Number of Citations: 0

Submitted: 8 January 2024
Accepted: 2 July 2024
Published online: 1 October, TAPS 2024, 9(4), 14-25
https://doi.org/10.29060/TAPS.2024-9-4/OA3212

Hema Suryavanshi¹, Santosh R Patil², Kaladhar Reddy Aileni³ & Mohmed Isaqali Karobari⁴

¹Department of Oral Pathology and Microbiology, Chhattisgarh Dental College & Research Institute, India; ²Department of Oral Medicine and Radiology, Chhattisgarh Dental College & Research Institute, India; ³Department of Preventive Dentistry, College of Dentistry, Jouf University, Kingdom of Saudi Arabia; ⁴Dental Research Unit, Centre for Global Health Research, Saveetha Institute of Medical and Technical Sciences, India

Abstract

Introduction: Oral health education is essential for adolescents, yet traditional methods face challenges in engaging this demographic. This study evaluates the effectiveness of a multimedia-based dental education program among high school students. This study was carried out to assess the impact of a comprehensive multimedia-based dental education program on oral health knowledge and practices among high school students.

Methods: A total of 228 students were recruited and randomly assigned to experimental (n=114) and control (n=114) groups. The experimental group received a four-week multimedia program, while the control group followed the standard curriculum. Outcome measures included oral health knowledge scores, brushing frequency, flossing habits, dietary choices, and observational assessments. Statistical analysis employed descriptive statistics, paired t-tests, and analysis of covariance (ANCOVA).

Results: The multimedia-based program led to a significant increase in oral health knowledge scores in the experimental group compared to the control group (Mean Change: 14.6, p < 0.001). Moreover, the experimental group demonstrated higher brushing frequency (p < 0.001), increased flossing habits (p < 0.001), and improved dietary choices (p < 0.05). Observational assessments showed higher adherence to oral hygiene practices in the experimental group (p < 0.001).

Conclusion: The multimedia-based dental education program effectively improved oral health knowledge and practices among high school students. This approach holds promise for scalable and engaging oral health education strategies.

Keywords:           Multimedia-based Education, Oral Health, Adolescents, Dental Education, Health Promotion, Preventive Dentistry

Practice Highlights

• Integrated multimedia elements enhanced participant engagement, utilising videos, e-learning modules, and pamphlets.
• Positive shifts in oral health practices observed, with increased brushing and flossing frequencies in the experimental group.

I. INTRODUCTION

Oral health education serves as a cornerstone in empowering adolescents with the knowledge and skills necessary to maintain optimal oral hygiene. By educating young individuals about the importance of regular brushing, flossing, and dental check-ups, as well as the impact of dietary choices on oral health, preventive practices can be instilled early on. This not only helps in preventing common dental problems like cavities and gum disease but also promotes overall health and quality of life (Nakre & Harikiran, 2013).

Furthermore, addressing oral health education during adolescence is strategic as it provides an opportunity to intervene during a critical developmental stage. By targeting adolescents with effective educational interventions, it becomes possible to shape behavior and instill healthy habits that can last a lifetime. This proactive approach not only benefits the individual’s oral health but also reduces the burden on healthcare systems by minimising the need for costly and invasive dental treatments later in life (Tadin et al., 2022).

The increasing prevalence of dental problems presents a significant public health challenge, as untreated oral diseases can lead to pain, discomfort, and even serious complications such as tooth loss, systemic infections, and impaired overall health (Texas Dental Association, 2008). Moreover, dental problems impose a substantial economic burden on healthcare systems, with costs associated with treatment, emergency care, and lost productivity. In light of these challenges, effective educational interventions are crucial for curbing the burden of oral diseases (Ghoneim et al., 2022). Oral health education programs aim to raise awareness about the importance of oral hygiene, preventive measures, and regular dental check-ups. By providing individuals with the knowledge and skills necessary to maintain good oral health practices, these interventions can empower them to take proactive steps to prevent dental problems and minimise their impact (Kassebaum et al., 2017). This study addresses this need by investigating the impact of a multimedia-based dental education program on the oral health knowledge and practices of high school students.

Adolescence represents a critical period for establishing lifelong health behaviors, and oral health is no exception (National Institutes of Health, 2021). Unfortunately, global studies indicate a concerning prevalence of dental issues among adolescents, including dental caries, gingivitis, and poor oral hygiene practices (Agbelusi & Jeboda., 2006, Zhang et al., 2021). Such issues not only impact immediate health but can also lead to long-term consequences, emphasising the urgency of effective oral health education.

Traditional oral health education methods often face challenges in engaging and effectively conveying information to adolescents. Conventional classroom lectures and textbook-based approaches may struggle to capture the attention of this demographic, potentially limiting the efficacy of such interventions. However, there is evidence to suggest that traditional oral health education has been effective in improving oral health knowledge (Angelopoulou et al., 2015), reducing plaque accumulation, and promoting oral health in adolescents (Gousalya et al., 2022). On the other hand, it is important to note that traditional models of oral health education have been criticised for their didactic delivery and failure to acknowledge the individual context and motivations of the recipients (Ford & Farah., 2012).

As technology becomes increasingly integrated into daily life, leveraging multimedia platforms for health education emerges as a promising strategy to enhance engagement and knowledge retention (George et al., 2014).

The primary objective of this study was to assess the effectiveness of a comprehensive multimedia-based dental education program in improving oral health knowledge and promoting positive oral hygiene practices among high school students. By employing a well-structured intervention and rigorous evaluation, this research aims to contribute valuable insights that can inform the design and implementation of future oral health education initiatives.

The significance of this study lies in its potential to inform evidence-based oral health education strategies for adolescents, especially in regions facing resource constraints. If successful, the multimedia-based approach could serve as a scalable and cost-effective model for widespread implementation in school settings. Ultimately, the outcomes may contribute not only to the improvement of oral health outcomes among adolescents in the study setting but also to the development of best practices with broader implications for global oral health promotion.

II. METHODS

A. Intervention

A comprehensive multimedia-based dental education program was developed by a team of experienced dental educators, multimedia designers, and content developers. The program included visually engaging educational videos covering various aspects of oral health, interactive e-learning modules to reinforce key concepts, and informative pamphlets providing supplementary written material.

Throughout the intervention period, the research team closely monitored the attendance and participation of students in both the experimental and control groups. Attendance records, completion rates of e-learning modules, and participation levels in interactive sessions were meticulously documented to assess the program’s adherence.

1) Program feedback and modification: Continuous feedback sessions were held with both students and educators to evaluate the effectiveness of the multimedia-based dental education program. Adjustments and modifications were made in real-time based on feedback received, ensuring the program remained dynamic and responsive to the specific needs and preferences of the participants.

2) Quality assurance: To maintain consistency and quality across program delivery, educators underwent training sessions, and periodic evaluations were conducted to assess their adherence to the prescribed curriculum and teaching methodologies.

B. Study Design

A randomised controlled trial was conducted involving 228 high school students, aged 14 to 18, recruited from four local high schools in Burhanpur, India, after obtaining permission from the school authorities. Institutional Review Board (IRB) approval with approval number GGSCDS&RC/2022/IEC/168 was obtained prior to the start of this study. Students and their parents/guardians were provided with detailed information about the study, and informed consent was obtained from all participants. The study was conducted between January 2022 and December 2023.

A sample size calculation was conducted prior to the initiation of the study to ensure adequate statistical power. Based on previous literature and anticipated effect sizes, the calculation indicated that a sample size of 228 participants would provide sufficient power to detect significant differences in oral health knowledge and practices between the experimental and control groups. Factors such as an alpha level of 0.05, a power of 0.80, and an effect size estimate derived from similar interventions were taken into consideration during the calculation. This approach ensured that the study was adequately powered to detect meaningful differences in the outcomes of interest.

Random assignment of participants to the experimental and control groups was performed using a computer-generated randomisation sequence. The sequence was generated by an independent researcher not directly involved in the implementation of the study. Participants were assigned to the experimental or control group based on their identification numbers, ensuring an equal chance of allocation to either group. This randomisation process helped minimise selection bias and ensure that any differences observed between the groups could be attributed to the intervention rather than systematic differences in participant characteristics.

Given that participants were recruited from multiple local high schools in Burhanpur, India, cluster randomisation was employed to minimise contamination between groups. High schools were considered as clusters, and randomisation was carried out at the school level to prevent potential contamination of intervention effects between students within the same school. This approach helped maintain the integrity of the study design and reduce the risk of cross-group contamination, thereby enhancing the internal validity of the findings.

To address potential biases related to academic performance, we collected demographic information from all participants, including indicators of academic achievement. This information allowed us to assess any confounding variables during data analysis. Additionally, randomisation was employed to ensure that participants with varying academic backgrounds were equally distributed between the experimental and control groups, minimising the impact of academic performance on study outcomes.

1) Experimental group (n=114): Prior to the intervention, informed consent was obtained from both students and their parents/guardians. The multimedia-based dental education program was delivered to the experimental group during regular school hours. The intervention spanned four weeks, with carefully structured sessions designed to cover topics such as oral anatomy, proper brushing and flossing techniques, the impact of diet on oral health, and the importance of regular dental check-ups. Each week, students participated in interactive discussions, watched educational videos, completed e-learning modules, and received informational pamphlets to reinforce the acquired knowledge. To ensure engagement and understanding, the program incorporated quizzes, group activities, and open discussions facilitated by trained dental educators.

2) Control group (n=114): The control group received the standard oral health education provided as part of the existing school curriculum. The standard curriculum included traditional classroom lectures, textbook readings, and basic demonstrations of oral hygiene practices. No additional multimedia resources were introduced to the control group to maintain a clear distinction from the experimental group.

C. Development of Survey Instrument

The survey instrument utilised for baseline assessment underwent a rigorous validation process to ensure its reliability and validity in measuring participants’ oral health knowledge. The validation process included several key steps aimed at enhancing the quality and accuracy of the survey instrument.

The survey items were delved based on an extensive review of existing literature on oral health knowledge among adolescents. Content experts in the fields of dentistry, public health, and education were consulted to ensure that the survey items adequately covered essential concepts related to oral health.

Prior to the commencement of the main study, a pilot test of the survey instrument was conducted with a small group of high school students similar to the study population. Feedback from the pilot test participants was carefully analysed, and adjustments were made to the wording and clarity of the survey items based on their input.

The survey instrument underwent thorough review by a panel of experts comprising professionals from diverse backgrounds, including dentistry, education, and survey design. The expert panel assessed the relevance, comprehensibility, and appropriateness of the survey items for the target population, providing valuable feedback for further refinement.

D. Outcome Measurements and Analysis

In this study, a comprehensive set of outcome measures was employed to assess the impact of the intervention on participants’ oral health knowledge and practices. The study commenced with a baseline assessment, during which demographic data, oral health history, and participants’ knowledge of oral health practices were collected. Throughout the four-week intervention period, participants’ oral health practices were evaluated weekly through self-reports and observations, ensuring continuous monitoring of their adherence and engagement with the program. Following the intervention, a post-intervention assessment was conducted, and participants’ oral health practices were monitored for an additional two weeks to assess the sustainability of behavior changes beyond the intervention period.

1) Pre-intervention assessment: Before the initiation of the intervention, a thorough baseline assessment of participants’ oral health knowledge was conducted using validated surveys (Appendix A). These surveys covered a wide spectrum of oral health concepts, including the anatomy of teeth and gums, the significance of fluoride, and common dental diseases. Individual knowledge scores were calculated, establishing a baseline measure for each participant, with the maximum score for the knowledge assessment set at 100 (Appendix B).

2) Post-intervention assessment: Following the four-week intervention period, participants from both the experimental and control groups underwent a post-intervention survey (Appendix C). This survey mirrored the pre-intervention assessment and allowed for a direct comparison of changes in knowledge. Individual knowledge scores were recalculated, and the difference between pre- and post-intervention scores was used to quantify the impact of the educational program.

3) Brushing frequency: Participants’ brushing habits were assessed through a combination of self-reporting and observation. Each participant maintained a detailed log, recording the frequency and duration of their toothbrushing activities. Trained researchers also conducted periodic observations to validate self-reported data, enhancing the reliability of the findings.

4) Flossing habits: Similar to brushing, participants self-reported their flossing habits, detailing the frequency and thoroughness of their flossing routine. Periodic checks were conducted to corroborate self-reported data, ensuring the accuracy of the information gathered.

5) Dietary choices: The study assessed participants’ dietary habits related to oral health, including the consumption of sugary snacks and beverages. Dietary logs and self-reporting were used, and nutritional assessments were conducted to evaluate participants’ awareness of the relationship between diet and oral health.

Trained researchers conducted periodic observations to assess participants’ oral health practices in a naturalistic setting. This included direct observations of toothbrushing and flossing routines, as well as an assessment of participants’ adherence to recommended oral hygiene practices.

Throughout the study, continuous monitoring and quality checks were implemented to ensure the accuracy and reliability of the outcome measures. Any deviations or unexpected trends in the data were promptly investigated, and corrective actions were taken as needed. This approach ensured the robustness of the study’s outcome assessments.

Descriptive statistics were employed for demographic data. Paired t-tests were used to compare pre- and post-intervention knowledge scores. Analysis of covariance (ANCOVA) was conducted to assess the impact of the intervention on oral health practices, controlling for baseline differences. IBM SPSS Statistics software (version 22.0) was utilised for data analysis, with a predetermined significance level set at p < 0.05.

III. RESULTS

The demographic characteristics table illustrates a well-balanced study population, with both the experimental and control groups having similar age distributions (16.2 ± 1.0 vs. 16.1 ± 0.9) and gender representation (Male/Female: 56/58 vs. 55/59). Baseline knowledge scores align closely, with mean scores of 45.2 (experimental) and 44.8 (control) and standard deviations of 8.3 and 8.1, respectively (Table 1).