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Purpose <p>To synthesize evidence on school toilet use and avoidance, and to examine associated barriers, facilitators, and health outcomes.</p> Methods <p>We conducted a systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines (Moher et al. PLoS Med 6:e1000097, <CitationRef CitationID="CR30">2009</CitationRef>), searching six academic databases and multiple gray literature sources in English and French through June 2025. Eligible studies focused on behavioral, infrastructural, psychological, or social aspects of school toilet use. Data were analyzed qualitatively using thematic synthesis.</p> Results <p>We included 38 studies, representing diverse methodologies and countries. Common barriers to school toilet use included poor cleanliness, lack of privacy, restrictive access policies, and unsafe environments. Adolescents reported heightened concerns about peer surveillance, stigma, and menstruation-related challenges, leading to greater avoidance among older students. Avoidance behaviors were linked to urinary and gastrointestinal disorders, dehydration, psychological distress, and academic difficulties. Girls and LGBTQ+ youth were disproportionately affected by avoidance-related health consequences.</p> Conclusion <p>Adolescence is a critical period during which toilet-related behaviors and vulnerabilities intensify. Addressing barriers to school toilet use requires developmentally appropriate, equity-focused interventions that consider both physical infrastructure and social dynamics. Future research should explore longitudinal outcomes and participatory strategies to improve access and student well-being.</p>

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School toilet use and avoidance: a systematic review of barriers, facilitators, and impact on child and adolescent health

  • 期刊论文

  • 发表日期：

    2026年2月16日

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  • Angela Li,
  • Julie Anne Hillion,
  • Emmanuelle Godeau

摘要

Purpose

To synthesize evidence on school toilet use and avoidance, and to examine associated barriers, facilitators, and health outcomes.

Methods

We conducted a systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines (Moher et al. PLoS Med 6:e1000097, 2009), searching six academic databases and multiple gray literature sources in English and French through June 2025. Eligible studies focused on behavioral, infrastructural, psychological, or social aspects of school toilet use. Data were analyzed qualitatively using thematic synthesis.

Results

We included 38 studies, representing diverse methodologies and countries. Common barriers to school toilet use included poor cleanliness, lack of privacy, restrictive access policies, and unsafe environments. Adolescents reported heightened concerns about peer surveillance, stigma, and menstruation-related challenges, leading to greater avoidance among older students. Avoidance behaviors were linked to urinary and gastrointestinal disorders, dehydration, psychological distress, and academic difficulties. Girls and LGBTQ+ youth were disproportionately affected by avoidance-related health consequences.

Conclusion

Adolescence is a critical period during which toilet-related behaviors and vulnerabilities intensify. Addressing barriers to school toilet use requires developmentally appropriate, equity-focused interventions that consider both physical infrastructure and social dynamics. Future research should explore longitudinal outcomes and participatory strategies to improve access and student well-being.