Date of Award


Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Nola Schmidt


Toilet training (TT) is a necessary developmental task that all healthy children must ultimately achieve. The Centers for Disease Control and Prevention (CDC, 2001) noticed that E. coli can be spread to playmates by toddlers who are not toilet trained. Studies showed parental participation in the TT process is crucial and parental readiness to pledge to TT is an important step for training. In Thailand, very few studies were conducted about TT a toddler, and all of the studies were descriptive. The purpose of this evidence-based practice project was to determine the effectiveness of a parental education intervention about TT, in a Thai context, based on guidelines recommended by the American Academy of Pediatrics (AAP) as to parental knowledge, self-efficacy, and child achieved in toileting skills. A single group pretest/posttest design to measure outcomes was conducted at the kindergarten school in Chiang Mai, Thailand. Participants (N = 36) were parents of toddlers aged 18 to 48 months. Questionnaires were used to assess participants’ knowledge and self-efficacy relevant to TT. Participants were encouraged to initiate TT their children after a parental education intervention. A child’s toileting skills progression was evaluated every 2 weeks for 12 weeks by using a potty log that was maintained by parents. Thirty-six participants completed pretest/posttest questionnaires that included a 30-question knowledge test in TT healthy children and the self-efficacy assessment tool. Paired-sample t-tests were conducted to analyze and compare the mean pretests to the mean posttests scores. The paired-sample t- tests demonstrated that the parental education intervention significantly increased participants’ knowledge (p < 0.001) and self-efficacy after the intervention (p < 0.001). There were 78.78% (n = 33) of children who achieved toileting skills within 12 weeks of intervention. It can be concluded that improvements were seen after the parental education intervention. The number of children who achieved toileting skills gradually increased as time passed, demonstrating the success of this project. The bestpractice guidelines in TT of healthy toddlers in a Thai context for health care professionals, parents and other caregivers are expected to be carried out

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