Volume 18, Issue 3 (8-2026)
jorar 2026, 18(3): 181-187 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Soleimaninejad A, Jafarzadeh D, SariKhani N. Assessment of Knowledge, Attitude, and Practice (KAP) Regarding Personal Hygiene Among Iranian Arbaeen Pilgrims. , jorar. 2026; 18 (3) :181-187
URL: http://jorar.ir/article-1-1002-en.html
URL: http://jorar.ir/article-1-1002-en.html
Research Center for Health Management in Mass Gathering, IRCS, Tehran, Iran
Abstract: (24 Views)
INTRODUCTION: The Arbaeen pilgrimage is one of the largest annual mass gatherings worldwide, and its high crowd density, prolonged walking, and strained sanitation infrastructure increase the risk of communicable diseases. Personal hygiene is a low-cost preventive measure, yet data on pilgrims’ hygiene-related knowledge, attitudes, and practices (KAP) and on perceived barriers are limited. This study assessed KAP regarding personal hygiene among Iranian Arbaeen pilgrims and described the physical, environmental, and service-related barriers they reported.
METHODS: This descriptive cross-sectional survey included 357 Iranian pilgrims who participated in the 2022 Arbaeen pilgrimage. Participants were recruited through IRCS pilgrim lists using convenience sampling (240 face-to-face and 117 telephone interviews). Data were collected using a researcher-developed 76-item questionnaire, including 15 items assessing knowledge (3), attitude (4), and practice (8) on a 5-point Likert scale. Content validity was assessed by 12 experts (mean CVR= 0.921), and internal consistency was acceptable (Cronbach’s α = 0.86). Scores were compared with the predefined desirable level of 4 using one-sample t-tests. Pearson’s correlation and independent-samples t-tests examined associations and subgroup differences. Data were analyzed using SPSS version 24.
FINDINGS: The main health challenges reported by pilgrims were excessive fatigue (45.1%), foot injuries (28.6%), heat exhaustion (22.4%), and foot blisters (21.3%). Overcrowding (97.8%) and extreme heat (96.4%) were the most frequently reported environmental factors. Inadequate access to suitable water (59.9%), disinfectants (64.4%), and hygienic public toilets (only 13.5% rated them hygienic) were also reported. Although attitudes toward personal hygiene were favorable (mean=4.1), knowledge (3.3) and practices (3.2) were below the desirable level. Attitude was moderately correlated with practice (r=0.44, p<0.001), whereas knowledge was not. Only 21.8% had attended pre-travel hygiene training.
CONCLUSION: Iranian pilgrims reported favorable hygiene attitudes but knowledge and practice below the study-defined desirable level, together with widespread perceived environmental and sanitation-related constraints. Because the design was cross-sectional, self-reported, and based on a convenience sample, these constraints should be regarded as potential contributors, not established causes, of the attitude–practice gap. Strengthening sanitation, water, and disinfection provision, together with context-specific pre-travel training, should be prioritized and evaluated in future studies.
METHODS: This descriptive cross-sectional survey included 357 Iranian pilgrims who participated in the 2022 Arbaeen pilgrimage. Participants were recruited through IRCS pilgrim lists using convenience sampling (240 face-to-face and 117 telephone interviews). Data were collected using a researcher-developed 76-item questionnaire, including 15 items assessing knowledge (3), attitude (4), and practice (8) on a 5-point Likert scale. Content validity was assessed by 12 experts (mean CVR= 0.921), and internal consistency was acceptable (Cronbach’s α = 0.86). Scores were compared with the predefined desirable level of 4 using one-sample t-tests. Pearson’s correlation and independent-samples t-tests examined associations and subgroup differences. Data were analyzed using SPSS version 24.
FINDINGS: The main health challenges reported by pilgrims were excessive fatigue (45.1%), foot injuries (28.6%), heat exhaustion (22.4%), and foot blisters (21.3%). Overcrowding (97.8%) and extreme heat (96.4%) were the most frequently reported environmental factors. Inadequate access to suitable water (59.9%), disinfectants (64.4%), and hygienic public toilets (only 13.5% rated them hygienic) were also reported. Although attitudes toward personal hygiene were favorable (mean=4.1), knowledge (3.3) and practices (3.2) were below the desirable level. Attitude was moderately correlated with practice (r=0.44, p<0.001), whereas knowledge was not. Only 21.8% had attended pre-travel hygiene training.
CONCLUSION: Iranian pilgrims reported favorable hygiene attitudes but knowledge and practice below the study-defined desirable level, together with widespread perceived environmental and sanitation-related constraints. Because the design was cross-sectional, self-reported, and based on a convenience sample, these constraints should be regarded as potential contributors, not established causes, of the attitude–practice gap. Strengthening sanitation, water, and disinfection provision, together with context-specific pre-travel training, should be prioritized and evaluated in future studies.
Article Type: Research article |
Subject:
Other matters related to crisis, disasters and rescue & relief
References
1. Hajian M, Mohaghegh S. [Factors influencing the health of participants in religious mass gathering ceremonies in Iraq: a systematic review (Persian)]. Trauma Mon. 2023;28(1):694-714. [DOI:10.30491/tm.2023.345410.1477]
2. Al-Ansari F, Al Ansari M, Hill-Cawthorne GA, et al. Arbaeen public health concerns: a pilot cross-sectional survey. Travel Med Infect Dis. 2020;35:101546. [DOI:10.1016/j.tmaid.2019.101546]
3. Memish ZA, Steffen R, White P, et al. Mass gatherings medicine: public health issues arising from mass gathering religious and sporting events. Lancet. 2019;393(10185):2073-84.
4. Abubakar I, Gautret P, Brunette GW, et al. Global perspectives for prevention of infectious diseases associated with mass gatherings. Lancet Infect Dis. 2012;12(1):66-74.
5. Al-Ansari F, Mirzaei M, Al-Ansari B, et al. Health risks, preventive behaviors and respiratory illnesses at the 2019 Arbaeen: implications for COVID-19 and other pandemics. Int J Environ Res Public Health. 2021;18(6):3287. [DOI:10.3390/ijerph18063287]
6. Moulaei K, Bastaminejad S, Haghdoost A. Health challenges and facilitators of Arbaeen pilgrimage: a scoping review. BMC Public Health. 2024;24:132. [DOI:10.1186/s12889-024-17640-9]
7. Ranjbaran S. Health challenges in the Arbaeen walking: health educators and medical services. Military Caring Sciences. 2023;10(2):106-9. [DOI:10.22034/10.2.106]
8. Alfelali M, Barasheed O, Alshehri J, et al. Foot injuries among Hajj pilgrims with and without diabetes mellitus: implications for infection management. Infect Disord Drug Targets. 2014;14(2):140-7. [DOI:10.2174/1871526514666140713160413]
9. World Health Organization. Ambient (outdoor) air pollution [Internet]. [cited 2024 Oct 24]. Available from: https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health
10. European Environment Agency. How air pollution affects our health [Internet]. 2024 Dec 3 [cited 2025 Jun 10]. Available from: https://www.eea.europa.eu/en/topics/in-depth/air-pollution/eow-it-affects-our-health
11. Ahmed OB, Attalah OA, Assaggaf H. Evaluation of food trucks' hygiene during mass gathering events. Cureus. 2021;13(11):e19470. [DOI:10.7759/cureus.19470]
12. Ng IKS. Adopting the Information Knowledge Attitude Practice (IKAP) model for transforming health behaviors in medical practice. Oman Med J. 2024;39(3):e624. [DOI:10.5001/omj.2024.120]
13. Smith JD, Hagger MS, Hamilton K. Forty years of the Theory of Planned Behavior: a bibliometric analysis (1985-2024). Manag Rev Q. 2025;75(1):1-25. [DOI:10.1007/s11301-025-00487-8]
14. Michaelsen M, Esch T. Functional mechanisms of health behavior change techniques: a conceptual review. Front Psychol. 2022;13:725644. [DOI:10.3389/fpsyg.2022.725644]
15. Green LW, Kreuter MW. Health program planning: an educational and ecological approach. 4th ed. New York: McGraw-Hill; 2005.
16. Israel GD. Determining sample size: Cochran's formula explained. Univ Florida IFAS Ext Bull. 2020;PEOD-6. [DOI:10.32473/edis-pd006-2020]
17. Nikolopoulou K. What is convenience sampling? Definition & examples. Scribbr [Internet]. [cited 2022 Jun 22]. Available from: https://www.scribbr.com/methodology/convenience-sampling/
18. Sarikhani N, Soleimaninejad A. Evaluating the effectiveness of public education courses by the Red Crescent Society on the attitude, knowledge, and performance of armed forces conscripts. J Rescue Relief. 2025;17(1):44-50. [DOI:10.61186/jorar.17.1.44]
19. Singh D, Arya S, Kumar L, Biju B, Singh AK. Assessing the impact of health education on health behavior change: a review. J Chem Health Risks. 2024;13(6):2380-7. [DOI:10.22034/jchr.2024.2380]
20. Backer HD, Hill V. Water disinfection for travelers. In: CDC Yellow Book: Health Information for International Travel [Internet]. [cited 2025 Apr 23]. Available from: https://www.cdc.gov/yellow-book/hcp/preparing-international-travelers/water-disinfection-for-travelers.html
21. Centers for Disease Control and Prevention. About water treatment options when hiking, camping, or traveling [Internet]. [cited 2025 Jan 30]. Available from: https://www.cdc.gov/drinking-water/prevention/water-treatment-hiking-camping-traveling.html
22. World Health Organization. WHO guidelines on hand hygiene in health care. Geneva: WHO; 2009.
23. Ahmadi H, Moghaddam NB. Understanding the pilgrims' lived experience of the effective health factors in the Arbaeen walk: an anthropological narrative. J Res Relig Health. 2024;10(2):10-21. [DOI:10.22037/jrrh.v10i3.41577]
Send email to the article author
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
