The present study was designed as a mixed-method study aiming to gain valuable insights into the knowledge, attitudes, and practices related to Water, Sanitation, and Hygiene (WASH) among adolescent students in schools within the municipal corporation area of the designated study city. The research spanned from July 2019 to December 2020, providing a comprehensive overview of the prevailing conditions during this period. The study specifically targeted secondary, co-educational schools, with participation contingent upon meeting predefined inclusion criteria.
Schools that fell within the municipal corporation area, catered to secondary education, operated on a co-educational basis, and willingly provided consent were considered eligible for inclusion in the study. These criteria were established to ensure a representative sample that aligns with the study's focus on adolescent students and their WASH-related knowledge, attitudes, and practices. Conversely, exclusion criteria were applied to schools located outside the municipal corporation area, exclusively catering to boys or girls, limited to primary and pre-primary education levels, and those unwilling to grant consent for participation.
By employing a mixed-method study design and carefully selecting schools based on the specified inclusion and exclusion criteria, the research aimed to provide a nuanced understanding of WASH-related dynamics among adolescent students in the designated urban context. The chosen duration allowed for a comprehensive examination of these aspects, contributing to a robust analysis of the prevalent conditions within the selected schools during the defined timeframe.
Selection of study sample
In the study area, there were a total of 120 secondary schools. Out of which 39 were government or government and the rest were private or trust-funded schools (Non-government).
As per our exclusion and inclusion criteria out of 39, 17 government schools were eligible to be considered in our study. Out of all private schools (81) located in the study area, 43 schools were eligible as per our inclusion and exclusion criteria. Out of these we randomly selected 17 schools for comparison purposes.
Therefore, all government schools in the study area which were eligible were included in our study which came to be 17 in number. Then we took 17 schools randomly selected from eligible non-government schools for comparison. Hence, a total of 34 schools (17 government and 17 non-government) were included in this study. (figure-1)
A sample of 566 students was recruited from government and non-government schools using stratified random sampling to obtain equal numbers of males and females aged ≤ 16 years (284 males, 282 females, 142 aged ≤ 10 years, 351 aged 11–15 years, 73 aged ≥ 16 years). Stratified random sampling ensures representativeness across key demographic factors [8]. The sample size was calculated using standard methods for cross-sectional surveys, assuming a 95% confidence level and 5% margin of error [9].
Study period and tools used for data collection
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KAP assessment was conducted by a structured questionnaire with a sample of 20 students from each school randomly selected from classes 9th and 10th .
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A pre-validated standard tool was used in the form of a questionnaire prepared by the WHO and UNICEF Joint monitoring program for water supply, sanitation, and hygiene monitoring in schools.
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The questionnaire includes questions on the knowledge, attitude, and behavior of students regarding WASH, water supply, and sanitation.
This study was done for a period of 18 months from July 2019 to December 2020. A pre-validated standard tool was used in the form of a questionnaire prepared by the WHO and UNICEF Joint monitoring program for WASH monitoring in schools.
Quantitative data was collected via a pre-tested, interviewer-administered structured questionnaire adapted from UNICEF (JMP, 2014) [4] and other standardized tools [10, 11]. The questionnaire captured data on participants’ demographic details, as well as knowledge, attitudes, and practices regarding WASH using closed-ended questions.
Qualitative data was collected via focus group discussions with 6–8 participants stratified by gender and school type using a pre-tested discussion guide. The guide contained open-ended questions to explore factors influencing WASH practices. All tools were translated to local languages and back-translated to ensure accuracy.
Ethical Clearance
The study was approved by the institutional ethics committee (ECR/6/INST/GUJ/2013) with ref.no.IEC/Certi/111/04/2019. In addition, informed consent from the sampled schools was sought. The study was initiated after obtaining permission from the district education officer.
Data Collection Procedures
Data collection was done by trained research staff after obtaining informed consent/assent. Quantitative data was gathered via face-to-face interviews at schools. Qualitative data was gathered via audio-recorded focus group discussions held in classrooms after school hours. Data quality was ensured through careful training of data collectors, questionnaire pre-testing, and pilot studies.
Analysis Plan Quantitative data was analyzed using Stata v16.0. Descriptive analyses were conducted to characterize the study population. Group comparisons were analyzed using chi-squared tests. Multivariate logistic regression was used to identify demographic factors associated with WASH knowledge, attitudes, and practices. Qualitative data was analyzed thematically using MAXQDA v20 software to derive common themes related to WASH practices. An integrated analysis of all data was conducted to derive converging or diverging results.