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RESEARCH ARTICLE Table of Contents  
Ahead of print publication
Cartoon based information booklet versus traditional teaching for better outcome in oral hygiene among primary school students


1 Assistant Professor, Tripura College of Nursing, Agartala, Tripura, India
2 Professor cum Principal, College of Nursing, Asia Heart Foundation, Kolkata, West Bengal, India

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Date of Submission02-Oct-2020
Date of Decision03-Nov-2021
Date of Acceptance03-Dec-2021
Date of Web Publication12-Jan-2022
 

  Abstract 


Dental caries and periodontal diseases have been considered the most important global oral health burdens. Dental caries is still a major oral health problem in both developing and developed countries, affecting 60%–90% of school children and majority of adults. The traditional teaching method is one of the oldest and most common methods of teaching. Innovative methods of teaching are needed for better uptake of information and behavior change. The objective of this study was to compare the effect of cartoon-based information booklet versus traditional teaching regarding oral hygiene on knowledge and practice among primary school students. The quasi-experimental study included a total of 46 Class IV primary school students from two different primary schools. Two schools were randomly assigned as experimental and control groups, the experimental group students had cartoon-based booklet and the control group had traditional method of teaching regarding oral hygiene practices. Structured interview schedule and observational checklist were used to collect the data. The result showed that knowledge and practice of oral hygiene improved after both teaching programme i.e., cartoon-based information booklet and traditional teaching as evident by paired “t” value for knowledge, and also paired “t” value for practice, but when both teaching methods were compared, it was found that cartoon based information booklet was more effective in bringing better outcome in knowledge and practice of oral hygiene compared to the traditional method of teaching. Cartoon-based booklets can be an effective educational tool to improve knowledge and behavior in primary school children.

Keywords: Cartoon based information booklet, oral hygiene, primary school students, Traditional teaching


How to cite this URL:
Bhattacharjee M, Mandal K. Cartoon based information booklet versus traditional teaching for better outcome in oral hygiene among primary school students. Indian J Cont Nsg Edn [Epub ahead of print] [cited 2022 Dec 6]. Available from: https://www.ijcne.org/preprintarticle.asp?id=335677





  Introduction Top


Dental caries and periodontal diseases have been considered the most important global oral health burdens. Dental caries is still a major oral health problem in both developing and developed countries, affecting 60%–90% of school children and majority of adults.[1] Dental care or oral hygiene broadly speaking is an important aspect of the personal health of an individual. Good oral hygiene implies sound teeth and healthy gums with healthy surrounding tissues. Improvement of oral hygiene improves general health.[2]

Dental caries and periodontal diseases are the two globally leading oral afflictions, according to the World Oral Health Report 2003.[3] Severe periodontal (gum) disease, which may result in tooth loss, is also very common, with almost 10% of the global population affected.[4] In the United States 16.9% of children aged 5–19 years suffer from untreated dental caries.[5] In India, the mean prevalence of dental caries and seen among children of 5 to years of age[6] About 60%–90% of school children and nearly 85%–90% of adults have dental cavities, which often leads to pain and discomfort.[7] A nationwide survey conducted by the India Dental Association showed that 70% of children under the age of 15 suffer from gum problems. They surveyed four lakhs of children across the country and found out that 40% were suffering from a faulty jawline. Moreover, it also showed that 92% of the students were found to be suffering from dental decay. Majority of the kids had dental problems with irregular teeth that need to be aligned and bad breath or teeth that needed cleaning, polishing, and fillings.[8]

The extent of dental problems especially in children needs attention and health education related to the prevention of dental problems needs constant updating in terms of methodology in line with the changing times. Although traditional teaching methods with the use of lecture and discussion have been useful in improving knowledge newer methods need to be incorporated to improve educational outcomes. Children enjoy cartoons and most of the children are exposed to some form of cartoons in the media. Therefore, this study was planned to use cartoon-based booklets to teach dental hygiene and compare this method of teaching with the traditional method of health education.

Objectives of the study

  1. To assess the knowledge and practice before and after administration of cartoon-based information booklet on oral hygiene among primary school students
  2. To assess the knowledge and practice before and after administration of traditional teaching on oral hygiene among primary school students
  3. To compare the effectiveness of cartoon-based information booklet versus traditional teaching in terms of knowledge and practice on oral hygiene.


Hypotheses

There will be a significant difference in knowledge and practice scores on dental care after cartoon-based booklet intervention in the experimental group compared to the scores in the traditional teaching method group.


  Methods Top


The quasi-experimental study was conducted at two Bengali medium Government primary schools in Kolkata. Two schools were selected by simple random technique from ten schools under one district. One section of students from class 4 was again selected by simple random sampling from the two schools. All students from that section were included in the study. The schools were randomly assigned to cartoon booklet group and the other to traditional teaching group. The experimental group students had cartoon-based booklet and the control group had traditional method of teaching regarding oral hygiene practices. The required sample size was calculated to include 27 respondents, however the researcher included a total of 46 primary school students. The 4th-grade students in school A (25 students) received cartoon based information booklet and a similar group of students from School B (21 students) were exposed to traditional teaching.

Data collection tools and technique

Data were collected through self-prepared structured interview schedule and observational Checklist. Structured interview schedule has 4 parts which included demographic profile, self-reported practice, and knowledge on oral hygiene. The structured interview schedule had multiple-choice items and 4 true and false questions. The maximum score was 46. An observation checklist was prepared for observing the brushing practice which had 12 items with score 1 for each correct response.

After taking consent from parents of the students, pretest knowledge and practice on oral hygiene was conducted. This was followed by distribution of cartoon-based information booklet to the experimental group and traditional teaching to the control group. After 7 days, post-test on knowledge and practice was done to find out the effectiveness of cartoon-based information booklet and traditional teaching on knowledge and practice regarding dental care. Only booklet was given to each student of experimental group, no formal teaching was administered. Booklet depicted cartoon based information on concept of oral hygiene, the importance of dental care, food pattern for healthy teeth, causes and effects of poor oral hygiene, rules of oral hygiene and brushing technique. In the traditional teaching method, a formal teaching was given with the help of audiovisual aids. The information content was the same and the method of delivery of the content was different to both the groups.

Tools were tested for face validity and content validity by seven experts. The reliability of the tool was established by test-retest method. Pearson product-moment was calculated for scoring questions in each part of the tool and ranged from 0.79 to 0.8. The reliability of the checklist was done by inter-rater method and the score was 0.72. Language validity was established.


  Results Top


The data presented in [Table 1] depicts that, 21 out of 25 students (84%) belonged to 8–9 years old in experimental group, 14 out of 21 students (66.66%) belonged to 8–9 years old in the control group. It also reveals that in both groups the proportion of male students was a little more than female students (52%, 52.38%). In both groups, the students' fathers were laborers (32%, 42.85%) and in both groups majority of the mothers (72%, 72.44%) were housewives.
Table 1: Frequency and percentage distribution of school students according to demographic variable

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[Table 2] highlights that, 8 students out of 25 students (32%) in the cartoon group and 8 students out of 21 students (38.09%) in the traditional group brushed their teeth for 2 min and 1 min respectively. Data also revealed that in both the groups, maximum students used to change their brush in more than 3 months interval. In the cartoon group, 25 students (100%) in the traditional teaching group among 21 students, 18 students (85.71%) were using paste for brushing respectively.
Table 2: Frequency and percentage distribution of school students according to self-reported practice (n=46)

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The data presented in [Figure 1] and [Figure 2] show that in the pretest children in both groups had average knowledge (50%) on food patterns for healthy teeth, some knowledge on cause and effects of poor oral hygiene (37%, 38.09%) and the lowest score in rules of oral hygiene. In the post-test, both group students gained comparatively more knowledge in the area of food pattern for healthy teeth (83%, 71%) and cause and effects of poor oral hygiene (67%, 71.42%), respectively.
Figure 1: Comparison between mean percentage of pre-test and post-test knowledge score of experimental group

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Figure 2: Comparison between mean percentage of pre-test anpost-test knowledge score of control group

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There was a significant difference in knowledge (P < 0.01) and practice (P < 0.01) on dental hygiene in both cartoon-based information booklet and traditional teaching groups of children [Table 3]. So, it was evident that both cartoon-based information booklet and traditional teaching were effective in enhancing knowledge and improving practice among primary school students.
Table 3: Comparison of pre- and post-test mean knowledge and practice scores within groups of receiving cartoon based information booklet and traditional teaching

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[Table 4] indicates the mean scores for knowledge and practice which was not statistically different in the pretest between the two groups. However the mean post-test knowledge and practice scores of the cartoon booklet group were significantly higher (P < 0.01, P < 0.05) than mean post-test knowledge and practice scores of the traditional teaching group. Therefore, cartoon-based information booklet was more effective than traditional teaching in increasing the practice of school students.
Table 4: Comparison of pre-test and post-test mean knowledge and practice scores between groups of both groups receiving cartoon based information booklet and traditional teaching

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  Discussion Top


Majority of the students in this study in both groups were males and between the age group of 8–9 years. This age group is the crucial age for developing permanent teeth and hence dental care becomes an important aspect of health at this stage. It was noted that students from both groups changed their brush more than 3 months intervals (40% and 28.57%) which was bad practice.

Researcher also found that in both groups students had poor knowledge in the area of importance of oral hygiene and rules of oral hygiene. They had adequate knowledge on food pattern for healthy teeth. This finding reiterates that some points on food are common knowledge as it is often represented in media. Both group students did not follow proper steps of brushing. This finding is replicated in other studies[9] also revealing a need for repetitive education on this aspect.

Both cartoon-based information booklet and the traditional teaching method groups showed a significant difference in knowledge and practice revealing that any type of education is effective in bringing the change in knowledge and practice. The study emphasizes the need for teaching preventive aspects such as dental care.

The present study is supported by another cross-sectional epidemiological study on dental caries prevalence, oral health knowledge and practice among five government schools of Nepal. The study results highlight that out of 56% of children reporting cleaning their teeth daily, only 24% reported brushing their teeth twice daily. About 86% of the children reported using toothbrush and toothpaste to clean their teeth. Although 61% of children reported to have received oral health education.[9]

The study revealed an important fact that cartoon-based information booklet was more effective than the traditional teaching method. This is an important finding as the cartoon booklet did not involve spending time in meeting and giving the teaching but invited the students to learn on their own. The findings bring out two vital information: (1) Cartoon based information attracts children to read the material on their own, (2) It is better in encouraging change. Another advantage is the time that is saved in individual or group education.

Findings of the study are strengthened by the findings of another study that compared conventional health promotion and the use of cartoon animation in delivering oral health education. One school received cartoon animation as a source of oral health education (intervention group) and for the other school; oral health education was given by dental nurses (control group). It was concluded that cartoon animation as a medium was more effective and sustainable in delivering oral health education messages compared to the traditional method.[10]

Hence, cartoon-based information booklet made learning easier and better experience for the students. Cartoons are very eye-catching and also help to develop more interest among preschool children.


  Conclusion Top


Cartoon-based information booklet and traditional teaching both were enhancing knowledge and practice of primary school students. However, cartoon-based information booklet was more effective than traditional teaching for better outcomes. Therefore innovative teaching methods that are appropriate for the developmental stage of the child (scholar) are more effective in bringing better outcomes and behavior change. Pediatric and community health nurses need to incorporate such innovative and effective methods when delivering health-related information to the pediatric group.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ 2005;83:661-9  Back to cited text no. 1
    
2.
Park K. Text Book of Essential Community Health Nursing. 4th ed. Jabalpur: M/s Banarsidas Bhanot Publishers; 2004.  Back to cited text no. 2
    
3.
Singhal DK, Acharya S, Thakur AS. Dental caries experience among pre-school children of Udupi Taluk, Karnataka, India. J Oral Health Commun Dent 2015;8:05-9.  Back to cited text no. 3
    
4.
World Health Organization. WHO Survey on Oral Health; 2017. Available from: https://www.who.int/news-room/fact-sheets/detail/oral-health. [Last accessed on 2020 Mar 17].  Back to cited text no. 4
    
5.
Center for Disease Control. CDC National Health and Nutrition Examination Survey.U.S; 2018. Available from: https://www.cdc.gov/nchs/fastats/dental.htm. [Last accessed on 2018 Nov 28].  Back to cited text no. 5
    
6.
Janakiram C, Antony B, Joseph J, Ramanarayanan V. Prevalence of dental caries in India among the WHO index age groups: A metaanalysis. J Clin Diag Res 2018;12:8-13  Back to cited text no. 6
    
7.
Indian Dental Association. Child Oral Health Card; 2017. Available from: http://child.nohp.org.in/new/#/Home. [Last accessed on 2018 Mar 14].  Back to cited text no. 7
    
8.
Singh M, Saini A, Saimbi CS, Bajpai AK. Prevalence of dental diseases in 5- to 14-year-old school children in rural areas of the Barabanki district, Uttar Pradesh, India. Indian J Dent Res 2011;22:396-9.  Back to cited text no. 8
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9.
Prasai Dixit L, Shakya A, Shrestha M, Shrestha A. Dental caries prevalence, oral health knowledge and practice among indigenous Chepang school children of Nepal. BMC Oral Health 2013;13:20.  Back to cited text no. 9
    
10.
Sinor MZ. Comparison between conventional health promotion and use of cartoon animation in delivering oral health education. Intl J Hum Soc Sci 2011;1:169-74.  Back to cited text no. 10
    

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Correspondence Address:
Kasturi Mandal,
Eden Tolly Lakeside, Flat No F1/3A, 319 MG Road, Kobordanga More, Kolkata - 700 104, West Bengal
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijcn.ijcn_103_20



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