Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 9  |  Issue : 1  |  Page : 66-71  

Impact evaluation of two methods of dental health education among children of a primary school in rural India


1 Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India
2 Department of Surgery, Armed Forces Medical College, Pune, Maharashtra, India

Date of Web Publication22-Dec-2015

Correspondence Address:
Neha Singh
Department of Community Medicine, Armed Forces Medical College, Pune - 411 040, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.167988

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  Abstract 

Background: Impact of two methods of dental health education (DHE) on knowledge and practices of primary school children in a rural area regarding oral care was planned to be studied. Materials and Methods: Study population comprised of 199 primary school children aged 10-13 years in rural field practice area of a medical college. After collecting baseline data, students were allocated into two groups by block randomization using variable blocks. DHE with educational pamphlets and demonstrations was given to both groups. In addition, the intervention group was also shown videos showing correct oral health practices. Data were proposed to be collected at 3 and 6 months from baseline for impact evaluation. The results at 3 months postintervention are being presented. Results: The results after 3 months of intervention found significant difference in the impact on: (a) Practices regarding method of cleaning teeth (P < 0.001), (b) knowledge on best method of cleaning teeth (P < 0.001), (c) reason for regular brushing of teeth (P < 0.001), and (d) requirement to clean teeth after eating something sweet (P < 0.001) in favor of group receiving additional intervention. Conclusion: There is a significant difference in the impact of health education using integrated modes of pamphlets distribution, demonstrations, and A-V aids (group A) as compared to demonstrations and pamphlets distribution only (group B).

Keywords: Dental health, health education, primary school, rural India


How to cite this article:
Singh N, Ramakrishnan TS, Khera A, Singh G. Impact evaluation of two methods of dental health education among children of a primary school in rural India . Med J DY Patil Univ 2016;9:66-71

How to cite this URL:
Singh N, Ramakrishnan TS, Khera A, Singh G. Impact evaluation of two methods of dental health education among children of a primary school in rural India . Med J DY Patil Univ [serial online] 2016 [cited 2020 Aug 10];9:66-71. Available from: http://www.mjdrdypu.org/text.asp?2016/9/1/66/167988


  Introduction Top


Oral health is recognized as an important unmet health need of a population. [1] Poor oral health negatively affects growth, development, learning, nutrition, communication, and self-esteem for all sections of a society with children being the most vulnerable. [2],[3],[4],[5] Children having poor oral health are 12 times more likely to have compromised quality of life, including missing school, than those who do not. Globally each year, more than 50 million h are lost from school due to oral diseases. [6]

Much thought has gone in framing the National Health Policy of India, but the National Oral Health Program still requires improvement in terms of implementation for achieving adequate effectiveness. India experiences disparities in oral health, with lower income groups and rural areas having higher disease rates due to limited awareness and access to care. [7] The results of the school health examination carried out for the primary schools located at rural field practice area in the year 2011, 2012, and 2013 revealed dental morbidity of 32%, 29%, and 33%, respectively (unpublished data). Most of the morbidity is preventable by public education and motivation. Schools are considered to provide a most favorable environment to impart education for bringing out a positive behavior change among children. A dental health education (DHE) planned in school settings is found to be most effective. [8]

There is a paucity of published literature in terms of comparing the impact and effectiveness of various methods of school-based DHE programs in India and this still remains a neglected area in terms of health promotion in public health. Majority of the published literature from India involves DHE performed using demonstrations and charts, very few have utilized A-V aids for oral health promotion and even fewer studies have compared the effectiveness of various methods of DHE. [9],[10],[11] More so, no such study has been published from Maharashtra, which forms the second most populous state in India.

The present study was planned to compare the impact of two methods of DHE on the knowledge and practices of children of a primary school in a rural area regarding oral care with the aim to help policymakers in formulating an effective oral health promotion policy for the state/country.


  Materials and Methods Top


Ethics and informed consent

Informed consent and assent were taken from the parents and study participants, respectively for the conduct of the study. Approval was also taken from the Institutional Ethics Committee before commencing the study.

Period of study

The study was conducted over a period of 6 months from October 2014 to March 2015. Results of the intervention were to be assessed at the end of 3 and 6 months. In this paper, we are presenting the results after a follow-up of 3 months postintervention.

Study population

The study population comprised of primary school children aged 10-13 years in the rural field practice area of a medical college.

Inclusion criteria

Primary school children aged 10-13 years in the rural field practice area of a medical college in Maharashtra consenting to participate in the study.

Exclusion criteria

  1. Absentees from school on the day of intervention.
  2. Students who did not own a toothbrush as their practices regarding oral care were compromised.
Sample size calculation

All the participants from the sampling frame, fulfilling the inclusion/exclusion criteria of the study were included. Hence, the sample size was not calculated. Out of 224 participants from sampling frame, consent/assent for being a part of the study was obtained from 217 participants. After the inclusion and exclusion criteria, a total of 199 students participated in the study [Figure 1].
Figure 1: CONSORT diagram showing the flow of participants through each stage of the randomized trial

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Research instrument

Baseline data were collected for sociodemographic variables, self-reported presence of dental morbidity for participants and educational status of parents for all participants. Data collection for the study was done by administering a nine element interviewer administered validated questionnaire [Appendix 1]. It included questions for assessment of the knowledge and practices of school children regarding oral care. The co-researchers were trained in administration of the questionnaire for 2 days before the conduct of the study.



Randomization

Students were divided into blocks of 2, 4, 6, 8 participants and were allocated to the two groups A and B using block randomization. Block randomization was applied to have similar number of participants in both the groups.

Mode of intervention

DHE was imparted using pamphlets with cartoons showing key messages of the study and demonstration of brushing teeth for both the groups that is, group A and group B. Time allotted for the demonstration was 20 min for each group. In addition, the participants of group A also received DHE in the form of a video which consisted of animated characters imparting the key messages of the study. The video was also explained in the local language for better understanding.

Key messages of the intervention

DHE was based on the following key messages:

  1. Twice daily brushing of teeth, that is after breakfast in the morning and before going to bed at night.
  2. Use of toothbrush and toothpaste for brushing of teeth.
  3. Use of pea size toothpaste on toothbrush for brushing of teeth each time.
  4. Cleaning teeth using a circular motion to toothbrush involving gums
  5. Rinsing of mouth with water after eating anything sweet.
Postintervention data collection

Post-DHE for both the groups data was collected after 3 months of intervention using the same 9-point questionnaire administered by trained co-researcher. The interviewers were blinded for the group distribution of the participant and the time allotted for each interview was 15 min to avoid any interviewer bias. No measures were taken to prevent the interaction between the participants of group A and group B as watching a video is a personal experience and its impact cannot be transferred among participants by interaction.

The same procedure of collecting post-DHE data will be repeated after a period of 6 months.

Data analysis

The data were compiled, coded, and tabulated. Data were analyzed as intention to treat analysis. Chi-square test with P value was calculated using IBM SPSS Statistics ver 22.0.


  Results Top


The results after 3 months of intervention are presented here.

Sociodemographic variables at baseline

There was no significant difference between the groups with regards to their gender distribution, educational level of the parents and self-reported presence of dental morbidity. The mean age of participants of in group A was 11.51 years (standard deviation [SD]: 1.09), while that of group B was 11.33 years (SD: 1.05) [Table 1].
Table 1: Demographic characteristics of participants aged 10-13 years of two primary schools

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Comparison of level of knowledge and practices of participants before intervention

At the baseline, there was no significant difference in the level of knowledge and practices among the participants of the two groups.

Comparison of level of knowledge of participants at 3 months postintervention

At 3 months postintervention, the response obtained from the participants of group A for the questions related to knowledge of the best method of cleaning teeth was found to be significantly different from the participants of group B with a P < 0.002. The difference in response among the groups regarding reason for regular brushing of teeth was found to be <0.000 and most of the participants from group A knew that regular brushing of teeth would decrease dental morbidity.

The response of question regarding a requirement for cleaning teeth after consumption of sweets was given in affirmative by a significantly more number of participants from group A than group B, even though there was an increase in knowledge and practices in both the groups from baseline [Table 2].
Table 2: Percentage responses by the respondents aged between 10 and 13 years for key questions regarding knowledge at baseline and postintervention

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Comparison of level of practices of participants at 3 months postintervention: Among the practices of participants for oral care, significantly high number of participants from group A gave a response of cleaning their teeth using toothbrush and toothpaste as compared to those of group B. The practice of cleaning of teeth using circular motions of toothbrush involving gums was reported from a significantly more number of participants from group A as compared to group B [Table 3].
Table 3: Percentage responses by the respondents aged between 10 and 13 years for key questions regarding practices at baseline and postintervention

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  Discussion Top


We found a significant difference between the impact of the two methods of DHE in favor of the integrated approach involving additional use of A-V aids, as compared to the use of demonstration and pamphlets.

Positive change was observed in the knowledge of participants for brushing of teeth with toothbrush and toothpaste as the best method for cleaning teeth. Impact of DHE was significantly more marked in the group that received AV aids. Similar results were obtained by Friel et al. during their study in Ireland where they found significant difference in the impact of DHE for brushing of teeth using toothbrush and toothpaste in favor of the group receiving integrated method of intervention. [12]

Knowledge that regular brushing of teeth is helpful in avoiding dental morbidity was perceived significantly better by the group receiving an integrated approach for DHE including A-V aids. The reason may be because the video shown to them revealed a reduction in the number of micro-organisms after brushing. Similar results were found by researchers in Tanzania where the two groups received intervention by modified and classical form of health education. [13]

Although it was shown in the video that a pea size of toothpaste should be used for brushing and the same was emphasized during the demonstrations, no significant difference was found in the impact of DHE. It can be hypothesized that the image on the cover of the toothpaste showing all the bristles of the brush covered with toothpaste possibly misled participants, contrary to our provided information. In contrast to our results, Friel et al. found a significant difference in knowledge and practices for use of pea size toothpaste for brushing in favor of the intervention group. [12]

The knowledge to clean teeth after eating anything sweet was found to be significantly higher among the participants of the group receiving DHE by all three methods but the difference was not significant in practices for the same. The participants were required to mention the reason if they omitted mouth rinsing after eating sweets. The main points brought out were nonavailability of adequate rinsing facility at school area and not remembering to rinse.

We found a significant difference between the groups for the practice of cleaning teeth using toothbrush and toothpaste. Similar results were obtained by researchers in studies where DHE was imparted to three groups by videos, demonstrations, and the third group acting as control, respectively. [14],[15]

We did not find any significant difference in the impact of DHE for knowledge or practices for twice daily brushing of teeth. Few researchers in their study have found the participants from intervention group practicing brushing of teeth twice daily significantly more than the control group. [16],[17] It could be hypothesized that repeated DHE if imparted to the participants or the involvement of the teachers and mothers in the study protocol could have brought the desired behavior change and enhance the effectiveness of a school oral health program. [16],[18]


  Limitations of the Study Top


The study protocol was limited to primary school children. However, the involvement of parents and teachers of the participants in health promotion activity could have affected the results as was seen in some studies.


  Conclusion Top


We conclude that there is a significant difference in the impact of integrated method of DHE using integrated modes of pamphlets distribution, demonstrations, and A-V aids as compared to demonstrations and pamphlets distribution only. We recommend the planners to utilize integrated approach reinforced over regular intervals to impart DHE for positive behavior change as compared to a solitary approach. We also plan to present the results of postintervention follow-up at 6 months to evaluate the difference in the impact of two methods of DHE on long-term memory of participants.

Acknowledgments

Dr. Methe Kailas Govindrao, Resident, Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India 411040. Dr. Kuntal Bandyopadhyay, Resident, Department of Community Medicine, Armed Forces Medical College, Pune, Maharashtra, India 411040.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Shenoy RP, Sequeira PS. Effectiveness of a school dental education program in improving oral health knowledge and oral hygiene practices and status of 12- to 13-year-old school children. Indian J Dent Res 2010;21:253-9.  Back to cited text no. 16
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