Hand hygiene of kindergarten children-Understanding the effect of live feedback on handwashing behaviour, self-efficacy, and motivation of young children: Protocol for a multi-arm cluster randomized controlled trial

PLoS One. 2023 Jan 24;18(1):e0280686. doi: 10.1371/journal.pone.0280686. eCollection 2023.


Early implementation of interventions at a young age fosters behaviour changes and helps to adopt behaviours that promote health. Digital technologies may help to promote the hand hygiene behaviour of children. However, there is a lack of digital feedback interventions focusing on the hand hygiene behaviour of preschool children in childhood education and care settings. This study protocol aims to describe a study that evaluates the effectiveness of a gamified live feedback intervention and explores underlying behavioural theories in achieving better hand hygiene behaviour of preschool children in early childhood education and care settings. This study will be a four-arm cluster randomized controlled trial with three phases and a twelve-month follow-up by country stratification. The sample size is 106 children of which one cluster will have a minimum number of 40 children. During the baseline phase, all groups will have automated monitoring systems installed. In the intervention phase, the control group will have no screen activity. The intervention groups will have feedback displays during the handwashing activity. Intervention A will receive instructions, and intervention B and C groups will receive instructions and a reward. In the post-intervention phase, all the groups will have no screen activity except intervention C which will receive instructions from the screen but no reward. The outcome measures will be hand hygiene behaviour, self-efficacy, and intrinsic motivation. Outcome measures will be collected at baseline, intervention, and post-intervention phases and a 12-month follow-up. The data will be analysed with quantitative and qualitative methods. The findings of the planned study will provide whether this gamified live feedback intervention can be recommended to be used in educational settings to improve the hand hygiene behaviour of preschool children to promote health. The trial is registered with ClinicalTrials.gov (registration number NCT05395988 https://clinicaltrials.gov/ct2/show/NCT05395988?term=NCT05395988&draw=2&rank=1).

Publication types

  • Clinical Trial Protocol
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child, Preschool
  • Feedback
  • Hand Disinfection / methods
  • Hand Hygiene*
  • Health Promotion
  • Humans
  • Motivation
  • Randomized Controlled Trials as Topic
  • Self Efficacy

Associated data

  • ClinicalTrials.gov/NCT05395988

Grant support

Business Finland and the Oras Group partly funded this study. The funders did not influence the study design, data collection, data analysis, decision to publish, or manuscript preparation. No additional external funding was provided for this study. The Grant number of the award is not available. NO.