Involving Children Under 5 years in a Hand Hygiene Intervention Study at Preschools in South Africa

Involving children in research may include opportunities for their participation in assisting in the development of appropriate data collection tools, providing ideas for interventions and even collecting data themselves. Using a reflexive approach to research by not having preconceived ideas, and recognising that children's participation can play an important role in improving the quality of the research. This paper aims to show how applying reflexivity and noting children's actions during research improved the ethical and methodological quality of a study, providing a roadmap for future researchers to follow.

An action-based approach, using the actions and reactions of the study participants, was applied during a hand hygiene intervention conducted at preschools in South Africa (N = 17). Data was collected from 19 caregivers, 191 parents and 160 children aged 4 to 5 years using various data collection tools. During the pilot and main study, the researcher made use of field notes to apply a measure of reflexivity and adaptability during the data collection and intervention stages.

Ethical considerations and methods were improved through the actions of the child participants. Children reacted with discomfort and trepidation to the swabbing of hands and use of unfamiliar research assistants to collect data, resulting in a change in the data collection methods. Actions of children during the observation phase resulted in additional data being collected to determine any significance between activities and HH moments. Handwashing was changed to include physical hand movement guidance, as 18.5% of children were unable to complete handwashing steps without assistance.

Researchers should apply reflexivity and adaptability when involving children, ethically prioritising children's needs and interpreting children's voices, with the child's best interest and comfort being paramount. Research protocols should be continuously adapted and revised based on participants' reactions during the study to improve the quality of research processes.