From Knowledge to Practice: A Mixed-Methods Examination of Deworming Perceptions and Implementation Barriers in Cebu City School Communities

Abstract

Soil-transmitted helminth control requires not only awareness but also sustained preventive behaviors and effective implementation of school-based deworming. This study examined knowledge, attitudes, and practices (KAP) related to soil-transmitted helminths and deworming and explored contextual factors influencing program implementation in selected school communities in Cebu City. A mixed-methods approach combined structured KAP surveys among 386 school-aged children, 317 parents or legal guardians, and 40 teachers with focus group discussions among parents and teachers and key informant interviews with school, health, and government stakeholders. Quantitative findings were descriptively assessed and integrated with qualitative findings derived through descriptive content analysis. Poor knowledge was observed among 42.5% of school-aged children, whereas 72.6% of parents and 57.5% of teachers demonstrated excellent knowledge. Despite relatively high adult knowledge, attitudes were predominantly neutral among children and parents, while preventive practices were generally moderate among both groups and good among teachers. Qualitative findings highlighted misconceptions and concerns surrounding deworming, inconsistent reinforcement of hygiene practices at home, communication challenges, resource limitations, water and sanitation constraints, and coordination issues. The findings suggest a gap between knowledge and its translation into attitudes and preventive practices. Strengthening school-based deworming may therefore require sustained health education, clearer risk communication, stronger school–household engagement, and improved intersectoral coordination.