift JL, Wetmore-Arkader L, McGinty E, Pietrzak G, Yaroch AL. Knowledge, barriers, and stage of change as correlates of fruit and vegetable consumption among urban and mostly immigrant black men. J Am Diet Assoc. 2008. 108:1315–1322.

15. Suh Y, Chung Y. Comparison of mineral and vitamin intakes according to the stage of change in fruit and vegetable intake for elementary school students in Chungnam province. Korean J Nutr. 2008. 41:658–666.

16. Byrd-Bredbenner C, Maurer J, Wheatley V, Schaffner D, Bruhn C, Blalock L. Food safety self-reported behaviors and cognitions of young adults: results of a national study. J Food Prot. 2007. 70:1917–1926.

17. Kang NE, Kim JH, Kim YS, Ha AW. Food safety knowledge and practice by the stages of change model in school children. Nutr Res Pract. 2010. 4:535–540.

18. Rosen L, Zucker D, Brody D, Engelhard D, Manor O. The effect of a handwashing intervention on preschool educator beliefs, attitudes, knowledge and self-efficacy. Health Educ Res. 2009. 24:686–698.

19. van de Mortel T. Development of a questionnaire to assess health care students' hand hygiene knowledge, beliefs and practices. Aust J Adv Nurs. 2009. 26:9–16.

20. National Statistical Office. Annual Report of Food Bone-Diseases. 2010. Seoul; Korea:

21. Trunnell EP, White GL Jr. Using behavior change theories to enhance hand hygiene behavior. Educ Health (Abingdon). 2005. 18:80–84.

22. Nobile CG, Montuori P, Diaco E, Villari P. Healthcare personnel and hand decontamination in intensive care units: knowledge, attitudes, and behaviour in Italy. J Hosp Infect. 2002. 51:226–232.

23. Zimakoff J, Kjelsberg AB, Larsen SO, Holstein B. A multicenter questionnaire investigation of attitudes toward hand hygiene, assessed by the staff in fifteen hospitals in Denmark and Norway. Am J Infect Control. 1992. 20:58–64.

24. Alvaran MS, Butz A, Larson E. Opinions, knowledge, and self-reported practices related to infection control among nursing personnel in long-term care settings. Am J Infect Control. 1994. 22:367–370.

25. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, Rubin HR. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999. 282:1458–1465.

26. Naikoba S, Hayward A. The effectiveness of interventions aimed at increasing handwashing in healthcare workers - a systematic review. J Hosp Infect. 2001. 47:173–180.

27. Henry H, Reimer K, Smith C, Reicks M. Associations of decisional balance, processes of change, and self-efficacy with stages of change for increased fruit and vegetable intake among low-income, African-American mothers. J Am Diet Assoc. 2006. 106:841–849.

28. Ladegaard MB, Stage V. Hand-hygiene and sickness among small children attending day care centers. An intervention study. Ugeskr Laeger. 1999. 161:4396–4400.

29. Black RE, Dykes AC, Anderson KE, Wells JG, Sinclair SP, Gary GW Jr, Hatch MH, Gangarosa EJ. Handwashing to prevent diarrhea in day-care centers. Am J Epidemiol. 1981. 113:445–451.

30. Guinan M, McGuckin M, Ali Y. The effect of a comprehensive handwashing program on absenteeism in elementary schools. Am J Infect Control. 2002. 30:217–220.

31. Niffenegger JP. Proper handwashing promotes wellness in child care. J Pediatr Health Care. 1997. 11:26–31.

32. Bowen A, Ma H, Ou J, Billhimer W, Long T, Mintz E, Hoekstra RM, Luby S. A cluster-randomized controlled trial evaluating the effect of a handwashing-promotion program in Chinese primary schools. Am J Trop Med Hyg. 2007. 76:1166–1173.

33. Kimel LS. Handwashing education can decrease illness absenteeism. J Sch Nurs. 1996. 12:14–16. 18

34. Turner G, Shepherd J. A method in search of a theory: peer education and health promotion. Health Educ Res. 1999. 14:235–247.

35. Ward J, Hunter G, Power R. Peer education as a means of drug prevention and education among young people : an evaluation. Health Educ J. 1997. 56:251–263.

36. Gürsoy AA, Yiğitbaş C, Yilmaz F, Erdöl H, Bulut HK, Mumcu HK, Calik KY, Kahriman I, Hintistan S, Nural N. The effects of peer education on university students' knowledge of breast self-examination and health beliefs. J Cancer Educ. 2009. 24:331–333.

37. DuBois DL, Holloway BE, Valentine JC, Cooper H. Effectiveness of mentoring programs for youth: a meta-analytic review. Am J Community Psychol. 2002. 30:157–197.

38. DuBois DL, Neville HA. Youth mentoring: Investigation of relationship characteristics and perceived benefits. J Community Psychol. 1997. 19:291–332.

39. Karcher MJ, Davis C, Powell B. Developmental mentoring in the schools: Testing connectedness as a mediating variable in the promotion of academic achievement. Sch Community J. 2002. 12:36–52.

40. Karcher MJ. The effects of developmental mentoring and high school mentors' attendance on their younger mentees' self-esteem, social skills, and connectedness. Psychol Sch. 2005. 42:65–77.