Analysis of factors affecting students going to school toilets in a rural primary school in China

BACKGROUND: Several factors may affect students going to school toilets, but a few studies have analyzed the reasons for students using toilets. This study aimed to use a structural equation model to understand the factors that impacted children’s toilet behavior. METHODS: This study was performed in 12 rural nonboarding primary schools (6 schools in the northern and 6 schools in the southern regions of China). All students of the third and sixth grades (761 students) were examined. A questionnaire on students’ toilet behavior was used. The questionnaire included 33 perceptual items based on 5 factors: toilet facilities, cleanliness, hygiene practices, peer relationship, and experience. The questionnaire also covered the frequency of voiding and defecating by themselves. The exploratory factor analysis, confirmatory factor analysis, and pathway analysis were used to analyze the causes of students’ toilet behavior. RESULTS: A statistically significant correlation coefficient of 0.300 indicated that cleanliness impacted the toilet frequency of students. The visual experience of the overall cleanliness of the toilet had the most significant impact on students’ toilet behavior (path coefficient, 0.81). Washing facilities and convenient handwashing had the least impact on toilet use (path coefficient, 0.52). CONCLUSION: Cleanliness was the primary consideration for students’ toilet use on campus. The visual experience of the overall cleanliness of toilets had the most significant impact when students used toilets. No pre-survey was conducted to test the reliability and validity of the questionnaire. Using self-reported data might be associated with potential recall errors. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-020-10099-4.