Table 1 Children's explanations of illness transmission, and reasons for practicing hand washing and respiratory hygiene

Transmission of flu and colds

Germs

'When you have a sneeze your germs will go to other people and other people will have sneezes as well' (Year 1)

'If I touch my baby sister she will have the germs' (Year 1)

'If they sneeze or cough and the germs get to you' (Year 6)

Person to person

Someone in my family had it, then I got it too' (Year 2)

'It goes from one person to another' (Year 2)

'If someone is coughing or sneezing around them then they will catch it' (Year 6)

Proximity/contact

'When you touch people who have flu or other diseases' (Year 6)

'Because they stand next to each other' (Year 1)

When other people have got it and you go near them then you get it. (Year 6)

'If you go close to someone with flu' (Year 6)

Cold

'It's cold and you didn't wear a coat, then you make cold' (Year 1)

'They don't wear a coat when they go outside, mostly in Winter'' (Year 6)

Dirt/contamination on hands

'If they don't wash their hands after they go to the bathroom' (Year 6)

'Eating without washing our hands' (Year 6)

'If you touch something dirty and then touch your face' (Year 6)

Other

'Some immune systems can't deal with it' (Year 6)

'...when you are not active' (Year 6)

Occasions for washing hands

Eating

'to eat our food' (Year 1)

'having dinner or tea' (Year 1)

Before eating (Year 6)

'Before I eat I have to wash my hands' (Year 6)

'Before eating' (Year 6)

Toilet

'After toilet' (Year 6)

'After toilet' (Year 1 picture)

Visible or sensory dirt

'...if you've played in the garden and touched soil' (Year 6)

Contact with contaminated object

'If they do something dirty in the garden' (Year 1)

'...after eating with hands' (Year 6)

Sneezing

'After touching a bin' (Year 6 picture)

'After sneezing on hands' (Year 6 picture)

Reasons for hand washing

Avoid germs

'Because you might get germs off the toilet' (Year 1)

'I went to the museum and they said germs go on your hands every 5 seconds.' (Year 6)

'Hygiene, you always have germs on your hands so when you eat without washing your hands all those germs go into your body.' (Year 6)

So you don't get germs on your mouth, face and hands (Year 1)

'Because if you don't you will get germs and you will start to be ill' (Year 1)

To get rid of germs (Year 6)

Avoid illness

'So I don't get ill' (Year 2)

Remove visible dirt

'Cleanliness, so there's no bits on your hands and you're not muddy or dirty or anything.' (Year 6)

'Because when you do dirty stuff like handstands you might get your hands dirty.' (Year 1)

Reasons for not washing hands

Don't want to/like dirt

'Because they don't want to, don't feel like it' (Year 1)

'They like their hands to be dirty' (Year 1)

No need

'They're not really bothered and they don't really care.' (Year 6)

Competing priorities

Because they don't eat'

'Because their favourite programme is coming and they don't want to miss it' (Year 1)

Ignorance

'...playing a game and not want to miss anything' (Year 6)

'They don't know the reasons why they should' (Year 6)

Poverty/moral judgement

'Because they are poor and they stink' (Year 1)

Respiratory hygiene practices

Turn away

'Face the other way so no one is there' (Year 1)

'Turn my head away from everyone' (Year 6)

Use Tissue

'Use a tissue' (year 6)

Cover with hands

'Cover my nose...get a tissue and put it' in the bin (Year 1)

'You need lots of tissues for sneezing so you can stop the sneeze go anywhere' (Year 1)

Cover and wash hands

'Put your hands up in front' (Year 1)

'You put your hand in front of your mouth' (Year 1)

'Use a tissue or your hand and wash your hand afterwards' (Year 6)

'Sneeze in hands and wash hands' (Year 6)

'Cover my mouth and wash hands after' (Year 6)

'If you cover your mouth with your hands when you sneeze it would be even better if you wash hands afterwards' (Year 6)

Reasons for respiratory hygiene

Protect others

'So they don't get germs on their face' (Year 1)

'When you sneeze the germs fo out of your nose and onto other people' (Year 1)

'Sneeze on your little sister and she won't go to nursery school'

'It protects other people from catching your germs' (Year 6)

Stop germs

'Use a tissue so germs go on the tissue and don't spread' (Year 6).

'When you sneeze the germs travel along to another person but a tissue blocks the germs' (Year 6)

'Germs get caught in the tissue and don't spread everywhere' (Year 6)

'The tissue traps germs...and they can't get out' (Year 6)