Version 1: The longitudinal effect of disseminating handwashing public health education to children in India via co-created, culturally relevant resources.

Infectious diseases are a leading cause of death for children from Low-and Middle-Income-Countries (LMICs), often due to inadequate hand-hygiene. This study evaluates culturally-relevant educational resources as a vehicle to disseminate the importance of handwashing amongst children in India. Employing a Participatory Action Research (PAR) model and mixed methods, this follow-up longitudinal study evaluates a set of innovate educational handwashing resources and workshops specifically co-created for use in the State of Gujarat, and how they aid teachers in the teaching of hand-hygiene over a three-year period. Working alongside local NGOs on-the-ground, teacher questionnaires to assess the impact of trainer workshops (n=58) and focus groups including a brief questionnaire with teachers (n=35) in 2019 were conducted. In addition, pre- and post-workshop worksheets were conducted with children in India (n=98). Percentage change was calculated between children’s pre and post worksheet scores and a cumulative frequency of responses to each questionnaire criterion was measured. Data from the focus group found that the resources had been used in over 200 schools by more than 5000 children. In addition, 92.28% of teachers said they would use the resources within their classrooms in India, with 58.16% of pupils having an increased understanding of germs/handwashing directly after the workshop. Teachers reported that they are able to teach microbiology and handwashing more effectively. Furthermore, following a focus group, 100% of teachers noted a reduction in childhood vomiting and diarrhoeal illnesses linked with insufficient hand-hygiene across 46 schools in the State of Gujarat since using the Germ’s Journey resources.