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Poor hygiene practice has been an ongoing issue among the Orang Asli community in Malaysia and is strongly linked to poor child growth and malnutrition. A theorybased intervention was developed and implemented to improve the knowledge, attitude, self-efficacy and practice related to hygiene among the primary caregivers of the under-three Orang Asli children. A single blinded clustered randomized control trial was conducted involving random allocation of five government health clinics into intervention and control groups, using random block method. Using the Information-Motivation-Behaviour Skills (IMB) model, an intervention was developed and delivered in the form of health talks, video presentation, group counselling and guided practical sessions. Knowledge (information) and attitude (motivation) on hygiene, self-efficacy (behavioural skills) towards practising good hygiene and hygiene practice were measured at baseline, 1 and 3 months follow-up. A total of 166 participants were recruited for the study. The overall between groups comparison showed significant different between mean scores for self-efficacy (MD = 1.22 [0.36, 2.10]) and hygiene practice (MD = 1.70 [0.47, 2.93]), with moderate effect size of 0.3 and 0.36 respectively. Self-efficacy and hygiene practice had significant different in mean scores at 2 time points (at 1-and 3-month post-intervention) with the highest effect size is observed for practice at 1-month post-intervention (ES = 0.74). Within the intervention group, significant improvement of knowledge (MD = 1.06 [0.49-1.63]), attitude (MD = 1.04 [−0.56, 2.65]) and hygiene practice (MD = 1.78 [0.04, 3.52]) mean scores were observed at 3-month post-intervention as compared to the baseline measurement. IMB-based intervention was found to effectively improved self-efficacy and practice related to hygiene among the primary caregivers of the Orang Asli children.However, the moderate effect size may reflect the needs to revise the intervention in order to increase its impact and transferability.

Background Parental and caregivers' hygiene‐related knowledge, attitude and practice are compelling factors in the prevention of stunting and malnutrition among the aboriginal children in Malaysia, which are highly modifiable. This study was conducted to explore the knowledge, attitude and practice related to hygiene among primary caregivers of the under three aboriginal (known as Orang Asli) children community in Malaysia. Methods A total of 166 primary caregivers of the under three children of the aboriginal community in Kuala Langat district, Selangor were recruited. Data related to caregivers', child's and environmental factors were collected using a validated and reliable questionnaire, with knowledge, attitude and practice being the dependent variables. IBM Statistical Package for Social Science (SPSS) version 25.0 was used to analyse the data. Pearson's correlation was conducted to identify the relationship between continuous data. Multiple linear regression analysis was performed to determine the relationship between knowledge, attitude and practice related to hygiene, as well as the predictors. Results The mean scores for knowledge, attitude and practice related to hygiene were 6.91 (2.12), 23.67 (3.16), 29.97 (3.55) and 43.05 (4.41), respectively. Significant moderate positive correlations were found between attitude and hygiene practice (r = 0.445, P < 0.001). Self‐efficacy was significantly correlated with attitude (r = 0.442, P < 0.001) and practice (r = 0.557, P < 0.001), with every unit increase in self‐efficacy will predict 0.281 and 0.536 increase in attitude (B = 0.281, 95% CI: 0.126–0.435) and practice (B = 0.536, 95% CI: 0.348–0.725) scores respectively. Conclusion Moderate mean scores for hygiene related knowledge, attitude and practice were observed in this study, with self‐efficacy being a significant predictor for both hygiene‐related attitude and practice but not knowledge. The self‐efficacy of the caregivers should be sustained through continuous health education and counselling, to ensure improved hygiene practice. Future related research should consider the mediating role of self‐efficacy on attitude and practice.