Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2013  |  Volume : 31  |  Issue : 2  |  Page : 96--99

Evaluation of different health education interventions among preschoolers: A randomized controlled pilot trial

BJ John1, S Asokan1, S Shankar2,  
1 Department of Pediatric Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India
2 Department of Community Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India

Correspondence Address:
S Asokan
Department of Pediatric Dentistry, KSR Institute of Dental Science and Research, Tiruchengode 637 215, Tamil Nadu


Objective: The aim of this study is to assess the impact of three different health education methods among preschoolers. Study Design: The study group included 100 preschoolers of the same socio-economic status randomly selected and divided into four groups. Debris index (DI-S) was recorded for all children followed by the dental health education. Group A received dental health education from the Dentist; Group B from the class teacher trained by the Dentist and Group C from the dental residents dressed mimicking cartoon characters. Group D acted as the control group. Post-intervention evaluation program was carried out after 3 months. Data were analyzed by Chi-square test, paired t-test and analysis of variance (ANOVA) appropriately using the SPSS Version 17.1. Results: Comparison of pre- and post-intervention data showed that there was a statistically significant improvement in the (DI-S) scores in all groups except the control group. Group C showed a significant improvement compared to the other Groups A, B, and D (P < 0.04). Conclusion: Drama as a method of health education can have a bigger impact on the oral health attitude and practices of the preschoolers. These modes can serve to reinforce as well as improve the oral health practices among pre-school children.

How to cite this article:
John B J, Asokan S, Shankar S. Evaluation of different health education interventions among preschoolers: A randomized controlled pilot trial.J Indian Soc Pedod Prev Dent 2013;31:96-99

How to cite this URL:
John B J, Asokan S, Shankar S. Evaluation of different health education interventions among preschoolers: A randomized controlled pilot trial. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2022 Oct 6 ];31:96-99
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Behavior change theories such as Social Learning Theory [1] and the Health Belief Model [2] suggests that changes in knowledge, attitudes and behavior may be brought about using a concerted approach involving mass media, community, and individual interactions. [3] The effectiveness of media campaigns is enhanced when reinforced by individual interaction. A sustained behavior change regarding health can be created using a combined approach of media supported by a health professional input. Mass media has been accepted as one of vehicles for dental health education. [4] the decline in the prevalence of dental caries in most industrialized countries is attributed to changing life-styles, effective use of oral health services, and the implementation of school based oral health-care programs. To ensure a long-term dental health, oral health practices are important right from a very young age. An integrated health education and health promotion approach is necessary to positively influence the knowledge, attitude, and behavior of children towards good oral health. The school based oral health education and preventive programs aim at improving oral health status of children. The current generation of preschoolers is not only influenced by their social environment and teachers, but also by electronic gadgets, media, television, and cartoons. The methods of health education provided to the school children vary among different age groups. There is limited literature to conclude that a particular mode is the most effective one for a particular age group. Hence, a randomized controlled pilot trial was planned to assess the impact of three different modes of health education among preschoolers and to determine the most effective mode among them.

 Materials and Methods

The study protocol was assessed and approved by the institutional review board of KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India. Parental consent was obtained to carry out the study and the sample was selected in such a way that all participants belonged to the same socio-economic status and had a full complement of primary dentition. The study group included 100 preschoolers aged 4-6 years from KSR Matriculation Higher Secondary School, Tiruchengode. The preschoolers were selected by simple random sampling and they were randomly allocated into four sample subgroups, Group A (n = 25), Group B (n = 28), Group C (n = 24) and Group D (n = 23).

Clinical examination was carried out for all participants prior to the health education in the school under natural light. This included the recording of debris index (DI-S), a part of the oral hygiene index modified for the primary dentition. The index teeth used were 55, 51, 65, 75, 71, and 85 (Pre-intervention data). Data were recorded by two calibrated examiners and the inter-examiner reliability was at Kappa value of 0.88. Following the baseline examination oral health education was provided as intervention. Oral health education consisted of demonstration of brushing technique, eating/snacking habits and its relation to dental caries and ill effects of improper brushing. Among the four groups, three groups received health education and one group acted as a control. For children in Group A, the health education was delivered by the dentist and for Group B children; a teacher who was trained by the Dentist delivered the health education. Group C children were shown a drama enacted by the senior dental residents (trained by the same Dentist) disguised as cartoon characters such as Dora, Mickey mouse, Power Ranger and a devil, for about 20 min. Dora maintains good oral hygiene, Mickey had poor oral hygiene, and the devil depicted the bacteria. Power ranger saves Dora and helps Mickey improve his oral hygiene. Audio-visual effects were also used along with the drama. The fourth group, Group D acted as the control group without any health education intervention. A post-intervention evaluation program was conducted 3 months later and the DI-S scores were recorded.

Data collected were statistically analyzed using the SPSS version 17.1. Chi-square test, paired t-test and ANOVA test were used appropriately with statistically significant level set at P ≤ 0.05.


The mean age of the entire sample and the subgroups was 5.5 years and hence there was no statistically significant difference among the groups based on age (P = 0.821). The gender distribution in all four groups was not statistically significant. It was found that there was a significant improvement in the oral hygiene based on the DI-S scores between the pre- and post-intervention data in all four groups [Table 1]. When the comparison was made between the different groups for the post-intervention scores, the group, which was given with the dramatic mode of health education showed statistically significant improvement in the oral hygiene compared to the other three groups [Table 2].{Table 1}{Table 2}


Oral health education can bring about positive changes in the attitude and behavior of an individual. In the recent decades, several initiatives have been taken to implement preventive oral health-care programs especially among school children. [5],[6],[7]] The school based oral health education programs conducted in Brazil, [8] Madagascar, [9] and Indonesia [10] showed encouraging results. In general, oral health education is given by the dental health personnel or the teachers of the school. Since not much of the literature exists on the impact of the modes of health education on children, a randomized controlled trial was planned. The target population was the preschoolers aged 4-6 years going to kindergarten school. The intervention was the different modes by which the health education was delivered to these children. The control group was introduced to have a comparison with the other three modes. The outcome studied was the impact (based on the DI-S score) of the different modes on the oral health of these children.

Children in all four groups had no significant difference in the average age, percentage of gender distribution and the pre-intervention scores of DI-S. Care was taken to avoid any bias in sampling distribution. All four groups showed a significant improvement between the pre- and post-intervention scores. Greenberg [11] showed there was no statistically significant difference among the different teaching modes: A parent-applied behavior modification program, student-centered instruction, health education teacher dominated instruction, dental hygienist dominated instruction, and a combination of the above termed the "kitchen sink" mode. In the present study, Group (A) that received health education from the oral health professional showed improvement, which was similar to previous studies. [12],[13],[14] This substantiates the fact that Dentists have a vital role to play in influencing the oral health knowledge and practices of school children. The Group (B), which received oral health education from teachers also showed an improvement probably because to a large extent teachers are responsible for children's life-style and habits. Teachers are good role models or ego ideals for children of this age group and therefore the health education provided by them showed a significant influence on children in relation to their oral health. [15] The teachers spend more time with school children than their parents and the Dentists; hence, they would be one of the most appropriate persons to deliver health education information. The Group (C) that received the dramatic mode of health education showed the most significant improvements compared to all other groups. Children enjoyed the drama and moreover watching their favorite cartoon characters performing an oral health act was found to have a greater impact. The current generation of children is attracted by the cartoon characters as they spend more time watching television and cartoon serials. The content of the message does matter; but the way it is conveyed to the target population, so that they retain the information well is more important. The specific quality that a message needs to be successful is the quality of "stickiness." [16] This was the probable reason for Group C to have better results than the other groups.

The feasibility of duplicating this recommended technique can be questioned. In fact, a video of the drama was also considered. However, we felt that children would really like a real life size cartoon acting in front of them instead of the regular videotaped drama. It was found during the study that most of the children actually enjoyed staying close to their favorite cartoon characters during, before and after the drama was enacted. There were a few limitations in this pilot study. The study group included only 100 kindergarten children with the same socio-economic background. A study with more diverse groups and number in can be carried out. Limited follow-up period of 3 months may not allow maturation of dental health messages, a limitation, which has been identified in dental health education literature. [17],[18],[19] The control group also showed improvement in DI-S score and this may be attributed to the various other factors such as the ripple effect (information from participants in the other groups), personal home oral hygiene practices, attitude, and education status of the parents, which were not considered in the study. Within the limitations of the pilot trial, we can conclude that the dramatic mode of providing oral health education to preschoolers was effective. This method's greater impact and better response, justifies that it may be routinely used for providing oral health education to preschool children.


Health education plays a vital role in oral health promotion among school children. This trial specifically focused on preschoolers and it was found that the dramatic way of health education produces a promising result in these children. Drama as a method of health education can have a greater impact on the oral health knowledge, attitude, and practices.


1Bandura A. Social Learning Theory. Englewood Cliffs, NJ: Prentice Hall; 1977. p. 247.
2Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health Educ Q 1988;15:175-83.
3Bakdash MB, Lange AL, McMillan DG. The effect of a televised periodontal campaign on public periodontal awareness. J Periodontol 1983;54:666-70.
4Schou L. Use of mass-media and active involvement in a national dental health campaign in Scotland. Community Dent Oral Epidemiol 1987;15:14-8.
5Pine CM, McGoldrick PM, Burnside G, Curnow MM, Chesters RK, Nicholson J, et al. An intervention programme to establish regular toothbrushing: Understanding parents' beliefs and motivating children. Int Dent J 2000;Suppl Creating A Successful: 312-23.
6Friel S, Hope A, Kelleher C, Comer S, Sadlier D. Impact evaluation of an oral health intervention amongst primary school children in Ireland. Health Promot Int 2002;17:119-26.
7Petersen PE, Peng B, Tai B, Bian Z, Fan M. Effect of a school-based oral health education programme in Wuhan City, Peoples Republic of China. Int Dent J 2004;54:33-41.
8Buischi YA, Axelsson P, Oliveira LB, Mayer MP, Gjermo P. Effect of two preventive programs on oral health knowledge and habits among Brazilian schoolchildren. Community Dent Oral Epidemiol 1994;22:41-6.
9Petersen PE, Razanamihaja N. Carbamide-containing polyol chewing gum and prevention of dental caries in schoolchildren in Madagascar. Int Dent J 1999;49:226-30.
10Hartono SW, Lambri SE, van Palenstein Helderman WH. Effectiveness of primary school-based oral health education in West Java, Indonesia. Int Dent J 2002;52:137-43.
11Greenberg JS. An analysis of various teaching modes in dental health education. J Sch Health 1977;47:26-32.
12Brown LF. Research in dental health education and health promotion: A review of the literature. Health Educ Q 1994;21:83-102.
13Kay EJ, Locker D. Is dental health education effective? A systematic review of current evidence. Community Dent Oral Epidemiol 1996;24:231-5.
14van Palenstein Helderman WH, Munck L, Mushendwa S, van't Hof MA, Mrema FG. Effect evaluation of an oral health education programme in primary schools in Tanzania. Community Dent Oral Epidemiol 1997;25:296-300.
15Flanders RA. Effectiveness of dental health educational programs in schools. J Am Dent Assoc 1987;114:239-42.
16Gladwell M. The Tipping Point: How Little Things Can Make a Big Difference. London: Abacus; 2000. p. 92.
17Rise J, Sögaard AJ. Effect of a mass media periodontal campaign upon preventive knowledge and behavior in Norway. Community Dent Oral Epidemiol 1988;16:1-4.
18Lewis CW, Grossman DC, Domoto PK, Deyo RA. The role of the pediatrician in the oral health of children: A national survey. Pediatrics 2000;106:E84.
19dela Cruz GG, Rozier RG, Slade G. Dental screening and referral of young children by pediatric primary care providers. Pediatrics 2004;114:e642-52.