Effect of Personal Hygiene Program on Knowledges and Practices of Mentally Retarded Students at El-Fikrya schools in Minia Governorate, Egypt.

Introduction:

Mentally disabled children are suffering from deficiencies in various abilities specially self-care abilities including personal hygiene. Personal hygiene is  the  most  important  one since  any failure  in  this  aspect  will  affect  the  rest  of  the  other  aspects  of  a  child's  life. Recently  there  is  an  interest  in  the  field  of  disability  by  designing  effective  programs  to train people with  intellectual disabilities (Kasem & Bo- Dhayaaf, 2017).

Personal hygiene requires the cleaning of all parts of the body (face, hair, body, legs and hands). Personal hygiene which is also referred to as personal care includes all of the following: hair care, nail care, foot care, genital care and dental care (United Nations Children's Fund (UNICEF), 2016).The maintenance of good hygiene is essential for population's health and well-being. Poor hygiene is a risk to public health. Poor hygiene is one of the important behavioral risk factors contributing to the global burden of diseases (Altun et al., 2013).

Personal hygiene is influenced by various factors such as society, family and individual awareness and attitudes concerning hygiene. Most of the health problems affecting school students are preventable by promoting proper hygiene practices through family and adopting good health education (Hazazi et al., 2019). Proper knowledge and practices of personal hygiene plays an important role in avoiding diseases like Diarrhea, Dysentery, Vomiting, Dental caries, Itching problems, Skin diseases etc., ( Kumar et al., 2018).  

Poor knowledge, practice of and attitudes to personal hygiene such as hand washing play major roles in the high incidence of communicable diseases and therefore has negative consequences for a child’s long term overall development (Sarkar, 2013 & Ghanim et al., 2016). Personal hygiene deficiencies have been found to be a serious public health problem and people often affected are school children. These have been attributed to inadequate knowledge of personal hygiene and its practices (Ajay et al., 2018).

The responsibility of local school districts is to educate students with intellectual disabilities in the least restrictive environment. The school nurse collaborates with education staff to promote a safe and accommodating school environment for children with chronic health conditions including disabilities (American Nurses Association & National Association of School Nurses [NASN], 2017; Brook et al., 2015).

Significance of the Study

Inadequate hygiene practices have been estimated to affect 80% of the population globally (Freeman, 2014). Improvements related to sanitation and hygiene could result in the reduction of almost 10% of the total burden of disease worldwide (WHO, 2016).  There is need to assess the personal hygiene knowledge and practices of mentally retarded students because they are more likely to engage in practices that may be unfavorable to their health than other groups and thus make them susceptible to hygiene deficiency illnesses.

Furthermore, developing an effective personal hygiene education programs is very essential to increase their basic knowledge. In addition, the findings from this study can also provide basic and useful information for policy formulation and strategic interventions on personal hygiene among disabled school students. The outcome of this study will serve as a guide for further research in this area.

Aim of study

This study aimed to:                                                                                

• Evaluate effect of personal hygiene program on the knowledge and practices of mentally retarded students at El-Fikreya schools in Minia Governorate.

Research Hypothesis:

1. Knowledges of mentally retarded girls about personal hygiene will be increased after implementation of the personal hygiene program.

Subjects and methods:

Research design:

Quasi experimental design (Pretest & Post-Test) was utilized in this research study.

Setting:

The study was conducted in all schools of mentally retarded students in Minia governorate, which were: El-Fikreya school for mentally retarded pupils in Minia city, El-Fikreya school in Matay district and El-Fikreya school in Malawy district.

Sample and sampling: - a convenient sample consisted of 53 mentally retarded girls in the three previous settings who met the inclusion criteria. Total Number was 53.

Inclusion Criteria:

• Female students
• Age ≥ 6years
• Have mild mental retardation (I.Q 50-70)

Exclusion Criteria:

• Autism
• Have speech disorders or other types of disabilities
• Have Attention Deficit Disorder (ADD).

Tools of Data Collection: 

Data was collected through using a mentally retarded students structured interview questionnaire that was designed by the researchers to collect data related to participant's knowledge and personal hygiene practices (self-reported practices) based on relevant literature, the tool contents were tested for validity by five experts in community health nursing and community medicine. It consisted of the following 3 parts:

Part I: Included 8 questions related to socio-demographic characteristics of participants.

Part II: It included 6 questions (1 to 6) related to participant's knowledge about personal hygiene and 18questions (7-25) related to participants personal hygiene practices (self -reported practices) included hand washing, oral care, and showering. Scoring system was:

• Personal hygiene knowledge: its questions were recorded into Yes with 2 grades and No with 0 grade and question No. 5 was recorded into complete correct answer with 2 grades, incomplete answer with score 1 and incorrect answer with 0 grade.   The total grades were ranged from 0 – 18 and classified as the following scoring: Poor score = less than 50% (less than 9 grades), Fair score= 50-70 % (9 -12 grades) and Good score = more than 70% (˃ 12 grades).
• Personal hygiene self  reported practices: its questions were recorded into Yes or correct answer with 2 grades and No or incorrect answer with 0 grade and the total grades were ranged from 0 – 34 and classified as the following: Unsatisfactory = less than 50% (17 or less) and Satisfactory = equal or more than 50% (≥ 17).

Part III: It included 4 questions (33-36) related to participant's knowledge about menstrual hygiene and 7questions (37-43) related to participant's menstrual hygiene practices (self-reported practices). This part is applied only for mentally retarded girls in puberty stage who have been menstruated. Its scoring was:

• Menstrual hygiene knowledge: its questions were recorded into correct answer with score 2, incorrect answer and don’t know with score 0 and the total score was ranged from 0 – 6 and classified as the following: Poor = less than 50% (3 or less), Fair = 50-70 % (3 - 4.1) and Good = more than 70% (˃ 4.1).
• Menstrual hygiene Practices: its questions were recorded into correct answer with score 2, incorrect answer and don’t know with score 0 and the total score was ranged from 0 – 12 and classified as the following: Unsatisfactory = less than 50% (6 or less) and Satisfactory = equal or more than 50% (≥ 6).

Content Validity: The tool was tested for content validity by a jury panel of five experts in the field of community and public health medicine who reviewed the tools for clarity, relevance, comprehensiveness, understanding, applicability and easiness. Based on experts' comments and recommendations; major modifications had been made such as deleting difficult questions. Rephrasing and rearrangements of some sentences was done.

Reliability: Internal consistency of interview questionnaire was assessed with the Cronbach's alpha coefficient after the pilot study done; parts II, III, were 0.60 and 0.062 respectively.

Pilot Study

A pilot study was conducted on 10% of the sample (6) to assess the clarity; reliability and applicability of the study tools; that were included in the study due to the smallest numbers of students.  

Procedure:

• The study lasted for 9 months (one academic year); it started at the beginning of September 2017, and was completed by the end of June 2018.
• The program was implemented to the girls in terms of sessions in their usual classrooms in each school by using a variety of teaching methods such as group discussion, demonstration and re-demonstration for hand washing and teeth brushing technique, role play and teaching videos, songs, colored cards. 
• The total number of sessions was 8 sessions for each group. This session included 2 theoretical sessions involved introduction of personal hygiene and body hygiene (hair, nose, skin and feet hygiene) and 6 practical sessions, two sessions for hand washing, two sessions for teeth brushing technique and two sessions for menstrual hygiene. Number of sessions per day were two sessions, (one hour for each session). 
• All sessions were conducted for each group of participants. Total number of participants were divided into small groups each group included 4-6 students to attend session.
• The researchers attended in the study settings two days per week; Saturday and Monday from 8.00 Am to 1.00 Pm. The researchers started a face to face individual interview; each interview took about 50-60 minutes. Throughout this interview relevant information was recorded in the designed sheet (about 4-5 sheets per day). Data were collected before the implementation of the program for pretest, immediately after and one month after the completion of the program for posttest and follow up.
• The  tool was used to collect data and applied to all participants except part III was applied only for mentally retarded girls in puberty stage who have been menstruated. 

Ethical Consideration

Research proposal was approved from ethical committee in faculty of Nursing. The purpose of the study, right for privacy, confidentiality and rights to withdraw at any time were explained for girls' caregivers (mothers, teachers) in the previously mentioned setting.

Statistical Design

The collected data was computerized, tabulated, analyzed and summarized by using statistical tests as one way ANOVA and Chi-Square to test research hypotheses by using SPSS version 20. The level of significance was accepted at P<0.05 and was considered highly significant when P-value less than or equal 0.01.

Results

Table 1: Distribution of studied students’ according to their socio-demographic data (n = 53).

Table 1: Shows that 56.6% of studied students their age ranged between 12 < 18years, with mean age 12.4 ± 3.2 years, 43.4% of them their IQ ranged between 50- < 55, with mean 56.9 ± 6.4 score, also 56.6% of students were come from rural area and 64.2% of them had unsatisfactory social class.

Concerning to their fathers occupation, 66% of them have an occupation and 39.7% of them had primary or preparatory education but 84.9% of their mothers were house wives and 50.9% of their mothers were illiterate

Table 2: Distribution of studied students’ according to their correct answer of knowledge about personal hygiene (n = 53).

NS= Not statistically significance                           * means there is statistically significant difference

** means there is highly statistical significant differences.

Table 2: presents that 64.2% of studied students answered correctly about the meaning of personal hygiene in pretest, increased to 92.5% in immediately posttest, while in the follow up was 66.0%.

Showering was the most important aspect or component of personal hygiene as ranked by the studied students, 79.2%,92.5% and 86.8% in pretest, immediately posttest and follow up posttest respectively.

The main sources of information about personal hygiene were parents; 50.9% followed by media &T.V; 17.0%, teachers; 15.1%, no source of information were 13.2% in pretest. In immediately posttest 47.2% of them answered parents, followed by Media &T.V 32.1%, teachers 9.4% and 1.9 % were books and no sources. In follow up 45.3% of them answered parents, followed by Media &T.V 24.5% and teachers 13.2%, figure 1

                                  Figure 1: sources of information about personal hygiene

Table 3: Distribution of studied students’ according to their correct answer of personal hygienic self-reported practices (n = 53).

NS= Not statistically significance                    * means there is statistically significant difference

** means there is highly statistical significant differences

Table 3: demonstrates that 39.6% of studied students uses soap to wash their hands in pretest vs 73.6% of them vs 45.3% of them in immediately and follow up after one month of educational program respectively and 9.4% of them wash hands after playing vs 17.0% of them vs 28.3% of them Immediately and follow up after one month of educational program respectively. Also 37.7% of studied students shower daily in pretest vs 69.8% of them vs 69.8 % of them in immediately and follow up after one month of educational program respectively

Table 4: Distribution of studied students’ knowledge regarding menstrual hygiene (n = 28).

** means there is highly statistical significant differences

Table 4: shows distribution of participants' knowledge about menstrual hygiene. There was a lack of knowledge regarding to age of menarche and duration of regular menses among 82.1% and 78.6% of participants in pretest respectively, with significant improvement in this knowledge after educational program compared to pretest, P < 0.01.

Concerning to time of bathing during menses, 17.9% of them answered correctly "Daily" in pretest, increased to 75.0% in immediately posttest and  53.6%  in follow up   with significant improvement in knowledge of studied sample after intervention compared to pretest, P < 0.001

Table 5: Distribution of studied students related to their total knowledge score about personal hygiene (n = 53).

Table 5:  demonstrates that 54.7% of studied students’ had poor knowledge score about personal hygiene in pretest vs 17.0% of them in immediately post educational program vs 34.0% of them after one month of educational program with highly statistically significance improvements where p-value =0.000.

Table 6: Distribution of studied students related to their total self-reported practices score regarding personal and menstrual hygiene (n = 53), (n = 28) respectively

Table 6:  demonstrates that only 15.1% of studied students’ had satisfactory level  of personal hygiene practices in pretest increased to 71.7% of them in immediately post educational program and 54.7% of them after one month of educational program with statistically significance improvements in their self-reported practices. There was highly significant improvement in total self-reported practices score of studied students related to personal hygiene, menstrual hygiene, teeth brushing and hand washing technique after completion of the program compared to pretest total score, P < 0.001.

Table 7:  Relation between studied student’s knowledge about personal hygiene and their demographic data in pretest, immediately and follow up   (n = 53).

NS= Not statistically significance       * means there is statistically significant difference

** means there is highly statistical significant differences.

Table 7 :  shows that there were statistical significant relation between students' total knowledge about personal hygiene and their demographic data related to their age and their mothers education in pretest only where p_value were 0.02 and 0.03 respectively and with I.Q in both pretest and follow up and with social class in immediately posttest only. But there were no statistical significant relation between total knowledge and socio demographic characteristics of the studied sample related to residence and father's education.