Advertisement

Importance of implementation level when evaluating the effect of the Hi Five Intervention on infectious illness and illness-related absenteeism

Published:January 02, 2018DOI:https://doi.org/10.1016/j.ajic.2017.10.021

      Background

      There is limited research on the importance of implementation when evaluating the effect of hand hygiene interventions in school settings in developed countries. The aim of this study was to examine the association between an implementation index and the effect of the intervention. The Hi Five Intervention was evaluated in a 3-armed cluster randomized controlled trial involving 43 randomly selected Danish schools.

      Methods

      Analyses investigating the association between implementation of the Hi Five Intervention and infectious illness days, infectious illness episodes, illness-related absenteeism, and hand hygiene were carried out in a multilevel model (school, class, and child).

      Results

      The level of implementation was associated with hand hygiene and potentially associated with number of infectious illness days and infectious illness episodes among children. This association was not found for illness-related absenteeism.

      Conclusions

      Classes that succeeded in achieving a high level of implementation of the Hi Five Intervention had a lower number of infectious illness days and infectious illness episodes, suggesting that the Hi Five Intervention, if implemented adequately, may be relevant as a tool to decrease infectious illness in a Danish school setting.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Meadows E.
        • Le Saux N.
        A systematic review of the effectiveness of antimicrobial rinse-free hand sanitizers for prevention of illness-related absenteeism in elementary school children.
        BMC Public Health. 2004; 4: 50
        • Willmott M.
        • Nicholson A.
        • Busse H.
        • MacArthur G.J.
        • Brookes S.
        • Campbell R.
        Effectiveness of hand hygiene interventions in reducing illness absence among children in educational settings: a systematic review and meta-analysis.
        Arch Dis Child. 2016; 101: 42-50
        • Priest P.
        • McKenzie J.E.
        • Audas R.
        • Poore M.
        • Brunton C.
        • Reeves L.
        Hand sanitiser provision for reducing illness absences in primary school children: a cluster randomised trial.
        PLoS Med. 2014; 11: e1001700
        • Denbæk A.M.
        • Andersen A.
        • Bonnesen C.T.
        • Laursen B.
        • Ersbøll A.K.
        • Due P.
        • et al.
        Effect evaluation of a randomized trial to reduce infectious illness and illness-related absenteeism among schoolchildren: the Hi Five study.
        Pediatr Infect Dis J. 2018; 37: 16-21
        • Durlak J.A.
        • DuPre E.P.
        Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation.
        Am J Community Psychol. 2008; 41: 327-350
        • Lendrum A.
        • Humphrey N.
        The importance of studying the implementation of interventions in school settings.
        Oxf Rev Educ. 2012; 38: 635-652
        • Dusenbury L.
        • Brannigan R.
        • Falco M.
        • Hansen W.B.
        A review of research on fidelity of implementation: implications for drug abuse prevention in school settings.
        Health Educ Res. 2003; 18: 237-256
        • Domitrovich C.E.
        • Bradshaw C.P.
        • Poduska J.M.
        • Hoagwood K.
        • Buckley J.A.
        • Olin S.
        • et al.
        Maximizing the implementation quality of evidence-based preventive interventions in schools: a conceptual framework.
        Adv Sch Ment Health Promot. 2008; 1: 6-28
        • Dane A.V.
        • Schneider B.H.
        Program integrity in primary and early secondary prevention: are implementation effects out of control.
        Clin Psychol Rev. 1998; 18: 23-45
        • Linnan L.
        • Steckler A.
        Process evaluation for public health interventions and research: an overview.
        in: Steckler A. Linnan L. Process evaluation for public health interventions and research. 1st ed. Jossey-Bass, San Francisco (CA)2002: 1-23
        • Nandrup-Bus I.
        Mandatory handwashing in elementary schools reduces absenteeism due to infectious illness among pupils: a pilot intervention study.
        Am J Infect Control. 2009; 37: 820-826
        • Chittleborough C.R.
        • Nicholson A.L.
        • Young E.
        • Bell S.
        • Campbell R.
        Implementation of an educational intervention to improve hand washing in primary schools: process evaluation within a randomised controlled trial.
        BMC Public Health. 2013; 13: 757
        • Johansen A.
        • Denbaek A.M.
        • Bonnesen C.T.
        • Due P.
        The Hi Five study: design of a school-based randomized trial to reduce infections and improve hygiene and well-being among 6-15 year olds in Denmark.
        BMC Public Health. 2015; 15: 207
        • Flay B.R.
        • Snyder F.J.
        • Petraitis J.
        The theory of triadic influence.
        in: DiClemente R.J. Crosby R.A. Kegler M.C. Emerging theories in health promotion practice and reseach. Jossey-Bass, San Francisco (CA)2009: 451-510
        • Bonnesen C.T.
        • Plauborg R.
        • Denbaek A.M.
        • Due P.
        • Johansen A.
        Process evaluation of a multi-component intervention to reduce infectious diseases and improve hygiene and well-being among school children: the Hi Five study.
        Health Educ Res. 2015; 30: 497-512
        • Danish Health and Medicines Authority
        Hand washing instructional video.
        (Available from) (Accessed September 4, 2009)
        • Goldstein H.
        • Browne W.
        • Rasbash J.
        Partitioning variation in multilevel models.
        Underst Stat. 2002; 1: 223-231
        • Merlo J.
        • Chaix B.
        • Ohlsson H.
        • Beckman A.
        • Johnell K.
        • Hjerpe P.
        • et al.
        A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena.
        J Epidemiol Community Health. 2006; 60: 290-297
        • Dohoo I.
        • Martin W.
        • Stryhn H.
        Veterinary epidemiologic research.
        VER, Canada2003
        • Gupta S.K.
        Intention-to-treat concept: a review.
        Perspect Clin Res. 2011; 2: 109-112
        • Forman S.G.
        • Olin S.
        • Hoagwood K.E.
        • Crowe M.
        • Saka N.
        Evidence-based interventions in schools: developers' views of implementation barriers and facilitators.
        School Ment Health. 2009; 1: 26-36
        • Denbæk A.M.
        • Bonnesen C.T.
        • Andersen A.
        • Holstein B.E.
        • Laursen B.
        • Due P.
        • et al.
        Agreement between children and parents demonstrated that illness-related absenteeism was validly reported by children.
        J Clin Epidemiol. 2016; 69: 61-69
        • Lee M.B.
        • Greig J.D.
        A review of gastrointestinal outbreaks in schools: effective infection control interventions.
        J Sch Health. 2010; 80: 588-598
        • Wich P.
        Skolen—mellem forandring og forankring [The school—between change and anchoring].
        in: Albers B. Høgh H. Månsson H. Implementering—fra viden til praksis på børne- og ungeområdet [Implementation—from knowledge to practice in the field of children and adolescents]. Dansk Psykologisk Forlag, København, Denmark2015: 168-186