The longitudinal effect of disseminating handwashing public health education to children in India via co-created, culturally relevant resources
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Infectious diseases are a leading cause of death for children from low- and middle-income countries (LMICs), often due to inadequate hand-hygiene. This study evaluates culturally relevant educational resources as a vehicle to disseminate the importance of handwashing amongst children in India. Employing a participatory action research (PAR) model and mixed methods, this follow-up longitudinal study evaluates a set of innovate educational handwashing resources and workshops specifically co-created for use in the State of Gujarat, and how they aid teachers in the teaching of hand-hygiene over a 3 year period. Working alongside local NGOs on-the-ground, teacher questionnaires ( n =58) and focus groups including a brief questionnaire with teachers ( n =35) were conducted to assess the impact of trainer workshops. In addition, pre- and post-workshop worksheets were conducted with children ( n =98). Percentage change was calculated between children’s pre-and post-worksheet scores and a cumulative frequency of responses to each questionnaire criterion was measured. Data from the focus group found that the resources had been used in over 200 schools by more than 5000 children. In addition, 92.28 % of teachers said they would use the resources within their classrooms in India, with 58.16 % of pupils having an increased understanding of germs/handwashing directly after the workshop. Teachers reported that they are able to teach microbiology and handwashing more effectively. Furthermore, following a focus group, 100 % of teachers noted a reduction in childhood vomiting and diarrhoeal illnesses linked with insufficient hand-hygiene across 46 schools in the State of Gujarat since using the Germ’s Journey resources.
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The work presented is clear and the arguments well formed. This study would be a valuable contribution to the existing literature. This is a study that would be of interest to the field and community. All comments by the reviewers were satisfactorily addressed.
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The work presented is clear and the arguments well formed. This study would be a valuable contribution to the existing literature. This is a study that would be of interest to the field and community. The reviewers have highlighted minor concerns with the work presented. Please ensure that you address their comments.
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Comments to Author
This is an interesting outreach paper on public health that has led to some very useful findings. The Introduction is very informative and the methodology quite sound. The presentation for the obtained data was very clear and the literature review provide a good background based on recent sources of good quality. Some minor corrections: Lines 79-82: Please rewrite this sentence it is very confusing Line 223: how were these test scores calculated? In the Discussion, explain how cited sources affect your study. Is there agreement with your results? Are there similar studies from other countries? Do they agree with your findings? If this work can be applied to other settings e.g. hospitals, army camps please give more details.
Please rate the manuscript for methodological rigour
G…
Comments to Author
This is an interesting outreach paper on public health that has led to some very useful findings. The Introduction is very informative and the methodology quite sound. The presentation for the obtained data was very clear and the literature review provide a good background based on recent sources of good quality. Some minor corrections: Lines 79-82: Please rewrite this sentence it is very confusing Line 223: how were these test scores calculated? In the Discussion, explain how cited sources affect your study. Is there agreement with your results? Are there similar studies from other countries? Do they agree with your findings? If this work can be applied to other settings e.g. hospitals, army camps please give more details.
Please rate the manuscript for methodological rigour
Good
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
Overall, I find this an interesting paper regarding the use of particular resources to educate children on the importance of handwashing. Unfortunately, I feel this paper requires some re-writing before it is ready to be published. Following the instruction from Access Microbiology, I find the following: 1. The mixed methodological approach, although relevant for this study, is not very well explained in this manuscript and are no reasons given as to why this approach was chosen; it would benefit the paper if this was included in the rewrite. This paper outlines a follow-up study and presumes knowledge of the previous study, therefore it would be useful for the reader to have some information on this background study. All questionnaires that were used should be included as supporting information as …
Comments to Author
Overall, I find this an interesting paper regarding the use of particular resources to educate children on the importance of handwashing. Unfortunately, I feel this paper requires some re-writing before it is ready to be published. Following the instruction from Access Microbiology, I find the following: 1. The mixed methodological approach, although relevant for this study, is not very well explained in this manuscript and are no reasons given as to why this approach was chosen; it would benefit the paper if this was included in the rewrite. This paper outlines a follow-up study and presumes knowledge of the previous study, therefore it would be useful for the reader to have some information on this background study. All questionnaires that were used should be included as supporting information as well as data obtained. 2. The findings are presented in a manner that could be improved upon, as the writing throughout this section does not flow that well. Not all results tables are included and how the results within these tables were obtained is not clear. The findings could be presented in a clearer way by putting the teachers' questionnaires in an appendix and referring to them in the document and using some specific comments from the focus groups. The questionnaire that was used with the children pre- and post the workshops could also be included in the appendix and the scoring system that was used needs to be explained. 3. There are issues around the quality of the writing, which includes grammar and the structure and flow of the various sections, which need to be addressed, as these influence the overall paper and its readability. Examples of issues that were observed are noted below. Line 29-31 This sentence is unclear and needs to be rewritten. Line 32 "in India" does not need to be included in this sentence Line 69 "Microbiologist" and "Educationalist" do not need to have a semicolon (;) afterwards Line 70 "in the UK" rather than "for the UK" Line 72 co-created with whom? Line 73 instead of "being developed" say "and were developed" Line 76 instead of "with" at the end of the sentence, use "as well as". This sentence is also very long, perhaps rewrite to make two sentences. Line79-82 This sentence is very long and unclear; it needs to be rewritten to include detail on the original study- perhaps similar to the detail in line 120-128 Line 106 "Section heading(s)" should be replaced with a relevant heading Line 142 Rewrite "data using mixed method was collected" to " A mixed method approach was used to collect data" Line 149 should "anganwadi" be with a capital A? Line 162 Use "partaking" instead of "partake" Line 171 Should be "carousel-style" rather than just "carousel" Line 172 Call this the "post-workshop questionnaire" Line 199 The value presented here is the teachers that do not "teach your pupils about handwashing", according to table 2 and not "do not use any resources when teaching about handwashing" as written here. There is also no need for a the "sum" in this sentence. Line 223 Need a description of how these test scores were calculated as well. The children's questionnaire needs to be included, with the other questionnaires in the appendix Line 253/276/307 The full research question needs to be written here Line 256 Need to give more information on this cited study- why is it relevant? There should be a few lines of text included before new sections in the manuscript to put them into context. 4. The discussion addresses the findings with respect to the research questions referring to some previous literature, but in some cases not explaining why the cited work is important to the current study. It is recommended to refer to more recent similar studies in other countries and settings.
Please rate the manuscript for methodological rigour
Satisfactory
Please rate the quality of the presentation and structure of the manuscript
Satisfactory
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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