Received Date: October 09, 2012; Accepted Date: October 26, 2012; Published Date: October 28, 2012
Citation: Ingole AN, Maliye CH, Bharambe MS, Mehendale AM, Garg BS, et al. (2012) The Effect of Participatory School Health Promotion Model on Knowledge and Practices of Rural School Children of Wardha, Maharashtra. J Community Med Health Educ 2:179. doi: 10.4172/2161-0711.1000179
Copyright: © 2012 Ingole AN, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Background: Involvements of parents and teachers have a superior role in imparting health education to school children. In the present study, an attempt has been made to find out impact of the “school health promotion program” with involvement of parents, teachers and a health agency on personal hygiene and related morbidities for the first time among the rural schools of Wardha district. Material and methods: The study was undertaken in the three government and two private schools in RHTC, Bhidi, MGIMS. “School Health Education Program” with emphasis on improvement in personal hygiene and health related practices of school children was started. No sampling technique was applied for selection of students as all the students in the age group of 10-15 years were included. In August 2010, the baseline health check-up of 470 children and an end line assessment was carried out after one year in March 2011. The planned health education sessions were conducted once a week in the schools. Data was entered and analysed using Epi Info (version 6.04d) software package. Results: The knowledge among students and practices compared before and after imparting health education sessions using Z test for difference between two proportions revealed significant change. Conclusion: The school health promotion program with the active involvement of school teachers leads to improvement in personal hygiene in school children and reduction in related morbidities.
Rural Health Training Centre (RHTC); School health education program
Effective health education for children and young people underlies the achievement of many national targets for improvement of health . Health promotion that builds on an accurate understanding of the beliefs and knowledge about health of the target group is probably more effective than strategies which lack this foundation . Much health education for children and young people has not been based on what they themselves know, believe, or want to know. There has been a tendency for children’s voices, to be silent and non-participatory .
Involvements of parents and teachers have a superior role over community health volunteer in imparting health education to school children under school health promotion strategy . In the present study, an attempt has been made to find out impact of the “school health promotion program” with involvement of parents, teachers and a health agency on knowledge and personal hygiene practices among the rural schools of Wardha district as most of the national studies do impart the School Health promotion model at the urban and boarding schools.
The present study was undertaken in the three government and two private schools in the field practice area of the Rural Health Training Centre (RHTC), Bhidi which is the peripheral rural centre of Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences, Sewagram. Participatory “School Health Education Program” was started in the schools with an emphasis on improvement in personal hygiene and health related practices of school children. No sampling technique was applied for selection of students in the schools as all the students in the age group of 10-15 years who were willing to participate in the study were included. Consent was taken from the Principal of the schools for including the school in present study and also from the students before subjecting them to the interview and medical examination. Ethical clearance was obtained from the institutional ethics committee prior to the data collection.
In August 2010, the baseline health check-up of 470 children in the school was carried out with the help of a pre-designed and pretested questionnaire to find out the status of personal hygiene and health related morbidities. The check-up was carried out by the team of medical officer, social workers and school teachers through a scheduled visit. Similarly, end line assessment was carried out after one year during March 2011.
The appropriate, need based, low cost health education materials (flip books) on sanitation and personal hygiene were developed according to PATH guide lines . The planned health education sessions were conducted once a week in the school for one hour for the period of ten months. It was carried out by the team of RHTC staff. Posters on personal hygiene were also displayed in the classrooms. The teachers were motivated to monitor and facilitate behaviour change of School children. Parents and community volunteers were involved in various activities undertaken in the schools. The data thus collected was entered and analysed using Epi Info (version 6.04d) software package. The proportions were expressed in percentages.
Total 470 school children were interviewed for the knowledge and practices related to personal hygiene at the baseline, while 451 students were reassessed after imparting the comprehensive school health education.
When the knowledge among students was compared before and after imparting health education sessions using Z test for difference between two proportions as shown in Table 1, it revealed significant difference of proportion in knowledge about immunization, knowledge about at least two diseases prevented by immunization, availability of treatment for TB, knowledge about ORS, heard of HIV AIDS, knowledge about modes of spread of HIV AIDS.
|Sr. No.||Knowledge among school students||Baseline (2010)||End line (2011)||Z value|
|Frequency (n=470)||Percent-age||Frequency (n=451)||Percent-age|
|1||Knowledge about immunization||110||23.4||173||38.4||5.11*|
|2||Knowledge about all the diseases prevented by immunization||15||3.2||17||3.8||0.53|
|3||Knowledge about at least two diseases prevented by immunization||101||21.5||123||27.3||2.25*|
|4||Knowledge about the availability of treatment for TB||194||41.3||244||54.1||4.11*|
|5||Knowledge about the complaints a case of TB will have||31||6.6||33||7.3||0.66|
|6||Knowledge about the duration of treatment for TB||11||2.3||13||2.9||0.81|
|7||Knowledge about the vector for the spread of Malaria||210||44.7||202||44.8||0.10|
|8||Knowledge about the preventive measures for spread of Malaria||27||5.7||31||6.9||0.70|
|9||Knowledge about ORS||122||25.9||273||60.5||11.20*|
|10||Knowledge about home-based treatment for diarrhoea||37||7.8||42||9.3||0.85|
|11||Ever heard about HIV or AIDS||172||36.5||317||70.3||10.76*|
|12||Knowledge about all the modes of spread of HIV infection||16||3.4||30||6.6||2.34*|
|13||Knowledge about few modes of spread of HIV infection||99||21.06||149||33.03||4.32*|
Table 1: Knowledge among students before and after imparting Health Education Session in the schools.
Table 2 shows practices among students before and after imparting Health Education Session in the schools among students compared using Z test for difference between two proportions. It revealed significant increase of proportion in practices like use of toothbrush and toothpaste for cleaning teeth, cutting nails weekly, washing hands with soap before meals and after defecation, taking bath daily and not eating food from vendors in the school.
|Sr. No.||Practices among school students||Baseline (2010)||End line (2011)||Z value|
|Frequency (n=470)||Percent-age||Frequency (n=451)||Percent-age|
|1||Cleaning teeth twice daily||48||10.2||63||13.9||1.80|
|2||Use of toothbrush and toothpaste for cleaning teeth||291||61.9||316||70.1||2.98*|
|3||Clean ears frequently||353||75.1||348||77.2||0.67|
|4||Cut nails weekly||117||24.9||139||30.8||2.42*|
|5||Wash hands with soap before meals||165||35.1||208||46.1||2.23*|
|6||Wash hands with soap after defecation||336||71.5||365||80.9||3.28*|
|7||Take bath daily||414||88.1||421||93.3||2.63*|
|8||Wear Chappals while going to school||361||76.8||368||81.6||1.60|
|9||Do not eat food from vendors in school||100||21.3||134||29.7||3.28*|
Table 2: Practices among students before and after imparting Health Education Session in the schools.
Present study reports a significant difference in the knowledge and practices amongst students compared after school based interventions and health education program for the duration of one year. The Implementation of Health Promotion Model at Rural schools is hence proved to be effective with several hurdles and obstacles in execution.
Significant increase in the knowledge about immunization, knowledge about at least two diseases prevented by immunization, availability of treatment for TB, knowledge about ORS, information on HIV/AIDS and knowledge about modes of spread of HIV/AIDS was reported by the study. It also revealed significant increase in practices like use of toothbrush and toothpaste for cleaning teeth, cutting nails weekly, washing hands with soap before meals and after defecation, taking bath daily and not eating food from vendors in the school.
Similar impact has been reported by several studies on the basis of school based health interventions. Planet health was a RCT done on 1295 school children in US (1999) . The interventions in the form of health sessions within existing curricula using classroom teachers, focus on behaviour changes like reducing viewing TV to less than 2 hours, increasing moderate and vigorous physical activity and decreasing consumption of high-fat foods and increasing consumption of fruits and vegetables decreased obesity among students and indicated a promising school-based approach to promote health among youth .
Dongre et al. in his study on Ashram schools in 2003-04 has reported significant improvement in the status of personal hygiene, knowledge and practices among school children [7,8]. The percentage of children reporting no physical fights increased significantly from 54.5% to 74.9%.Significantly more children (77.7%) reported that they had heard about HIV/AIDS. There was a significant increase in the percentage of children who had normal haemoglobin from 17% to 38.9% [7,8]. Notably, there was significant improvement in green leafy vegetables’ and fruits’ consumption among students. Thus school based health interventions were found to have impact over knowledge and practices among school children.
Since, the overall approach was participatory and emphasized the empowerment of teachers and students for self-care, the gains achieved by the interventions are expected to sustain. The study thus concludes that the school health education program with the active involvement of school teachers leads to improvement in personal hygiene in school children and reduction in related morbidities.
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