Training intervention to improve hygiene practices in Islamic boarding school in Yogyakarta, Indonesia: A mixed-method study

Background
The primary objective of this study was to determine the effect of a training intervention in
overall improvement in students’ (santris) knowledge, behavior, and outcome.
Methods
A mixed-methods exploratory sequential design was applied. First, qualitative data were col-
lected from three focus group discussions with 20 supervisors and one in-depth interview
with school principal to explore current hygiene practices. The information was then used to
develop training intervention using either video, poster, and leaflet. To measure the effect, a
stepped wedge cluster design with pre- and post-test analyses was conducted. A total of
452 junior high school santris in one Islamic boarding school were non-randomly allocated
to either three intervention groups. Outcome measures were knowledge, personal behavior,
and room hygiene. Codes and categories were produced in the qualitative analysis, while
paired t-tests and Wilcoxon rank tests test were used in the quantitative analysis.
Results
The qualitative study identified poor practices on personal and room hygiene among the
santris and proposed a training intervention. Overall, there was a significant increase in
knowledge and personal behavior after the intervention (7.22 ± 1.34 pre-intervention to 7.70
± 0.74 post-intervention and 9.75 ± 2.98 pre-intervention to 12.16 ± 2.12 post-intervention,
respectively, p < 0.001). Room hygiene was significantly improved among boys and those
who received leaflets.
Conclusion
Having developed a specific training materials, school-based hygiene training intervention
improved knowledge and personal behavior. Its effect on room hygiene particularly for
female santris needs further strengthening of the intervention in this Islamic boarding school
setting