Experiences of implementing hand hygiene for Malawian schoolchildren: a qualitative study.

AIM: To explore the experiences of schoolchildren, school personnel and parents who participated in a school-based hand hygiene programme implemented by nurses in Malawi. BACKGROUND: There is low uptake of hand hygiene practice in developing countries due to limited resources available and no standardized hand hygiene policy. INTRODUCTION: Current health policies acknowledge the advantage of investing in disease prevention and health promotion among young children in Malawi. School nurses should adopt good evidence-based practice in promoting school-based hand hygiene programmes which remain a challenge in Malawi. METHODS: In this descriptive qualitative study, 10 focus group discussions were conducted with 23 females and 14 males including schoolchildren, school personnel and parents participating in a school-based hand hygiene programme. The programme was implemented by nurses in three primary schools between May and July 2017 in Malawi. Data from these discussions were coded and analysed using thematic analysis. FINDINGS: The school-based hand hygiene programme was well received by participants. Four themes illustrated effective strategies in implementing the hand hygiene programme from the participants' view, including 'Being committed', 'Sharing responsibilities', 'Disseminating good practice' and 'Appreciating assets'. These are essential resources and strategies that school nurses need to mobilize and integrate when they advocate handwashing policy by delivering hygiene promotion activities. DISCUSSION: School nurses play a significant role in helping to achieve United Nation's Sustainable Development Goal 3 through promoting hand hygiene to minimize transmission of diseases and reduce mortality rate. CONCLUSION AND IMPLICATIONS FOR NURSING AND HEALTH POLICY: An evidence-based protocol based on study findings is beneficial for school nurses in formulating handwashing policies. It is important for developing countries to formulate the much-need policies for primary care practices.