A Comprehensive Assessment of Hand Washing: Knowledge, Attitudes and Practices (KAP) and Hand-Washing Behaviors among Primary School Students in Northeast China

Globally, the most common cause of death of children is infectious diseases, particularly in low- and middleincome countries. In China, infectious diseases, especially diarrhea, are still some of the most serious public health problems, simultaneously suggesting that effective hand washing may help prevent these diseases. However, its effectiveness has remained unclear in terms of the difficulty in measuring children’s hand-washing behavior. The aim of the present study was to develop a hand washing checklist that is handy and suitable for children, to comprehensively evaluate their hand washing practice. In this study, 269 students aged 7–13 years and their mothers completed measures of knowledge, attitude and practices (KAP) level of sanitation and hygiene and demographics. In addition, this study tested participants’ and washing skills following both the World Health Organization (WHO) checklist and new checklist (modified based on the WHO checklist). Two cameras were used to record the whole progress of hand washing test. The present study showed that knowledge and attitude had no correlations with hand washing test. None of the children perfectly completed all steps of the WHO checklist. Given this, after simplifying the WHO checklist, the completion rate has significantly improved. The findings of this study also demonstrated that social economic status plays a significant role in shaping students’ hand washing behaviors along with the striking factor that children’s age, and gender differences had a significant correlation with their hand washing behaviors.