Appropriate handwashing can prevent 50–70% of water and foodborne infections. However, schoolchildren who are in the formative stage of life, particularly in low-income countries like Nepal, are deprived of such a lifesaving skill. This study investigates the effectiveness of a school-based participatory action research intervention to promote handwashing with soap among basic level community school students in Nepal. Teachers, the school management committee, the participatory action research committee, and child-club members actively participated in designing and implementing the intervention. This study employed a semi-structured interview with the headteacher, five focus group discussions, and spot observations during 50 handwashing with soap events involving students, to collect the data. This study assesses the handwashing situation of students before and after the intervention. As part of the intervention, participatory teaching methods such as singing, drawing, showing a video, games, and demonstrations were used. Findings from basic level students who actively participated in hygiene sessions and increased their handwashing with soap before meals and after toilet use were used as a comparison to baseline. Participants reported that the intervention was perceived positively, pragmatic, and cost-effective. This intervention study concluded that handwashing behaviors improved because of the influence of sensitization sessions and demonstrations about handwashing. However, some predominant issues in the teaching of handwashing practices include limited hygiene contents in the curriculum and the practical use of teaching and learning activities. The lack of availability of soap at handwashing stations is the main barrier in sustaining handwashing behaviors in schoolchildren.


  • This is the first study in Nepal on HWWS issue in a school setting from the PAR approach. It has paved the way for a new paradigm of research in the future.

  • The findings from this study show that participants themselves have taken ownership, which can be a strong basis for sustainable behavior change.

  • This study provided some important solutions to make HWWS in school sustainable and motivation for practical teaching.

This content is only available as a PDF.