The Effect of Therapeutic Clowning on Handwashing Technique and Microbial Colonization in Preschool Children

Purpose: This study aimed to determine the effect of therapeutic clowning on handwashing technique and microbial colonization in preschool children. Design: This randomized controlled trial was conducted using pre-test and post-test experimental and control groups. Methods: The study was conducted between March and June 2016 in two kindergartens in eastern Turkey. The study was completed with a total of 195 students, including 90 students in the experimental group and 105 students in the control group. A questionnaire was used for data collection. This questionnaire included sections about the subjects’ descriptive characteristics and the results of the bacterial cultures of their hand swabs. For the collection of these swabs, the subjects were informed in advance, and samples were collected at predetermined times. The swabs were analyzed to determine the bacterial colonization of the subjects’ hands. Clowns and video activities were used as intervention tools in the study. Findings: In the post-test, the microbial growth was ≤103 in 68.9% and >103 in 31.1% of the subjects in the experimental group. In contrast, the growth was ≤103 in 34.3% and >103 in 65.7% of the control group subjects. The difference in the post-test microbial growths of the two groups was statistically significant (p <.000). Conclusions: The hygienic handwashing technique taught in the therapeutic clowning and videos reduced the bacterial colonization on the preschool children's hands by 50%. Moreover, this method was effective in reducing the growth rate of coliform bacteria that indicate undesirable, poor hygiene of the hands. Clinical Relevance: Considering these results, we recommend that pediatric healthcare professionals use entertaining methods such as those involving clowns to teach and guide children regarding hygienic handwashing techniques.