Trends in the Use of Non-Pharmaceutical Interventions in Schools During the COVID-19 Pandemic, February 2021 to December 2023: A Mixed Methods Study

The use of non-pharmaceutical interventions (NPIs) was imperative to avoid prolonged school closures during the COVID-19 pandemic. The purpose of this study was to understand the levels of adherence to and attitudes towards NPIs from February 2021 to December 2023 in schools in Ontario, Canada. Participants reported how frequently they, their coworkers, and their students used five NPIs: hand hygiene, covering coughs, staying home when ill, wearing a mask, and physically distancing. Open text comments provided participants with the option to provide additional details. A mixed methods approach incorporated a series of descriptive statistics calculated at consecutive time points and thematic analysis. Participants reported higher adherence to NPIs than their coworkers and students, with less than perfect adherence that declined over time. Six themes emerged from the analysis on NPI use in schools: 1) the influence of time; 2) managing competing priorities; 3) lack of enabling factors; 4) lack of reinforcing factors; 5) responsive use of NPIs; and 6) emotional toll. Poor use of hand hygiene, covering coughs, and staying home when ill indicate a need to improve these in schools as it would help reduce the transmission of communicable diseases and thereby reduce sick days for staff and students.