Contents lists available at ScienceDirect Evaluation and Program Planning journal homepage: www.elsevier.com/locate/evalprogplan School-based, blacklight handwashing program can improve handwashing quality and knowledge among pre-school aged children Deirdre Dingman a , Jingwei Wu b , Heather M. Murphy b, * a Department of Social Behavioral Science, College of Public Health, 1301 Cecil B. Moore, 9th Floor, Ritter Annex, Temple University, Philadelphia, PA, 19122, USA b Department of Epidemiology and Biostatistics, College of Public Health, 1301 Cecil B. Moore, 9th Floor, Ritter Annex, Temple University, Philadelphia, PA, 19122, USA ARTICLE INFO Keywords: Handwashing Pre-school Children Soap Blacklight Evaluation Knowledge Quality ABSTRACT In the United States, lack of proper handwashing is associated with respiratory and gastrointestinal illnesses. Interventions to improve handwashing practices have led to an increase in handwashing knowledge and be- havior, and decreases in gastrointestinal illnesses. Most studies have evaluated their interventions in the context of reported handwashing rates by observation, reduction of illnesses, as well as reduced absences, however none of these studies examined handwashing quality or knowledge as outcome measures. The objective of this paper is to present the results from a handwashing program with a special focus on the evaluation methods. A pre-post design was used to evaluate a handwashing program that took place in two pre-schools the northeast of the United States. The program utilized a black light technology to demonstrate to children the importance of good quality. The evaluation consisted of assessing knowledge and quality of handwashing using a linear puzzle and individual handwashing observation, respectively. Students from both schools improved on both knowledge and quality over time (p-values 0.071 and < 0.001, respectively). The present study demonstrates that the use of black light technology as an educational tool may help to improve handwashing quality among pre-school aged children, even after only one instructional session. 1. Introduction In the United States, lack of proper handwashing is associated with respiratory and gastrointestinal illnesses (Centers for Disease Control & Prevention, 2017). This is of special concern for preschool children (ages 3–4) who routinely touch their mouths and eyes with their hands. Without guidance on proper handwashing, children are more likely to become sick (Aiello, Coulborn, Perez, & Larson, 2008) and have ex- cessive school absences, which can put them at an educational dis- advantage. Interventions to improve handwashing practices have led to an increase in handwashing knowledge and behavior (Witta & Spencer, 2004) and decreases in gastrointestinal illnesses (Lau et al., 2012; (Curtis and Cairncross, 2003)). Several handwashing studies have been conducted to look at the effectiveness of hand hygiene programs in elementary schools to reduce absenteeism among students using a variety of behavioral (visual cues and prompting of handwashing by teachers) (Gore & Lambert, 2001; Master, Hess-Longe, & Dickson, 1997; Snow, White, & Kim, 2008), instructional (tutorials on handwashing) (Morton & Schultz, 2004; Snow et al., 2008; Thompson, 2004) and environmental (posters, provision of soap/hand sanitizer) interventions (Dyer, Shinder, & Shinder, 2000; Early et al., 1998; Gore & Lambert, 2001; Hammond, Ali, Fendler, Dolan, & Donovan, 2000; Thompson, 2004). These studies evaluated their interventions in the context of reported handwashing rates by observation, reduction of illnesses, and reduced absences, however none of these studies examined hand- washing quality or handwashing knowledge as outcome measures in their evaluations. Work in developing country contexts has demon- strated that handwashing quality is an important aspect to consider in order to reduce the microbial contamination on hands (Amin et al., 2014; Fuls et al., 2008). In September of 2017, the authors were approached by Essity, a global health company that sustainably develops, produces, markets and sells personal care and tissue products. Essity had created a handwashing program for pre-school aged students (3–4 years old) and asked the authors to conduct an independent evaluation of that pro- gram. Prior to the development of their program, Essity surveyed nurses in the School District and found that a plurality of nurses (35%) be- lieved that pre-school students did not know the basics of handwashing. The school nurses and the School District supported the current pro- posed Essity-designed handwashing program as a means to reduce https://doi.org/10.1016/j.evalprogplan.2019.101731 Received 15 February 2019; Received in revised form 23 September 2019; Accepted 10 October 2019 ⁎ Corresponding author at: Department of Epidemiology and Biostatistics, College of Public Health, 1301 Cecil B. Moore, 9th Floor, Ritter Annex, Temple University, Philadelphia, PA, 19122, USA. E-mail addresses: deirdre.dingman@temple.edu (D. Dingman), jingwei.wu@temple.edu (J. Wu), heather.murphy@temple.edu (H.M. Murphy). Evaluation and Program Planning 78 (2020) 101731 Available online 31 October 2019 0149-7189/ © 2019 Elsevier Ltd. All rights reserved. T