Infectious diseases are diseases that causing by organisms, bacterias virus fungi  or parasites. These organisms can spread from person to person either direct or indirect. Once organisms live in our bodies then destroyed the normal processes causing signs and symptoms that depend on the type of organisms. Good hygiene behavior is one of the important means to reducing transmitted diseases. To promote knowledge, attitude, hygiene practices among high school students, especially hand hygiene are significantly prevent the spread of infectious disease not only oneself but also classmates. Objective: To assess knowledge, attitude, and hygienic behavior and to study factors associated with hygienic behavior. Study Methods: A cross sectional survey research that studied a group of high school students. An online survey was developed in a google form and distributed to grade 10-12 students of a private high school in Chiangmai, Thailand, during April-May 2022. Descriptive statistics frequency, percentage, mean and standard deviation, were used to analyze participants characteristics. Persons correlation coefficient was used to study association among variables. Results: A total of 381 students participate in this study. Most participants were female (n=199, 62.6%). Most of them studied in grade 11 (n=187, 58.8%). Majority of participants parents worked in the health science field (n=79,24.8%).  Most participants reported a good level of hygiene-related knowledge (M=9.15, SD=1.70), Attitude toward hygiene(M=49.52, SD=1.57), and hygiene practice (M=49.00, SD=2.72).  Male participants had attitudes toward hygiene and hygiene practice higher than females but had scores of  hygiene knowledge less than females. Grade 10 students showed the highest scores of knowledge about hygiene(M=8.46, SD=2.57), attitudes toward hygiene(M=49.77, SD=1.02), and hygiene practice(M=49.51, SD=1.57). Participants whose parents worked as a teacher earned the highest scores in both hygiene knowledge (M=9.55, SD=0.60) and hygiene practice (M=49.68, SD=1.04). Conclusion: This study showed that almost all volunteers have a high excellence knowledge about hygiene. Good attitude toward hygiene. Excellent hygiene practices . Factors that affect students hygiene are attitude toward hygiene and hygiene practices. To encourage education about hygiene, attitude toward hygiene, and hygiene practices through social media, online, and website. Keyword: hygiene behavior, adolescent, knowledge     Introduction           Infectious diseases are illnesses that are caused by organisms such as bacteria, viruses, fungi, or parasites1. They can spread from one person to another either directly (via skin contact with bodys fluid, bodys secretion, or droplets in the air though coughing and sneezing) or indirectly ( via contaminated food or water), including insects, animals, or the environment (table top, door knob, or faucet handle) to person2. Organisms that cause disease are called pathogens3.When pathogens enter our bodies then destroy the normal process of our bodies and/ or stimulate immune systems, reaction of tissue4. The defense responses depend on the organisms, often including fever, fatigue,inflammation, and other systemic or local symptoms5.          Hygiene is the series of practices performed to preserve health. Hygiene behavior is the process to control transmission of infectious disease to the public, including individual communities. According to the World Health Organization (WHO) “ Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases”.personal hygiene refers to maintaining cleanliness of ones body and clothing to preserve health and well-being6. To promote personal hygiene might be the single cost- effective way to reduce the global burden of infectious diseases like that for COVID-19, Avian influenza, ( aerosol route) Cholera (oral route), etc. Stimulation for personal hygienic practice reduces personal infection, healing process, recovery time, good health,and wellbeing. Good personal hygiene practices are the most effective way to protect contaminated pathogens7. Hand hygiene,hand washing with soap, water, or hand sanitizer especially before eating, feeding, after toilet are the cessation of fecal- oral route transmitted diseases, example diarrhea, food poisoning8. Hand washing after coughing and sneezing reduces pathogens in aerosol droplets before catching surroundings things to quit the air - borne respiratory infection,for example cold , flu, moreover regularly hand washing when contact outside body is important for health hygiene practices. So hand hygiene is the major key in preventing the spreading of infectious disease in daily life. Body hygiene,showering or bathing regularly usually twice a day , but during an outbreak of infectious disease showering and changing clean clothes after going outside to reduce pathogens that contaminated clothes are necessary9.         High school students, teenagers, or teens 15-19 years old. Inadequate knowledge, lack of attitude toward hygiene, without routine hygiene practices leading to transmitted disease not only oneself but also classmates. Motivation for good personal hygiene practices are important to prevention of transmitted disease10. Teens might  learn how to care for their body health and avoid high risk behaviors in contact with pathogens. Many high schools have high personnel density and close contact so easily causing outbreak of transmitted diseases especially respiratory disease and gastrointestinal diseases .Social distancing, reducing gatherings places, strict hand sanitizer, cover mask, well cooked food, and healthy food. These are important factors to get healthy and prevent transmitted disease11. The clever new technology, the change of teens health behavior . Furthermore some teens live in a dormitory far from family combined with imitative behavior getting from social media surrounding persons. the urgent health problem in teens are sexual transmitted diseases including unwanted pregnancy12. Unhealthy, or contaminated food  that brought from street  causing diarrhea.   Objective of the study To assess knowledge, attitude, and hygienic behavior To study factors associated with hygienic behavior     Methods Participants and procedure This was a cross-sectional observational study. An online questionnaire was purposely developed and made available through Google From between 13 April 2022 and 14 May 2022. All students who were eligible were invited to participate in the study. The invitation was sent  to social media groups of all classes. The students have access to their classes social media groups, so they all receive an invitation. In this invitation, information about the objectives of the study as well as the ethical guarantee of confidentiality and anonymity in the data collected as stated in the informed consent were explained. Participation was completely free and voluntary, and no personal data were collected from any participant. Of the 318 students, a total of 1,342 students participated in the study (response rate: 24%).   Instrument The questionnaire was developed based on a literature review including Hygiene knowledge ,infection prevention and control knowledge which reviewed from Ministry of Public Health related studies on hygiene practice   among high school students. A preliminary version of the instrument was reviewed by students to  validate its content. A pretest was then performed with a small sample of students to test for comprehension and difficulty. All the questions remained without modifications. The psychometric characteristics of the questionnaire were tested, as described in the statistical analysis subsection. The final version of the questionnaire contained 33 questions 3 about sociodemographic date ( gender, education level and parents occupation) and 30 items divided into 3 sections                 First Independent Variable is knowledge about hygiene. This scale consisted of 10 statements related to hygiene. The participants were asked to choose the correct answer from multiple choices of 3. One point was assigned to each correct answer, while providing an incorrect answer received zero points. The sum of all items was made hence higher scores corresponded to a higher level of knowledge.                 Second Independent variable is attitude toward hygiene. This scale was composed of  items, and response categories consisted of a five-point likert scale (from 1-strongly disagree, to 5 agree) with the highest score corresponding to more positive attitudes toward preventive behaviors.Some items on the scale were inverted for the analysis. A sum of all the items was made to obtain a score. The “Attitude toward hygiene” factor consisted of 10 items and varied from 1 to 5 and the higher values corresponded to a more positive attitude toward hygiene.                 Dependent variable is hygiene behavior. This scale referred to the number of preventive behaviors adoption and included 10 items. The data analysis reports 5 items. Each item was answered using a five-point scale (From 1-Never to 5-Always), with one point assigned to each behavior that was always practiced. The number of behaviors practiced was added up. A high score on this scale indicated good preventive behaviors, ranging from 12 to 60.   Statistical analysis The analysis was performed using SPSS for windows, version 26. To analyze psychometric characteristics of the scales, an exploratory factor analysis, using principal component analysis with varimax rotation, was carried out. Reliability was analyzed through the calculation of item-total correlation coefficients and Cronbachs alpha (α ) for the scales of the questionnaire. The descriptive analysis were presented in absolute (n) and relative (%) frequencies, mean (M) and standard deviations (SD). To assess the differences between the outcome variables (Knowledge, attitudes and hygiene practice) and the sociodemographic characteristics, considering the sample size, independent t-test and the ANOVA were used as appropriate. The correlations between the outcomes of the study were calculated by Pearsons correlation. Lastly, a generalized linear model was calculated to determine the predictive variables of the preventive behaviors. Exp (β) and the respective 95% confidence intervals (95% IC) were presented. Statistical significance was defined as p < 0.05.   Ethical Approval. Ethical approval was obtained from the study sites prior to data collection, and consent was assumed as completing the survey questions. Participants were informed that their participation was voluntary and that they could withdraw from the study at any point or choose not to answer any question. Participants confidentiality was maintained as no identifying information was collected and findings will be disseminated only in aggregate.   Ethical Considerations This research uses an anonymous data collection method to collect data from grade 10-12 Students of private school in Chiang Mai, Thailand, by using Google form. The invitation was sent to the classroom social media group In these invitations, information about the studys objectives and the ethical guarantee of confidentiality and anonymity in the data collected as stated in the informed consent was explained. Participation was completely free and voluntary, and no personal data were collected from any participant.   Result This study comprised a total of 318 students. The sociodemographic characteristics of the sample are presented in Table 1. Most students were female (n=199, 62.6%), 187 (58.8%) of the students studied in grade 11. 70 (22%) of the students studied in grade12. The rest studied in grade10 and above (n=61, 19.2%). Most students parents occupation were Medical / Nurse / Pharmacy / Dentist / Veterinary / Medical Technician (n=79, 24.8%) followed by Business / Trading of parents occupations group (n=74, 23.3%) and Executives / Company employees / Civil servants / State enterprises parents occupations group (n=71, 22.3% ) respectively.   Regarding knowledge about hygiene, students revealed good knowledge about hygiene, correctly answering mean of 9.15 (SD=1.70) questions in a total of 10. Female students showed higher knowledge scores (M=9.40, SD=1.03) than male students (M=8.74, SD=2.04). Education level group of grade11 showed the highest hygiene related knowledge score of 9.41 (SD=1.29). Students whose parents occupation was teacher showed the highest hygiene related knowledge score of 9.55 (SD=0.60).   Students showed a good level of attitude toward hygiene with an average score of 49.52 from 50 full scores. Male students showed a higher attitude toward hygiene score (M=49.77, SD=0.98) than female students (M=49.37, SD=1.82). Education level group of grade10 showed the highest attitude toward hygiene score of 49.77(SD=1.02). Students who parents occupation were Medical / Nurse / Pharmacy / Dentist / Veterinary / Medical Technician showed the highest attitude toward hygiene score of 49.76 (SD=1.17)   Students showed a good level of hygiene practice with the average score of 49.00 from 50 full scores. Male students showed higher hygiene practice scores (M=49.71, SD=1.40) than female students (M=48.58, SD=1.39). Education level group of grade10 showed the highest hygiene practice score of 49.51(SD=1.57). Students whose parents occupation was teacher showed the highest hygiene practice score of 49.68 (SD=1.04).   Table 1. Differences in outcomes according to the sociodemographic characteristics of participants (N = 318)     Sociodemographic characteristics     N (%) Knowledge about hygiene (Range 0-10) M (SD) Attitude toward hygiene (Range 10-50) M (SD) Hygiene practice (Range 12-60) M (SD) Gender            Male 119 (37.4) 8.74 (2.40) 49.77 (0.98) 49.71 (1.40)    Female 199 (62.6) 9.40 (1.03) 49.37 (1.82) 48.58 (3.19) Education Level            Grade 10 61 (19.2) 8.46 (2.57) 49.77 (1.02) 49.51 (1.57)    Grade 11 187 (58.8) 9.41 (1.29) 49.62 (1.62) 49.25 (2.65)    Grade 12 70 (22) 9.07 (1.58) 49.04 (1.73) 47.90 (3.35) Parents Occupation            Medical / Nurse / Pharmacy / Dentist / Veterinary / Medical Technician 79 (24.8) 8.32 (2.75) 49.76 (1.17) 49.34 (2.27)    Teacher 22 (6.9) 9.55 (0.60) 49.73 (0.88) 49.68 (1.04)    Business / Trading 74 (23.3) 9.46 (0.89) 49.49 (2.03) 49.23 (2.47)    Executives / Company employees / Civil servants / State enterprises 71 (22.3) 9.30 (1.43) 49.59 (1.04) 48.82 (2.67)    Freelance 37 (11.6) 9.46 (0.90) 48.65 (2.47) 47.70 (4.50)    others 35 (11) 9.54 (0.74) 49.71 (0.86) 49.06 (2.14) Total 318 (100) 9.15 (1.70) 49.52 (1.57) 49.00 (2.72)   The analysis of the correlations between the outcomes of the study - knowledge, attitudes and hygiene practice- revealed the existence of positive and statistically significant correlations between  attitude toward hygiene practice (r=.663, p<0.01).   Table 2. Pearsons correlation coefficient between the study outcomes Variables Knowledge about hygiene   Attitude toward hygiene   Hygiene practice   Knowledge about hygiene 1     Attitude toward hygiene   .017 1   Hygiene practice   .018 .663** 1 **Correlation is Significant at the 0.01 *Correlation is Significant at the 0.05   Discussion This study focused on assessing hygiene knowledge, attitude toward hygiene, and hygiene practice among high school students. A total of 381 students participate in this study. Most participants were female (n=199, 62.6%). Most of them studied in grade 11 (n=187, 58.8%). Majority of participants parents worked in the health science field (n=79,24.8%).  Most participants reported a good level of hygiene-related knowledge (M=9.15, SD=1.70), Attitude toward hygiene(M=49.52, SD=1.57), and hygiene practice (M=49.00, SD=2.72).  Male participants had attitudes toward hygiene and hygiene practice higher than females but had scores of  hygiene knowledge less than females. Grade 10 students showed the highest scores of knowledge about hygiene(M=8.46, SD=2.57), attitudes toward hygiene(M=49.77, SD=1.02), and hygiene practice(M=49.51, SD=1.57). Participants whose parents worked as a teacher earned the highest scores in both hygiene knowledge (M=9.55, SD=0.60) and hygiene practice (M=49.68, SD=1.04). Female participants showed a higher level of hygiene knowledge than male participants while male participants had a higher score of attitude toward hygiene and hygiene practice than females. This may be because male participants have started following both hygiene and beauty trends. This may be because male participants have started following both hygiene and beauty trends. This may be because over the last decade, male participants have started following both hygiene and beauty trends13.This study was consistent with the study of SAUDI nursing students showed that male participants had higher score of hygiene practices than female participants, but lest attitude toward hygiene14.Grade 10 students reported the highest score of hygiene knowledge, hygiene attitude and hygiene practice among participants from other classes. This may be because of  grade 10 students, the younger participants had more docile than  grade 11 and grade 12, . It was not consistent with the study among Koreas general populations showed that the older age groups showed better than the younger age groups.15. Our results contrasted to Mohammed ALBashtawys study that the higher class level students had the higher hygiene scores16. Participants whose parents worked as a teacher reported the highest score of hygiene knowledge, hygiene attitude and hygiene practice amongst participants whose parents were from other occupation fields. There was a positive and statistically significant correlation between Hygiene Attitude and Hygiene practice. Therefore improving hygiene practice among high school students could be done by strengthening attitudes toward hygiene through various means of effective communication that are suitable for this group17.These study results were different from Stephen T Odonkor and et al.s study that participants whose parents worked in the science field showed the highest level of hygiene knowledge among others parents occupations18.   Limitation This studys questions are about general knowledge not specific to high school students. Even  when answering the online questionnaire some students may search from the internet. Moreover the data collected during COVID-19 pandemic, all participants working from home, study online may not be aware of the risk of infection.   Conclusions This study showed that almost all volunteers have a high excellence knowledge about hygiene. Good attitude toward hygiene. Excellent hygiene practices . Factors that affect students hygiene are attitude toward hygiene and hygiene practices. To encourage education about hygiene, attitude toward hygiene, and hygiene practices through social media, online, and website.

Knowledge

adolescents

hygiene