– Manpreet Kaur, Indarjit Walia, Sushma Kumari Saini

Abstract: Hair is considered as a sign of personal, social and cultural significance. The present study was undertaken with the objectives to make an assessment of maintenance of hair hygiene among women, operationalization and evaluation of nursing interventions for maintenance of hair hygiene. Data was collected by interviewing and observation of hair hygiene of women. Two types of nursing interventions were performed either supportive educative or compensatory, and the planned subsequent visits were undertaken. Hair hygiene status showed that nearly half (49.3%) of the subjects had unhygienic hair, with majority having uncombed hair. Interventions offered were either supportive educative or compensatory (partially or wholly), depending on the self-care ability and therapeutic self-care demand of the subjects. A declining trend in the number of subjects who remained with unhygienic hair on subsequent visits i.e.69 remained with unhygienic hair on second visit, which decreased on subsequent visits 16,4, and 3 on third, fourth and fifth visit.

Key Words :

Hair, hair hygiene, self care ability, supportive educative, compensatory

Correspondence at : Manpreet Kaur

National Institute of Nursing Education, PGIMER, Chandigarh, India.


“Whoever has hair, should care about it”, very rightly quoted by Prophet Mohammed centuries ago (related by Abu Dawood)1, still holds true. Hair being the sign of personal, social and spiritual significance2, the importance of day-to-day hair care is very well documented and recommended by religious institutions3. Ayurveda recognizes the condition of hair as the reflection of the complete constitution of an individual and recommends for day-to-day care given to hair and scalp to maintain its health and to increase its beauty.4 This routine includes brushing, combing, cutting, shampooing, massaging and application of hair dressing/lotion. L’Oreal has reported that in Europe, the average frequency for washing hair is three times a week. One quarter of the population shampoo their hair every day. 80% of North Americans and 90% of Japanese wash their hair twice a week.5

A study in 1987 explored the hair washing practices among females and children at a resettlement slum Colony, U.T., Chandigarh. Findings revealed that 15.1 % were washing their hair daily, 35.1 and 49.8% were washing their hair once and twice respectively.6 Combing, washing and application of hair oil contribute toward maintaining hair hygiene and hence awareness of self-care. To understand the clinical appearance of hair and scalp disorders and to design an effective treatment plan, a clear knowledge of these basic hair-care practices is very necessary.7 These hair-grooming practices have also been shown contributing toward a positive self- image.8 Central and state governments are putting lot of emphasis, to control sicknesses leading to mortality. But sicknesses, which give constant morbid health to people, are yet to draw attention of health services and Pediculosis is one of them.6 Although infestation is neither life threatening nor associated with significant complications, it does cause considerable distress, embarrassment, misunderstanding and expenses.9,10 In most of the cases it reflects only a poor hygiene and itching in the scalp and leading to dermatitis but rarely can cause diseases like epidemic typhus, relapsing fever and trench fever.11

In first world countries, the pediculosis infestation rate is believed to be much the same with 1-2% of the population affected. In second and third world countries, the percentage of the population affected may be much higher with some published reports suggesting over 40% of children affected.9 Various studies have suggested a varied prevalence of head lice infestation.

Being health personnel, we quite often talk and emphasize upon personal hygiene, but somehow maintenance of hair hygiene takes a back seat. Literature is also devoid of studies reflecting practices of maintenance of hair hygiene. Community health nurses are in a unique position to make an assessment of hair hygiene, particularly of women in community settings and perform some nursing interventions to strengthen the ability of women to maintain their hair hygiene. Therefore, an operational study was conducted in the month of January and February 2005 in a resettlement Colony, U.T., Chandigarh on maintenance of hair hygiene among women.


  • To assess the maintenance of hair hygiene among women at a resettlement colony, T., Chandigarh.
  • To operationalize the nursing interventions for maintenance of hair
  • To evaluate the effectiveness of nursing intervention for maintenance of hair

Materials and Methods

The present study was undertaken in Dadu Majra Colony, U.T., Chandigarh. Dadu majra colony is situated on Northwest corner of Chandigarh and is at a distance of 5 km from National Institute of Nursing Education (NINE) P.G.I., Chandigarh and 6 km from the interstate bus terminus of Chandigarh.

Dadu majra colony is well equipped with all modern sanitary facilities like an underground drainage system, tap water supply, and electricity and other amenities like market, anganwadi, middle schools, senior- secondary school and adult education centres. Dadu majra colony has a government allopathic dispensary and many private practitioners. Through systematic random sampling, 369 women were selected and studied for maintenance of hair hygiene. A check list was prepared with 15 items on codition of hair, scalp and comb. Proportionate scoring was done with 12 score to each hair hygiene aspect i.e. combing, washing hair, application of hair oil and free from head lice, hence making maximum score of 48. The tools were validated and pilot study was undertaken to test the feasibility of the study. Data was collected by interviewing and observation of hair hygiene of women.

Study was based on Orem’s self care deficit theory12. Being an operational study, once the hair hygiene deficits were identified, nursing interventions were performed as suggested by Orem’s self care model i.e. compensatory and supportive educative, depending upon the subjects self care ability and self care demand and the planned subsequent visits were undertaken i.e. five alternate day visits for combing, three visits at an interval of one week, for washing hair, application of hair oil and for control of head lice, till the subjects started maintaining their hair hygiene by themselves. Descriptive statistics was used while analyzing the findings.


Regarding socio-demographic profile of subjects, the age of the subjects ranged from 17 to 80 years, with a mean age of 34.84 years. Approximately 41% of the subjects were from the age group of 21 to 30 years, 31% were illiterate and 72.3% were housewives. Majority of the subjects (90.2%) belonged to Hindu religion and nearly half stayed in joint families. Half of the subjects had per capita income in the range of Rs. 501 to 1000.

Nearly half of the subjects had unhygienic hair i.e. either uncombed, unwashed, unoiled or were infested with head lice (obtained score less than 48). (Fig 1).Many subjects had more than one hair hygiene deficit. Majority 175 (96.2%) of the subjects had uncombed hair, while 12.6 and 12.1 subjects had unwashed and unoiled hair respectively. Six subjects (3.1%) harboured head lice.

Hair hygiene status of the subjects

About 50% subjects had maximum score of 48, hence considered hygienic. Subjects who obtained a score less than 48 were considered unhygienic. None of the subjects obtained a score less than 20. A score of twenty was obtained by 7(1.8%) of the subjects. Approximately 40% of the subjects scored 36 on hair hygiene assessment. Mean score was 41.4 with Standard Deviation of 7.14 as shown in (Table 1).

Table 1 : Initial scores obtained by subjects on Hair Hygiene Assessment

Scores f (%)  
20 7 (1.8)  
24 9 (2.5)  
28 3 (0.8) Mean=41.4
30 2 (0.5) SD±7.34
32 8 (2.2)  
36 146 (39.6)  
40 3 (0.8)  
44 4 (1.1)  
48 187 (50.7)  



Nursing interventions were performed on subsequent visits to help the subjects in maintenance of hair hygiene as depicted in Table 2. Interventions offered were either suppor tive educative or compensatory (partially or wholly), depending on the self- care ability and therapeutic self-care demand of the subjects. Only two subjects required direct assistance with combing on first visit, while others were supported and educated to perform combing, washing of hair and application of hair oil. For control of head lice, five subjects were assisted in a compensatory manner, while only one subject required a supportive educative role.

On first visit, about 80% subjects obtained scores of 36, followed by 4.9% subjects who obtained a score of 24. On second visit, 132 (62.2%) subjects were able to score hygienic score i.e. 48. On third and fourth consecutive visits, about three fourth of the subjects were able to score the hygienic score of 48, none of the subject obtained score less than 36. Even on a follow up on

Table 2 : Nursing Interventions performed by investigator on maintenance of hair hygiene for subjects


Visits hair hair   hair oil   head lice
Compensatory Supportive Compensatory Supportive Compensatory Supportive Compensatory Supportive
  educative educative   educative   educative
  f f f                f f                f   f f
First 2 173 –                     23 –                       22 5   1
Second 65 –                       8 –                       12 5   1
Third 16 –                       – –                        –   1
Fourth 4 –                       – –                        –  
Fifth 3 –                       – –                        –  


Combing                      Washing                     Application of                       Control of

the fifth visit, out of four subjects, three were not able to obtain a score above 36. The trend of scores is presented in Table 3.

On subsequent visits, number of subjects with unhygienic hair decreased (Fig 3). More than half (60.4%) had combed their hair on second visit. Similarly, 8.2 % had washed their hair and 5.5 % applied hair oil on second visit. A similar declining trend was noted on further visits. Five subjects were observed to be free from head lice on third visit, while one was still infested with head

lice. Also, a similar declining trend in the number of subjects who remained with unhygienic hair on subsequent visits was observed.


Literature is scarce of studies, depicting how people maintain their hair hygiene. Hair hygiene has been studied in relation to its effect on self-image, but how frequently, people maintain their hair hygiene i.e. combing, washing hair and applying hair oil


Table 2 : Progression of scores on hair hygiene assessment on subsequent visits

Score                                                                Visits



First                     Second                       Third                           Fourth                 Fifth n=182                             n=182                      n=69                     n=16                 n=4 f   (%)                             f   (%)                      f   (%)                   f  (%)               f (%)


20 7 (3.9) 2 (2.2) –                           –                       –
24 9 (4.9) 8 (4.4) –                           –                       –
28 3 (1.6) 1 (0.5) –                           –                       –
30 2 (1.1)   –                           –                       –
32 8 ( 4.4) 3 (1.6) –                           –                       –
36 146 (80.3) 51 (28.1) 16 (23.2)                         4(25.0)              3(75.0)
40 3 (1.6)   –                           –                       –
44 4 (2.2) 4 (2.2) 1 (1.5)                  –                       –
48   113 (62.2) 52 (75.3)                       12(75.0)                    1(25.0)


is yet an area to be explored and studied upon systematically.

Findings are not comparable due to scarcity of data on maintenance of hair hygiene. The present study revealed prevalence of head lice among subjects is 1.6% subjects. Gupta and Walia, in 1987, reported a prevalence of 18.6% among women6 of the same area under present study, but the time gap between the present and previous study may be another consideration. The other available worldwide data presents broadly








Se cond v isit      Third v ist       Fourth v isit       Fifth v isit

varied prevalence of pediculosis from as low as 0.48 % among urban school children at Poland13 to as high as 81.5 among school children in Argentina14. Similarly Indian studies also depict prevalence of Pediculosis ranging between 2.4% (among children in South India)15 to 22.6 % (among children in Garhwal, U.P.)16.As majority of subjects were able to maintain hair hygiene at the end of the study period. The suppor tive educative and compensatory roles performed by nursing agency strengthened the ability of subjects in maintenance of hair hygiene (Table:3). Based on findings of the study, it is fur ther recommended that, a similar study can be conducted on a larger sample to make generalizations and even a qualitative research design may prove more helpful in exploration of maintenance of hair hygiene.


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