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Personal hygiene is acutely important in preventing bloom problems. It is a self-care action whereby bodies assure and advance their health. Generally, the aboriginal footfall in claimed hygiene is the development of actual duke abrasion behavior (Özcebe, Ulukol, Mollahaliloğlu, Yardim, & Karaman, 2008). Duke abrasion is the simplest and best able adjustment for preventing infection and foodborne diseases as able-bodied as ensuring aliment aegis in about every breadth of amusing life, abnormally amid school-aged accouchement (Bakken, 2015; Swearingen, 2015).

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The World Bloom Organization (WHO) has appear accepted duke abrasion is the atomic big-ticket and best able hygiene convenance for preventing diarrhea and pneumonia, two of the best accepted causes of afterlife amid accouchement (WHO, 2005). Similarly, the Centers for Ache Ascendancy and Blockage (CDC) states that acquirements actual duke abrasion behavior could abate the accident of diarrhea and associated diseases by 50% (CDC, 2019). In a meta-analysis, Ejemot-Nwadiaro, Ehiri, Meremikwu, and Critchley (2015) appear duke abrasion interventions bargain diarrhea-related diseases by 39% in accouchement from advantageous countries and by 32% in accouchement from low- or middle-income countries. Another meta-analysis approved duke abrasion added amnesty adjoin respiratory amplitude infections from 6% to 44% (Rabie & Curtis, 2006).

Correct duke abrasion habits acquired in elementary academy anticipate a aggregation of ailments, including communicable diseases, and may prove added able than vaccinations (Pittet, Allegranzi, & Boyce, 2009). Studies additionally accept appear that duke abrasion training reduces absence accompanying to respiratory amplitude infections and astute gastroenteritis (Azor-Martinez et al., 2014, 2016; Munn, Tufanaru, Lockwood, & Stern, 2017; Wang, Lapinski, Quilliam, Jaykus, & Fraser, 2017).

According to the after-effects of antecedent studies, abounding diseases affecting individuals and association at ample are preventable through basal duke abrasion training (Şahin, Vural, Vuralli, Yüksel, Yildiz, & Aslan, 2008). The best able aeon for axis claimed hygiene rules into basement behavior is during primary school. During this time back accouchement are accepting advantageous affairs habits, the accomplishing of a connected and absolute training affairs is recommended (Loschiavo, 2015). Ensuring the alive accord of accouchement and adolescents through altered bloom training techniques is important for instilling key behavioral changes (Özcebe et al., 2008; Benes & Alperin, 2016).

The abstract on academy bloom recommends that an chip and absolute bloom training affairs should be accomplished as allotment of basal elementary academy apprenticeship (Bastable, 2003, Gündüz & Albayrak, 2014). Approaches that put learners in the centermost of the training process, accouterment ability and accomplishment simultaneously, are methods that facilitate acquirements in duke abrasion instructions (Kaya & Aslan, 2009). Therefore, this assay was conducted to actuate the furnishings of “demonstration, puzzle, dance, song (DPDS)” training on primary academy students.

This community-based, semi-experimental, pretestposttest accumulation abstraction aimed at auspicious advantageous duke abrasion habits amid adolescent children.

Participants were 744 primary academy acceptance in Nevsehir, Turkey. No sampling was conducted in this study; rather, an attack was fabricated to ability the absolute population. Seventy-three acceptance who did not appear school, did not complete the assay form, or did not accommodate accord to participate in the abstraction were excluded; 90.2% of the ambition citizenry was reached. The assay was a society-based accessible bloom activity that was developed calm with chief acceptance of the nursing department, and assay was conducted alert a anniversary for one semester.

Demographic Abstracts Form. This anatomy consisted of questions about participants’ gender, age, ancestors type, father’s educational cachet and occupation, mother’s educational status, and cardinal of ancestors (Aslan et al., 2006; Kitiş & Bilgili, 2009; Şimşek, 2012).

Hand Abrasion Accomplishment Evaluation List. A Duke Abrasion Accomplishment Evaluation List, created according to the WHO’s (2002) duke abrasion guide, was acclimated in the research. This account is not a scale, and the Turkish adaptation was acclimated (Kitiş & Bilgili 2009; Şimşek, 2012). The account included the afterward 12 accomplish performed during duke washing:

Pull up your sleeves.

Wet your hands.

Turn off the tap.

Take some soap in your hands.

Foam your easily thoroughly.

Rub amid the fingers.

Scrub your easily with thumbs and fingers.

Rub the backs of your hands.

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Rub your wrists.

Rub your fingertips into your hands.

Rinse your hands.

Rinse the tap with water.

It was important to backpack out the accomplish in the declared order. The accomplish in the Duke Abrasion Accomplishment Evaluation Account were apparent as yes (correct) or no (incorrect). In this study, a nursing apprentice empiric students’ duke abrasion technique, and the aforementioned eyewitness connected during the absolute assay action to abbreviate the allowance of absurdity amid observers.

This assay was a community-based activity aimed at convalescent elementary academy bloom services. It was performed alert a anniversary for one semester. Abstracts were calm by chief nursing acceptance beneath the advice of the researchers. At the alpha of the study, a training affair was captivated with the nursing acceptance apropos the aim of the study, abstracts accumulating tools, and duke abrasion instructions. Afterward, the training was evaluated by a question-and-answer adjustment and again for the genitalia bent to be deficient.

Before accession data, the purpose of this assay was explained to the academy principals and teachers. Letters anecdotic the abstraction again were beatific to parents through the teachers, and accounting permission to participate was obtained. The abstraction was conducted amid February 1 and March 29, 2016. Evaluations were based on the responses in the abstracts accumulating forms, opinions of the teachers, and letters of the advice center. The cardinal of ancestors for anniversary apprentice was acquired by allurement the acceptance and their teachers.

The Duke Abrasion Accomplishment Evaluation Account was completed by the nursing acceptance afore the training, anon afterwards the training, and 4 weeks afterwards the training. During the aeon for commutual the form, nursing acceptance had the accouchement ablution their hands. The Duke Abrasion Accomplishment Evaluation Account was completed by the nursing acceptance by observation, and the continuance of duke abrasion was bent with a chronometer. During the research, one nursing apprentice empiric one participant’s duke abrasion skill; the aforementioned eyewitness followed the participant’s duke abrasion behavior throughout the research.

For primary academy acceptance to access actual duke abrasion behaviors, a training affairs that comprised DPDS performances was developed by the researchers; the affairs was conducted already a anniversary for a aeon of 4 weeks. The affairs was acquired from children’s acquirements attempt and archetypal alertness techniques. The all-embracing agreeable of the training included the accession of the abstraction of microbes, the agency through which bacilli spread, and the role of easily in the bane process. Acceptance were accomplished and accomplished about how and in what situations easily should be washed.

For the presentations and puzzles in the training program, the advisers acclimated “Hand Hygiene for Primary Academy Children,” which was appear by the Turkish Ministry of Health, General Directorate of Primary Bloom Services, Administration of Nutrition and Physical Activities (Bilici & Buzgan, 2008). Afterwards selecting the animations, dances, and songs to be acclimated in the training program, the opinions of two experts from the acreage of educational sciences were sought. DPDS training programs were conducted by an interviewer/educator nursing student, a lecturer/researcher, and an elementary academy abecedary in the schools and playgrounds, with groups of 20 children.

The training affairs lasted about 4 weeks, with account 1-hour sessions. Children’s questions were answered afterwards anniversary session. The ascertainment was fabricated by accepting the accouchement ablution their easily three times: afore the training, anon afterwards the training, and 4 weeks afterwards the training. Successful accomplishment of duke abrasion tasks and continuance were recorded in the accomplishment list. The action accomplish are abbreviated in Figure 1.

Figure 1.

Flow blueprint assuming action steps.

In the aboriginal week, acceptance watched a 10-minute PowerPoint® presentation about the appellation “germ,” agency of bane and the role of easily in contagion, the altitude beneath which the easily should be washed, and how to ablution the hands. Accouchement again watched a 4-minute activated cine accompanying to duke washing. Finally, duke abrasion was approved by the trainers, and the accouchement were asked to echo this application.

In the additional week, duke washing-related puzzles were provided. The puzzles consisted of three types: award the words, allotment the actual picture, and bushing in the blanks in sentences. In the aboriginal puzzle, words accompanying to duke abrasion and bloom were provided to acceptance in a accolade form. With hints, acceptance were asked to acquisition and address bottomward the actual word. For example, “Poas: As it foams, it locks abroad the bacilli . . . SOAP,” or “Mibcore: It’s airy but cat-and-mouse everywhere to accomplish you ailing at any time . . . Microbe.” This addle blazon was not acclimated with aboriginal graders.

For the additional blazon of puzzle, acceptance were asked advertence questions with pictures that included accurate or apocryphal applications. For example, one catechism asked, “What should we do to assure Little Monster from the germs?” Another catechism asked, “Can you mark the actual pictures?” Acceptance were asked to accept the actual picture. This addle blazon was acclimated for all grades.

For the third addle type, a arrangement with pictures was used, absolute bristles propositions accompanying to the duke abrasion application. In this template, the accouchement were apparent an angel accompanying to the hypothesis and asked to complete the missing allotment of the book by attractive at the image, for example, “Wet your easily with….” This addle blazon acclimated a catechism and acknowledgment adjustment for the aboriginal graders and accounting answers for added grades.

In the third week, the aim was for accouchement to affectation their abstract compassionate of duke abrasion acquired ahead in the training through dancing and in a fun manner. Led by the nursing students, the accouchement wore white t-shirts to represent cleanliness and atramentous pants to represent the germs. Holding their easily in avant-garde of them, their moves mimicked the duke abrasion techniques they had afresh learned. The dancing took abode in academy breadth or multi-purpose halls, such as auditoriums, and lasted 7 to 10 account (Figure 2).

Figure 2.

Hand abrasion ball performed by elementary academy acceptance accompanied by nursing students.

In the fourth week, for acceptance to apprentice in an absorbing manner, a video action featuring a song about duke abrasion was apparent to the students. The video was about 2.5 account long, with activated characters accepted amid Turkish children. Afterwards the action was apparent to the students, the song in the video was again by the children.

The abstraction accustomed approval from the university’s Ethics Committee (01.02.2016, N:84902927), and permission was acquired from the Provincial Directorate for National Apprenticeship (29.02.2016, E. 2309349). Accounting permission additionally was acquired from the parents of the children, and photographs were acclimated with the accord of the interviewed students. For the primary academy students, photographs that did not accommodate their faces were preferred.

Demographic abstracts for participants, administration statistics for absolute changes (i.e., numbers and percentages), and Shapiro-Wilk assay from accustomed administration tests were used. Because the abstracts did not represent a accustomed distribution, nonparametric tests were acclimated for the analysis. For the allegory of absolute abstracts amid the groups, the McNemar assay was used. The Friedman assay and assay of about-face were acclimated to appraise the continuance of duke abrasion amid observations. The Wilcoxon alive rank assay was acclimated to actuate the causes for statistically cogent differences. The akin of acceptation was set as p < .01.

The absolute variables of this abstraction were the bloom training about duke abrasion and the follow-up. The abased variables of the abstraction were duke abrasion abilities and duke abrasion times.

Table 1 displays the sociodemographic characteristics of the acceptance who alternate in the study. In total, 51.4% of the acceptance were male, 79.9% had nuclear families, and 38.7% of the acceptance had two siblings. Added demographic abstracts adumbrated 46.8% of the mothers and 41.4% of the fathers were primary academy graduates or had a lower educational level, 70% of the mothers were housewives, and 3.4% of the fathers were unemployed (Table 1).

Table 1:

Demographic Characteristics of Participants (N = 671)

Table 2 shows that the duke abrasion accomplish above-mentioned to the training were not performed at aerial adequacy levels by students, decidedly “rubbing fingertips in hands” (70.8%), “making easily cream with soap” (69.4%), “rubbing deride in hands” (69.2%), and “rubbing wrists” (50.4%). Afterwards the training, anniversary footfall was performed with college adequacy levels compared with the pretraining period, and the differences amid observations were statistically significant, except for “wetting easily with some water” and “taking some aqueous soap in hands” (p <.01). In the observations conducted during the posttest and the aftereffect period, the differences amid accomplishing accomplish 4, 8, 10, and 12 were statistically cogent (p < .01). Differences amid observations conducted in the pretest against the aftereffect aeon were statistically significant, except for the “wetting easily with some water” footfall (p < .01) (Table 2).

Table 2:

Comparison of Students’ Duke Abrasion Abilities Before, During, and Afterwards Training Period

Table 3 shows the administration of the agency and medians of the duke abrasion durations of acceptance according to the pretraining, posttraining, and aftereffect periods; the average duke abrasion continuance was 13 seconds, 17 seconds, and 20 seconds, respectively. The aberration in continuance amid the three ascertainment periods was statistically cogent (p < .001). Statistically cogent differences in duke abrasion continuance (p < .001) (Table 3) were begin amid the three measurements.

Table 3:

Average Duke Abrasion Time Before, After, and During Training Period

This abstraction on duke abrasion apprenticeship was conducted in a rural breadth and was far abaft the burghal centermost in agreement of development. This project, which does not assume to be a call in burghal centers in Turkey, is all-important in rural areas. It is important for acceptance to accept able ability to affectation and advance actual duke abrasion abilities (Aslan et al., 2006; Kaya & Aslan, 2009). Within the ambit of the study, altered training techniques (DPDS) were acclimated to advice acceptance apprentice duke abrasion skills. The afterward applications were acclaimed to be absent the best during duke washing: demography the fingertips into the duke (70.8%), bubbles easily thoroughly with some soap (69.4%), ablution the thumbs by demography into the duke (69.2%), and abrading the wrists (50.4%). Studies conducted by Şimşek (2012) and Kitiş and Bilgili (2011) additionally begin agnate accomplish were skipped in duke washing. It is recommended that training should be conducted to ensure that accouchement accretion duke abrasion abilities (Loschiavo, 2015).

Moreover, it is recommended that accomplishment training be conducted for behaviors such as duke abrasion with the advice of assorted accoutrement and methods, including videos and cast archive (Loschiavo, 2015). A abstraction investigating the duke abrasion ability and attitudes of preschoolers in Malaysia conducted training application abandoned posters, and back compared with the use of assorted teaching methods activated in Turkey, the affiche adjustment was begin to access the ability of accouchement apropos duke washing, yet was advised bereft for alteration their attitudes. The abstraction recommended that educational programs with activating elements such as comedy and storytelling should be developed (Mohamed, Ridzuwan, Ungah, & Jamaluddin, 2018). In a agnate abstraction that was conducted in a rural breadth in India, the outcomes of the duke abrasion training, application animation, drama, and folk tales, were begin to be absolute (Biran et al., 2014).

In New Delhi, a cogent advance was appear in students’ duke abrasion ability and abilities afterward a duke abrasion action affairs that included posters, slogans and in-class interactions (Garg, Taneja, Badhan, & Ingle, 2013). In several studies conducted in Turkey that acclimated altered methods such as videos and demonstration, a cogent access was adumbrated in a majority of duke abrasion stages afterwards training (Aslan et al., 2006; Bilgin, Evcili, Kaya, & Bekar, 2016; Kitiş & Bilgili, 2011). In the accepted study, which ensured alive accord of accouchement in rural areas in Turkey application DPDS to accomplish acquirements fun, the duke abrasion behaviors of the accouchement afflicted positively.

The CDC (2019) emphasizes that the time spent in duke abrasion is as important as implementing the accomplish of duke abrasion to abolish microorganisms and recommends that easily should be done for at atomic 20 seconds. In this study, the average continuance of duke abrasion amid acceptance was 13 abnormal afore training, 17 abnormal afterwards training, and 20 abnormal 1 ages afterwards training. The aberration in the continuance of duke abrasion was statistically cogent (p < .001). In a abstraction that provided acceptance with a 4-hour training on duke abrasion and abject diseases, the amount of responding “sometimes” to the account “I ablution my easily for at atomic 1 minute” added from 21.3% to 25.7% afterwards training. However, the amount of those who responded with “always” decreased from 73% to 67.4% (Bilgin et al., 2016). In a school-based action affairs conducted in India to advance duke abrasion behavior, bloom affliction apprenticeship was conducted on the base of alive accord of students, and the duke abrasion continuance of the acceptance bigger afterwards the action (Amudha et al., 2018). Agnate to the accepted study, the absolute change empiric by added studies in duke abrasion durations is advised to appear from the accomplishment of alive accord of accouchement through agreeable educational methods.

In a Kenyan abstraction on children’s duke abrasion behaviors, it was begin that aftereffect with assemblage added the actual duke abrasion behaviors by about 10% compared with aftereffect application video abandoned (Pickering, Blum, Breiman, Ram, & Davis, 2014). Similarly, a abstraction conducted in Bangladesh articular that back accouchement who were accompanied by an developed alternate from the washroom, their duke abrasion with soap behaviors added by 30% compared with back they went to the bathroom abandoned (Grover et al., 2018). It is believed that observations fabricated by the nursing acceptance in the accepted abstraction additionally were able in the absolute changes in duke abrasion behavior and duration. It ability arise from the actuality that it is a affective agency for accouchement to advance their duke abrasion behavior back actuality observed.

It is important for school-aged accouchement to access duke abrasion skills, booty albatross for their own health, and advance constant advantageous attitudes and behaviors. Aboriginal adolescence action studies in the acreage of health-related teaching methods are capital for the amusing and bread-and-butter abundance of society, as able-bodied as for preventing illnesses and acceptable the children’s affection of activity (Bartik, 2013; Uysal & Akman, 2015). Thus, altered training techniques (i.e., DPDS) were acclimated in this abstraction to advance students’ duke abrasion skills. Because it takes time for an alone to anatomy abiding health-related behaviors, the abstract recommended that abiding empiric studies to appraise the behavioral furnishings of duke abrasion training programs be conducted (Dreibelbis, Kroeger, Hossain, Venkatesh, & Ram, 2016; Yılmaz & Özkan, 2009). In this research, ascertainment was conducted both anon and 4 weeks afterwards training, and the duke abrasion behaviors of the acceptance had afflicted absolutely amid the observations. Such change may accept occurred from the use of altered training methods (i.e., DPDS) and accord of the acceptance forth with the observations.

This abstraction was a community-based activity conducted with nursing students, which was a action that bound the accessible time for the study. Although ascertainment was a able ancillary of the research, it was a limitation that duke abrasion was empiric a absolute of abandoned three times: afore the training, anon afterwards the training, and 4 weeks afterwards the training.

There additionally may accept been added factors that afflicted the duke abrasion behavior of the accouchement during the study. Besides the absolute factors, such as accouchement watching action characters’ duke abrasion and acquainted earlier ancestors as role models in duke washing, there were abrogating factors, such as the abrogating attitude of the family, bereft baptize supply, abridgement of soap in the house, and children’s disability to ability the sink. The disability of advisers to ascendancy such factors is a limitation of this study.

The allegation of this abstraction adumbrated that DPDS training led to a absolute access in children’s duke abrasion accomplish and duration. This abstraction additionally appear that assorted training methods bigger the duke abrasion abilities of primary academy acceptance in rural areas of Turkey. Popularizing applicable, sustainable, and cost-effective action studies aimed at aboriginal adolescence that absorb altered training methods accompanying to duke abrasion is capital with attention to the amusing and bread-and-butter abundance of society, as able-bodied as the acquaintance of accouchement about their own bloom albatross and ache prevention. This community-based activity was conducted with the accord of the chief nursing acceptance in Turkey. Recommendations for approaching studies accommodate application abiding action and administering aftereffect studies of the aforementioned activity with altered samples.

The analytical plannability, practicability, and sustainability of academy bloom casework are astute for attaining the ambition of a convalescent society. Starting from the preschool period, nurses comedy an important role in academy bloom casework by allowance accouchement advance absolute bloom habits and auspicious them to booty a added alive role while accepting these habits. The capital cold of bloom education, which forms the base for academy bloom assistant services, is enabling acceptance to advance a advantageous activity by developing absolute behaviors. The duke abrasion affairs implemented by nurses in the present abstraction should be included in academy curricula.

In addition, nurses who focus on able abilities training are amenable for planning bloom apprenticeship programs by because the cultural characteristics of the ambition population. Connected educational programs such as the one implemented in the present abstraction or agnate studies can be organized for nurses who are attractive for solutions to access the duke abrasion abeyant of their colleagues, patients, or the association in clinics, academy bloom services, or in the field. The undergraduate and postgraduate apprenticeship curricula of the academy bloom nursing advance can accommodate a added absolute abstract understanding. Agnate to the present study, nursing acceptance can be provided with an befalling to plan and apparatus academy bloom initiatives afore graduation in an accomplishment to accredit added abiding learning.

Demographic Characteristics of Participants (N = 671)

Comparison of Students’ Duke Abrasion Abilities Before, During, and Afterwards Training Period

Average Duke Abrasion Time Before, After, and During Training Period

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