Haleem Abdul, Khan Muhammad Khalil, Sufia Shamta, Chaudhry Saima, Siddiqui Muhammad Irfanullah, Khan Ayyaz Ali
Department of Oral Health Sciences, Federal Postgraduate Medical Institute, Shaikh Zayed Medical Complex, Lahore, 54600, Pakistan.
Department of Community and Preventive Dentistry, de' Montmorency College of Dentistry, Fort Road, Lahore, Pakistan.
BMC Public Health. 2016 Jan 4;16:2. doi: 10.1186/s12889-015-2676-3.
Repetition and reinforcement have been shown to play a crucial role in the sustainability of the effect of Oral Health Education (OHE) programs. However, its relevance to school-based OHE imparted by different personnel is not depicted by the existing dental literature. The present study was undertaken to determine the effectiveness of the repeated and reinforced OHE (RR-OHE) compared to one-time OHE intervention and to assess its role in school-based OHE imparted by dentist, teachers and peers.
The study was a cluster randomized controlled trial that involved 935 adolescents aged 10-11 years. Twenty four boys' and girls' schools selected at random in two towns of Karachi, Pakistan were randomly assigned to three groups to receive OHE by dentist (DL), teachers (TL) and peer-leaders (PL). The groups received a single OHE session and were evaluated post-intervention and 6 months after. The three groups were then exposed to OHE for 6 months followed by 1 year of no OHE activity. Two further evaluations at 6-month and 12-month intervals were conducted. The data were collected by a self-administered questionnaire preceded by a structured interview and followed by oral examination of participants.
The adolescents' oral health knowledge (OHK) in the DL and PL groups increased significantly by a single OHE session compared to their baseline knowledge (p < 0.05) and the increase was sustained over 6 months. Although one-time OHE resulted in a significant improvement in adolescents' oral health behavior (OHB) related to the prevention of gingivitis in the two groups (p < 0.05), no significant change was observed in their behavior towards prevention of oral cancer. One-time teacher-led OHE was ineffective in improving adolescents' OHK and OHB. The oral hygiene status (OHS) of the participants in all three groups did not change statistically after one-time OHE. The OHK, OHB and OHS indices increased significantly 6 months after RR-OHE than the initial scores (p < 0.001) irrespective of OHE strategy. Although the OHK scores of the DL and PL groups decreased significantly at 12-month evaluation of RR-OHE (p < 0.05), the said score of the TL group; and OHB and OHS scores of all three groups remained statistically unchanged during this period.
The repetition and reinforcement play a key role in school-based OHE irrespective of educators. The trained teachers and peers can play a complementary role in RR-OHE.
重复和强化已被证明在口腔健康教育（OHE）项目效果的可持续性方面发挥着关键作用。然而，现有牙科文献并未描述其与不同人员开展的校内OHE的相关性。本研究旨在确定重复强化口腔健康教育（RR-OHE）相较于一次性OHE干预的有效性，并评估其在牙医、教师和同伴开展的校内OHE中的作用。
该研究为整群随机对照试验，涉及935名10 - 11岁的青少年。在巴基斯坦卡拉奇的两个城镇随机选取的24所男校和女校被随机分为三组，分别由牙医（DL）、教师（TL）和同伴领袖（PL）进行OHE。这些组接受一次OHE课程，并在干预后和6个月后进行评估。然后这三组接受6个月的OHE，随后1年不开展OHE活动。每隔6个月和12个月进行另外两次评估。数据通过在结构化访谈之前进行的自填问卷收集，并在参与者口腔检查之后进行。
与基线知识相比，DL组和PL组的青少年通过单次OHE课程，其口腔健康知识（OHK）显著增加（p < 0.05），且这种增加持续了6个月。虽然一次性OHE使两组青少年与预防牙龈炎相关的口腔健康行为（OHB）有显著改善（p < 0.05），但他们预防口腔癌的行为未观察到显著变化。一次性教师主导的OHE在改善青少年的OHK和OHB方面无效。一次性OHE后，所有三组参与者的口腔卫生状况（OHS）在统计学上没有变化。无论采用何种OHE策略，RR-OHE 6个月后的OHK、OHB和OHS指数均比初始得分显著增加（p < 0.001）。虽然在RR-OHE的12个月评估中，DL组和PL组的OHK得分显著下降（p < 0.05），但TL组的该得分以及所有三组的OHB和OHS得分在此期间在统计学上保持不变。
无论教育者是谁，重复和强化在校内OHE中都起着关键作用。经过培训的教师和同伴在RR-OHE中可以发挥补充作用。
