|Year : 2020 | Volume
| Issue : 1 | Page : 83-91
Impact of oral health education on oral health knowledge, attitude, and practices among 13–15 years' school-going children from Kanpur city, India: A quasi-experimental study
Devina Pradhan1, Nidhi Pruthi1, Lokesh Sharma2, Jyothi Chavan1, Pratik Verma3
1 Department of Public Health Dentistry, Rama Dental College Hospital and Research Center, Kanpur, Uttar Pradesh, India
2 Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
3 Department of Orthodontics and Dentofacial Orthopaedics, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
|Date of Submission||08-Jan-2019|
|Date of Decision||31-Jan-2020|
|Date of Acceptance||02-Jan-2020|
|Date of Web Publication||2-Mar-2020|
Dr. Devina Pradhan
3/99, Vishnupuri, Kanpur, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Oral health is fundamental to general health and well-being. Schools may serve as the best platform for the promotion of oral health. Thus, it is essential to promote oral health in schoolchildren as they are the future of our nation. Aim: The aim of this study was to assess the impact of oral health education (OHE) on the knowledge, attitude, and practice of 13–15-year-old schoolchildren. Materials and Methods: A quasi-experimental study was conducted on a total of 876 schoolchildren aged 13–15 years of age. They were assessed for their oral health knowledge, attitude, and practice at the start of the study using a specially designed questionnaire. OHE was imparted to the children at baseline, 2 months, 4 months, and 6 months. All the children were later reassessed for their oral health knowledge, attitude, and practice using the same specially designed questionnaire after 6 months. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 21. Chi-square test was used for comparing the categorical data. Results: The schoolchildren in the study group showed higher levels of knowledge, attitude, and oral hygiene practices after OHE at the end of 6 months. Before and after the intervention, the scores were found to be statistically significant (P < 0.001). Conclusion: The OHE imparted proved to be effective in improving the oral health knowledge, attitude, and practices of schoolchildren.
Keywords: Adolescents, dental health education, oral health, oral hygiene
|How to cite this article:|
Pradhan D, Pruthi N, Sharma L, Chavan J, Verma P. Impact of oral health education on oral health knowledge, attitude, and practices among 13–15 years' school-going children from Kanpur city, India: A quasi-experimental study. J Indian Assoc Public Health Dent 2020;18:83-91
|How to cite this URL:|
Pradhan D, Pruthi N, Sharma L, Chavan J, Verma P. Impact of oral health education on oral health knowledge, attitude, and practices among 13–15 years' school-going children from Kanpur city, India: A quasi-experimental study. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2020 Apr 4];18:83-91. Available from: http://www.jiaphd.org/text.asp?2020/18/1/83/279821
| Introduction|| |
Health is considered to be the most common theme in various cultures. It is a fundamental human right irrespective of any caste, creed, religion, political beliefs, and economic or social conditions. Oral health is fundamental to general health and well-being. A healthy mouth enables a person to eat, speak, and socialize without having any disease which is in active form or causes any type of embarrassment and discomfort. It is concerned with the maintenance of the health of craniofacial complex, gingiva, teeth, and the facial tissues of the head-and-neck region that surrounds the mouth.
Oral diseases are considered to be the major public health issues depending on their incidence and prevalence. However, oral health knowledge is a necessary prerequisite for health-related behaviors., Studies conducted also reveal that children in India have a lower level of knowledge related to oral health as compared to those in Western countries., Dentists struggle globally in order to improve the oral health of the public with the help of oral health education (OHE) that enhances not only oral health literacy but also aims at changing the behavior.
Schools serve as the best platform for the promotion of oral health among the children. However, adolescence is a very crucial period of transition with personal responsibilities in order to prevent disease, beginning at this early age and determining future oral health. Thus, adolescents can be benefited from oral health promotion interventions provided to them at this initial stage of development. The reinforcement and motivation can pave their ways toward a healthier life in future.
OHE programs aim to provide oral health by imparting information in order to improve awareness that could help in leading to the adoption of a healthy lifestyle, dietary practice, positive attitudes, and good oral health behaviors. Hence, the school-based approach for providing OHE is considered to be the best in improving the awareness regarding the oral health among the children. These OHE programs have been proved to be very cost-effective and practical in delivering oral health in schools.,
Thus, the present study was initiated in an attempt to evaluate the impact of OHE on oral health knowledge, attitude, and practices among 13–15–year-old schoolchildren from Kanpur city.
| Materials and Methods|| |
The present quasi-experimental study was conducted among 13–15-year-old schoolchildren from Kanpur city between July 2016 and January 2017. An official permission was obtained from the principal/headmaster of the participating schools prior to the start of the study. Consent was obtained from the class teachers, and information sheet was given to the class teachers of the participating schools in the language which they could read.
- All the children available at the time of the study
- Schools who had not received any dental health education program in the last 1 year.
- Children with any fixed orthodontic treatment
- Children requiring any emergency dental treatment.
A pilot study was conducted to determine the feasibility of the study and to get acquainted with the study work. Face and content validity were tested with regard to wording, content, and appropriateness of both the questionnaires administered (Hindi and English). Modifications required were done, and the difficulties experienced were overcome by redesigning the pro forma, which was later used for conducting the study.
The present study was a quasi-experimental study. Simple random sampling technique was used to select schools for the study. Before the instigation of the study, an official list of all the secondary schools of Kanpur city was obtained from the Joint Director Education, Kanpur region. In the first stage, Kanpur city was divided into four zones. From the north and west zones, two schools each were selected and from the east and south zones, three schools each were selected. In total, ten schools were randomly selected from all the four zones using lottery method. In the second stage, all schoolchildren aged 13–15 years from the selected school were invited to participate in the study in order to assess their oral health-related knowledge, attitudes, and practices before and after the intervention. The total number of schools selected for the study was six private schools and four government schools.
The sample size was calculated using G Power 220.127.116.11 software (Denmark, Europe). Taking effect size as 0.2, at α = 0.05 and power of 0.85, the total sample size for two groups was estimated to be 854. To accommodate dropouts, 10% was added to the estimated sample size, so the sample size was 940. At the end of 6 months, there were 64 dropouts because the participants were absent on the days of study. Therefore, the final sample size was 876.
The data were collected using a questionnaire to assess the schoolchildren's oral health-related knowledge, attitude, and practices once at baseline and at the end of the 6th month. OHE was imparted to the study group children once at baseline, at the 2nd month, and at the 4th month in all the selected schools by the principal investigator. Before the commencement of the study, the investigator was standardized and calibrated in the department of public health dentistry by the faculty members to ensure uniform interpretations and understanding. OHE was provided to both government and private schools, so the educational material was prepared both in English and Hindi languages. The OHE was provided using the following OHE aides:
- PowerPoint presentation: Basic information about tooth morphology, tooth eruption, dental caries, gingivitis, periodontitis, mal-aligned teeth, and correct toothbrushing technique was provided through the PowerPoint presentation
- Pamphlets containing the take-away message for the children were prepared as a means of a handy reminder to them
- Posters containing messages regarding the dentition of children, common oral diseases affecting permanent dentition, prevention of dental caries, etc., were used for the purpose of the study from the Dental Museum of Rama Dental College, Kanpur
- Toothbrushing model was used for the demonstration of correct toothbrushing technique to the schoolchildren
- Posters and pamphlets containing messages regarding the ill effects of tobacco consumption were used for schoolchildren.
Data collected were analyzed using SPSS software version 21 (IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0, IBM Corp., Armonk, NY, USA). Data distribution was assessed for normality using Shapiro–Wilk test. Categorical data were compared using Chi-square test. All values were considered statistically significant at P < 0.05.
| Results|| |
A total of 876 schoolchildren participated in the study. The mean age (in years) of the study group children was 13.6 ± 0.878 years and the control group children was 14.03 ± 0.764 years. It comprised of 54.4% males and 45.6% females in the study group, whereas there were 39.2% of males and 60.8% of females in the control group [Table 1]. The comparison of responses of the participants according to their knowledge on oral health, pre- and postintervention, was made, where the participants were asked about the importance of oral health and all the respondents chose yes (100%) as an answer. The knowledge of the participants was found to be statistically significant after the OHE was imparted to them [Table 2]. The table shows the comparison of responses between pre and post intervention in the study group regarding oral health related attitudes. Statistically significant differences were observed among the participants after the OHE was imparted for the questions such as importance of cleaning teeth (85.9%, P < 0.001), regular visits to dentists (82.2%, P = 0.047), stop using tobacco if already using it (55.78%, P < 0.001), and reasons for last dental visit (65%, P = 0.025) [Table 3]. The table shows the comparison of responses between pre and post intervention in the study group regarding oral health related practices. Majority of the respondents chose the correct options for questions such as type of aid used for brushing teeth (99.3%, P < 0.001), frequency of cleaning teeth (67.8%, P < 0.001), frequency of changing toothbrush (61.3%, P < 0.001), frequency of consumption of sweets/toffees/candy/chocolates (96.1%, P < 0.001), using a mouthwash (91%, P < 0.001), and rinsing after every meal (92.4%, P < 0.001). Statistically significant changes were found among the participants after the OHE was given [Table 4]. The table shows the comparison between pre and post intervention in the control group regarding oral health related knowledge. As there was no OHE imparted, the knowledge scores were found to be less than that of the study group participants. However, statistically significant differences were observed for questions such as correct method of toothbrushing (36.05%, P = 0.043), reasons for brushing teeth (62.61%, P < 0.001), and reasons for dental decay (52.5%, P < 0.001) [Table 5]. The table shows the comparison between pre and post intervention in the control group regarding oral health related attitudes. Statistically significant change was observed when the participants were asked about the importance of regular visits to the dentist (71.39%, P = 0.033) [Table 6]. The comparison of responses of the participants in the control group according to their oral hygiene practices on oral health, pre- and postintervention, for questions such as cleaning of tongue (68.92%, P = 0.027) and consumption of tobacco in any form (99.5%, P < 0.001) was found to be statistically significant among the participants [Table 7].
|Table 1: Age and gender distribution of participants according to groups|
Click here to view
|Table 2: Comparison of responses of the participants according to their knowledge on oral health, pre- and postintervention|
Click here to view
|Table 3: Comparison of responses of the participants according to their attitude on oral health, pre- and postintervention|
Click here to view
|Table 4: Comparison of responses of the participants according to their oral hygiene practices on oral health, pre- and postintervention|
Click here to view
|Table 5: Comparison of responses of the participants in the control group according to their knowledge on oral health, pre- and postintervention|
Click here to view
|Table 6: Comparison of responses of the participants in the control group according to their attitude on oral health, pre- and postintervention|
Click here to view
|Table 7: Comparison of responses of the participants in the control group according to their oral hygiene practices on oral health, pre- and postintervention|
Click here to view
| Discussion|| |
Oral health is an essential component of general health. The role of prevention in oral health in India is a massive challenge to all dental professionals. This area must be given importance and priority in the arena of health promotion as there is a higher incidence of disease being reported. The practical approach that is worth heading is primary prevention, wherein the problem is struck at the root, that is even before its inception. Primary prevention comprises of disease prevention by imparting OHE.
Dental health education has been considered to be an essential and integral part of the oral health promotion activities and has been delivered to groups, individuals in settings such as dental practices, residential care settings, schools, etc., The educational interventions incorporated have varied considerably, from simple to complex programs in providing OHE to change the behavioral patterns of individuals. The basic goals of these interventional programs aim to bring a change in the beliefs, behaviors, knowledge, attitudes, practices, oral health status, and use of dental services.
On analyzing the overall knowledge, it was found that there was a significant increase in the proportion of correct responses to knowledge questions from baseline to 6 months. After the intervention, most of the children had answered correctly for questions: how many milk and permanent teeth do humans have (from 44.8% to 77.8%, P < 0.001), types of teeth present in humans (from 39.4% to 94.4%, P < 0.001), functions of teeth (from 34% to 83.6%, P < 0.001), and correct method of toothbrushing (from 53.5% to 94.4%, P < 0.001). A similar picture was depicted in the studies conducted by Ganesh et al., Chachra et al., and Fernando et al. The results of these studies were found to be statistically significant (P < 0.001).
On analyzing the attitudes of the participants, it was found that there was a significant increase in the attitudes of the participants from baseline to 6 months in the study group. Positive attitudes were found among the study participants regarding the importance of cleaning teeth (from 83.3% to 85.9%, P < 0.001), reasons for last dental visit (from 18.3% to 65%, P = 0.025), and ability to stop tobacco if already using it (from 54.3% to 55.78%, P < 0.001). Statistically significant differences were obtained. Studies conducted by Naidu and Nandlal, Vishwanathaiah, and Harikiran et al. had shown results which were in accordance with those of the present study conducted.
The oral hygiene practices of the participants were found to be far better at 6 months than they were at baseline. Some of the questions include aid used for brushing teeth (from 92.6% to 99.3%, P < 0.001); material used for cleaning teeth (from 96.6% to 98.8%, P = 0.142); frequency of cleaning teeth (from 60% to 67.8%, P < 0.001); time of consumption of cookies, candies, and chocolates (from 51.8% to 96.1%, P < 0.001); and consumption of tobacco in any form (from 99.3% to 100%). These results were in accordance with those of the studies conducted by Niranjan and Knight and Conrado et al.
Thus, OHE programs aim to provide oral health by imparting information in order to improve awareness that could help in leading to the adoption of a healthy lifestyle, dietary practice, positive attitudes, and good oral health behaviors. Health-related behaviors are well established in preadolescence or adolescence. Hence, the school-based approach for providing OHE is considered to be the best in improving the awareness regarding the oral health among children. These OHE programs have been proved to be very cost-effective and practical in delivering oral health in schools.
| Conclusion|| |
Schools act as building blocks in shaping up children's behavior. Enhancing the levels of a child's knowledge by school dental health education plays a pivotal role in improving the overall health. In developing countries like India, where majority of the population being in middle- and low-socioeconomic status schools, dental health education programs with constant reinforcement is a feasible way to reach out all sections of children. Henceforth, imparting OHE should be part of the academic curriculum to achieve positive oral health and cavity-free future.
Thus, the present study concludes that the children in the study group showed higher levels of knowledge, attitudes, and oral hygiene practices after the intervention at baseline, at 2nd month, and at 4th month. These scores were found to be statistically significant (P < 0.001). However, lesser scores were observed among the control group children as there was no OHE imparted to them.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Alotaibi AS, Jad A, Al-Sadhan AS. The impact of school based oral health education program on the level of oral health knowledge among public intermediate school girls at Riyadh. Dentistry 2016;7:1-11.
Bhat P, Kumar A, Badiyani B, Aruna C, Sangeeta T, Bhaskar N. Effect of oral health education on the knowledge, attitude and behavior regarding oral health among school children in Bengaluru, India. Int J Contem Dent 2012;3:83-8.
Bhardwaj VK, Sharma KR, Luthra RP, Jhingta P, Sharma D, Justa A. Impact of school-based oral health education program on oral health of 12 and 15 years old school children. J Educ Health Promot 2013;2:33.
Raj S, Goel S, Sharma VL, Goel NK. Short-term impact of oral hygiene training package to Anganwadi workers on improving oral hygiene of preschool children in North Indian City. BMC Oral Health 2013;13:67.
D'Cruz AM, Aradhya S. Impact of oral health education on oral hygiene knowledge, practices, plaque control and gingival health of 13- to 15-year-old school children in Bangalore City. Int J Dent Hyg 2013;11:126-33.
Harikiran AG, Pallavi SK, Hariprakash S, Ashutosh, Nagesh KS. Oral health-related KAP among 11- to 12-year-old school children in a government-aided missionary school of Bangalore city. Indian J Dent Res 2008;19:236-42.
] [Full text]
Hebbal M, Ankola A, Metgud S. Caries risk profile of 12 year old school children in an Indian City using cariogram. Med Oral Patol Oral Cir Bucal 2012;17:e1054-61.
Angelopoulou MV, Kavvadia K, Taoufik K, Oulis CJ. Comparative clinical study testing the effectiveness of school based oral health education using experiential learning or traditional lecturing in 10 year-old children. BMC Oral Health 2015;15:51.
Ramesh Kumar S, Aswath Narayanan M, Jayanthi D. Comparison of oral hygiene status before and after health education among 12-18-year-old patients. J Indian Assoc Public Health Dent 2016;14:121-5.
Prabhu S, John J. Oral health education for improving Oral health status of school children – A systematic review. IOSR J Dent Med Sci 2015;14:101-6.
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.
] [Full text]
Das UM, Beena JP, Azher U. Oral health status of 6- and 12-year-old school going children in Bangalore City: An epidemiological study. J Indian Soc Pedod Prev Dent 2009;27:6-8.
] [Full text]
Garbin C, Garbin A, Dos Santos K, Lima D. Oral health education in schools: Promoting health agents. Int J Dent Hyg 2009;7:212-6.
Ganesh SA, Bhat PK, Jyothi C. Initial impact of health education program on oral health knowledge and awareness among 15-year old children of government high school, Sarakki, Bangalore. J Indian Assoc Public Health Dent 2007;10:51-65.
Chachra S, Dhawan P, Kaur T, Sharma AK. The most effective and essential way of improving the oral health status education. J Indian Soc Pedod Prev Dent 2011;29:216-21.
] [Full text]
Fernando S, Kanthi RD, Johnson NW. Preschool teachers as agents of oral health promotion: An intervention study in Sri Lanka. Community Dent Health 2013;30:173-7.
Naidu J, Nandlal B. Evaluation of the effectiveness of a primary preventive dental health education programme implemented through school teachers for primary school children in Mysore City. J Int Soc Prev Community Dent 2017;7:82-9.
Vishwanathaiah S. Knowledge, attitudes, and oral health practices of school children in Davangere. Int J Clin Pediatr Dent 2016;9:172-6.
Niranjan N, Knight S. An education intervention to improve oral health knowledge and behaviour in learners: A cluster randomized controlled trial. S Afr Dent J 2017;72:167-72.
Conrado CA, Maciel SM, Oliveira MR. A school-based oral health educational program: The experience of Maringa- PR, Brazil. J Appl Oral Sci 2004;12:27-33.
Gauba A, Bal IS, Jain A, Mittal HC. School based oral health promotional intervention: Effect on knowledge, practices and clinical oral health related parameters. Contemp Clin Dent 2013;4:493-9.
] [Full text]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]