La Sante nan Pwòp Men Nou The Development, Implementation and Evaluation of a Hand Hygiene Education Curriculum for Community Members in Cavaillon, Haiti: A Special Studies Project Open Access

Savino, Cassandra (Spring 2019)

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Background: Haiti has the lowest rates of access to improved water sources and sanitation facilities in Latin America and the Caribbean, contributing to high diarrhea-related morbidity and mortality. Although interventions promoting handwashing with soap have been found to reduce the risk of diarrhea, proper hand hygiene with soap is not widely practiced, particularly in rural areas of Haiti.

Methods: This hand hygiene education project was conducted in the NOVA Hope for Haiti clinic in the rural town of Cavaillon, Haiti in the summer of 2017. A KAP survey was administered to 28 NOVA clinic patients, 18-35 years old. A hand hygiene education curriculum was developed using information from the KAP survey, literature and elements of the Health Belief Model and Community Based Participatory Action Research theoretical framework. The curriculum was implemented at the NOVA clinic among 23 patients, 18-35 years old and was evaluated.

Results: A culturally appropriate curriculum and evaluation plan were developed for a one-week hand hygiene education project. KAP survey results identified gaps in awareness of the perceived benefits of hand hygiene and inconsistencies with practicing hand hygiene at critical times. Data from the KAP survey was integrated with the literature review to develop the curriculum. An evaluation of the project demonstrated participant satisfaction of the project (9.84 out of 10) and facilitators (5 out of 5). A pre- and post-test was used to measure participant retention of knowledge at the conclusion of the intervention. Initial analysis of the pre- and post-test scores identified a trend towards improvement in test scores after the project implementation (p=0.065). However, after excluding two outliers in the data, the comparison of pre- and post-test scores showed a significant improvement in post-test scores, suggesting potential for positive behavior change (p<0.05).

Discussion: Hand hygiene is a known preventative method for diarrheal diseases. This hand hygiene education curriculum addresses gaps in knowledge and provides an opportunity for community participation, to educate and empower NOVA clinic patients in an effort to increase appropriate hand hygiene behaviors. Reinforcing hand hygiene knowledge among NOVA clinic patients by implementing this project yearly is important for sustained behavior change. 

Table of Contents

Chapter 1: Background. 1

1.1 Introduction and Significance. 1

1.2 Purpose Statement 4

Chapter 2: Review of the Literature. 5

2.1 The Republic of Haiti 5

2.2 Cholera, Typhoid and Other Diarrheal Diseases in Haiti 8

2.3 Hand Hygiene and Enteric Disease Prevention. 13

2.4 Existing Hand Hygiene Interventions in Haiti 16

2.5 Behavioral Theory: Health Belief Model 21

2.6 Behavioral Theory: Community-Based Participatory Action Research. 24

2.7 Nuances of Health Education Projects in Rural Communities. 29

Chapter 3: Methods. 33

3.1 Introduction. 33

3.2 Study Setting. 34

3.3 Study Population. 35

3.4 Instrument Design for the Community Needs Assessment 36

3.5 Data Collection for the Community Needs Assessment 38

3.6 Data Management 39

3.7 Data Analysis. 39

3.8 Curriculum Development Methods for Hand Hygiene Project (Adults 18-35) 39

3.9 Curriculum Implementation. 41

3.10 Evaluation of the Hand Hygiene Project 42

3.11 Data Management 44

3.12 Data Analysis. 44

3.13 Ethical Considerations 45

Chapter 4: Results. 46

4.1 Community Needs Assessment 46

Figure 1. Hand Hygiene KAP Survey Question #B1. 47

Figure 2. Hand Hygiene KAP Survey Question #B2. 47

Table 1. Hand Hygiene KAP Survey Knowledge Assessment. 48

Figure 3. Hand Hygiene KAP Survey. 49

Figure 4. Hand Hygiene KAP Survey. 49

Table 2. Hand Hygiene KAP Survey Question C2. 50

Figure 5. Hand Hygiene KAP Survey Question #C3. 51

Figure 6. Hand Hygiene KAP Survey Question #C9. 52

4.2 Curriculum Development and Implementation. 52

Table 3. Hand Hygiene Education Project Attendance. 53

Table 4. Activities and Tools used in Hand Hygiene Education Project and Associated Behavioral Theories and Components. 55

Table 5. Module topics and goals. 55

Table 6. Activities and Tools Descriptions. 57

4.3 Evaluation. 57

Table 7. Comparison of means of pre- and post-test scores out of 12 questions. 58

Table 8. Analysis of Variance Table. 58

Figure 7. Plot of paired pre- and post-test results from a paired t-test (n=14) 59

Table 9. Analysis of Variance Table. 59

Figure 8. Plot of paired pre- and post-test results from a paired t-test (n=12). 60

Figure 9. Course evaluation responses. 61

Chapter 5: Discussion, limitations and conclusions. 62

5.1 Discussion. 62

5.2 Limitations 66

5.3 Conclusions 68

References. 70

Appendix A: Hand Hygiene Survey (English) 75

Appendix B: Hand Hygiene Survey (Haitian Creole) 88

Appendix C: Final Curriculum.. 101

Appendix D: Pre- and Post-Test 132

Appendix E. Course Evaluation. 134

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