Factors associated with handwashing behaviour among rural schoolchildren: a cross-sectional study in Georgia, 2024

Handwashing is a critical measure for reducing diarrhoeal and respiratory infections among school-aged children, yet maintaining consistent practice remains a challenge. Behavioural factors, including daily routines, environmental cues, and perceptions of hygiene spaces, shape handwashing behaviour beyond the availability of water and soap. This study examined the behavioural determinants of handwashing among rural schoolchildren in Georgia using the Capability, Opportunity, Motivation-Behaviour (COM-B) model.

A cross-sectional survey was conducted in 2024 among 368 students from 10 rural public schools in the Adjara region. A structured interviewer-administered questionnaire assessed sociodemographic characteristics, knowledge, environmental conditions, motivational factors, and self-reported handwashing practices. Adequate handwashing was defined as washing hands both before eating and after toilet use. Variables associated with adequate behaviour in bivariate analyses (p < 0.20) were considered for inclusion in a multivariable logistic regression model.

Overall, 85.9% of students reported adequate handwashing behaviour. Although knowledge of correct handwashing steps was high (91.3%), substantial behavioural gaps were observed. In the adjusted model, three factors independently predicted adequate handwashing: not relying solely on washing when hands were visibly dirty-indicating a stable hygiene routine (AOR = 30.3, 95% CI [13.0-71.4]); perceiving the school toilet environment as comfortable or safe (AOR = 6.6, 95% CI [1.8-23.8]); and washing hands at least five times per day (AOR = 2.22, 95% CI [1.04-4.74]). Water, adequate Sanitation, and proper Hygiene (WASH) education showed a borderline association (AOR = 2.15, p = 0.060). Knowledge-related indicators and availability of water or soap were not significant predictors in the multivariable analysis.

Handwashing behaviour among rural schoolchildren in Georgia is driven less by knowledge or basic facility availability and more by routine formation, perceived comfort of hygiene spaces, and motivational factors. Strengthening handwashing habits, improving the qualitative aspects of school toilets, and incorporating behaviourally informed approaches into hygiene education may enhance the sustainability of WASH outcomes. Applying the COM-B model provides guidance for designing interventions that support consistent, protective hygiene practices in school settings.