RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS

Mr.Esakkiraj.VFirst year M.Sc.Nursing,Rajarajeswari College Of Nursing, Mysore Road, KambipuraBangalore- 560074.

2. NAME OF THE INSTITUTION Rajarajeswari college of Nursing

3. COURSE OF THE STUDY AND SUBJECT

M.Sc NursingCommunity Health Nursing

4. DATE OF ADMISSION TO THE COURSE

31-10-2009

5. TITLE OF THE STUDY “A study to evaluate the effectiveness of information, education, and communication program on knowledge, attitude and knowledge of practice regarding dental hygiene among primary school children in selected schools of Bangalore.”

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6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

Oral Health is an integral component of general health. It has also become clear that

causative and risk factors in oral diseases are often the same as those implicated in the major

general diseases (WHO,2003). The overall health, well being, education and development of

children, families and communities can be affected by oral health. Though there has been

considerable improvement in the oral health of children in the last few decades, dental caries

(tooth decay) still remains one of the most commonly occurring oral health problems in the

children all over the globe. A considerable population of children in the developing nations is

being affected by tooth decay and most of the time their proper treatment is given the last

priority owing to limited access to oral health services. The lack of availability and affordability

of oral health services not only results in aggravation of the disease but also enhances the cost of

treatment and care. There is no single country that claims to have caries free children1.

In India, a very less percentage of mothers have received proper advice on oral care of

the children from dentists or health care workers. In many countries, the number of children

brushing their teeth is very unsatisfactory including India. A small proportion of children do not

clean their teeth at all, some may not have access to a toothbrush and many are using the

traditional cleaning aids like datum salt and oil, coal ash and locally made powders etc.

The high prevalence of Dental Caries has been brought under control in many developed

countries during the last three decades. This was possible only through community or school

based organized primary preventive programmes essentially composed of generation of oral

health awareness through education of the public and school children at large. We have high

prevalence of dental caries which can be attributed to shift in diet pattern towards more refined

food, lack of appropriate knowledge about oral hygiene and causation and prevention of common

oro-dental problems. Moreover, the dental professionals are unequally distributed and catering to

mainly curative/restorative needs of the urban areas. Health education and prevention is almost

non-existent in the country2.

School is a place of learning for the children and is in fact microcosms of the larger

community. Schools are the ideal setting for integrating oral health instructions in the

curriculum. At the school age, children are receptive to guidance and familiar with the learning

environment and culture. School teachers can effectively influence student’s knowledge, attitude

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and practices regarding oral health and can bring change in behavior. It is very important to

target oral health education to the children since the lifestyle and hygiene practices once

established at an early age can go a long way in spending rest of the life in a healthy way2.

Oral health educational programmes implemented through schools have the additional

advantage of imparting primordial and primary preventive instructions to all the children of all

socio-economic status. Based on this background, an attempt has been made to develop an

accessible and sustainable module for prevention of dental caries among school children using

existing educational infrastructure and to find out the feasibility of such a primary preventive

module for prevention of dental caries in school children3.

6.1 NEED FOR THE STUDY

Dental care or broadly speaking oral hygiene is an important aspect of the personal health

of an individual. Good oral hygiene implies sound teeth and healthy gums with healthy

surroundings tissues. The physical act of chewing food promotes saliva and gastric secretions

and helps indigestion. The act chewing and tasting is called mastication. Teeth are essential not

only for mastication of food, but also good appearance and clear speech. There is the evidence

that improvement of oral hygiene does improve the general health. The nursing staff have a

special contribution to make in the care of oral hygiene of their patients in hospital, nursing

homes and other residential institutions4.

The two most common dental ailments, throughout the world, are dental caries(tooth

decay) and periodontal disease(gums disease or pyorrhoea). The term halitosis is used forbad

breath. Halitosis is due to poor oral hygiene, periodontal disease, sinus infections, tonsillitis, and

infections of nose and throat. Dental diseases in children often continue into adult life5.

A study was conducted on dental caries remains the most important dental health

problem in developing countries. In India the prevalence of dental caries is reported to be about

50-60%. Most of the Indian studies have been carried out in school children and very few in

adults. This study aimed to estimate the prevalence of dental caries in the adult population (aged

35-44 years) and in the elderly (60 years and above) in an urban resettlement colony in New

Delhi. A total of 452 participants were enrolled in the study. The prevalence of dental caries in

the 35-44 years age-group was 82.4% and it was 91.9% in those > or =60 years. The DMF index

was 5.7 +/- 4.7 in the 35-44 years age-group and 13.8 +/- 9.6 in the > or =60 years age-group. Of

the participants, 27.9% were currently using tobacco. A statistically significant association was

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found between tobacco consumption and dental caries ( P = 0.026). The awareness about good

and bad dental practices was found to be low among the study participants. One-fifth of the

individuals with dental problems relied on home remedies6.

Therefore, the investigator himself saw most of the primary school children having dental

problem during the school services, so the investigator selected this study to evaluate the

effectiveness of information, education, and communication program on knowledge, attitude and

knowledge of practice regarding dental hygiene among primary school children in selected

schools of Bangalore, Karnataka.

6.2 REVIEW OF LITERATURE

A cross-sectional study to investigate the relationship between maternal related factors

and the dental health status of pre-school children in two primary health centre Lagos State,

Nigeria. The study sample was 404 pairs of mothers and their pre-school children. The result of

the study shown that Maternal age, maternal education, location of residence, maternal

knowledge, and attitudes were all positively correlated with the child's caries and oral hygiene

status. This study concluded that maternal age and attitude were important determinants of caries

experience whereas the mother's attitude was an important determinant of oral cleanliness in pre-

school children in Lagos State Nigeria7.

A study conducted on Brazil in health education programme was to verify the influence

of preschool children participating in an oral health education programme on daily health

practices of their families, through parent's perception. The study sample was 119 parents of 5-

to 6-year-old preschool children were selected. The result of the study shown 63 (52.9%)

parents agreed to participate. Ninety-eight per cent knew about educative and preventive

activities developed at school and all of them affirmed that these activities were important,

mainly because of knowledge, motivation and improvement in children's health. Ninety and half

per cent of parents reported that they learned something about oral health from their children

and, among these, almost half (47.8%) cited tooth brushing as the indicator for better learning.

Besides this, 87.3% of participants revealed the change in oral health habits of their family

members8.

The cross-sectional descriptive study conducted on Saudi in frequency of consumption of

cariogenic foods, oral hygiene practices and dental health knowledge among Saudi male primary

school children in relation to socio-demographics and to find the possible predictors for dental

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caries among them. The study sample was 1115 Saudi male selected by multistage random

sample from 18 public primary schools. Subjects were interviewed by closed ended

questionnaire gathering data regarding frequency consumption of some cariogenic foods, oral

hygiene practices and dental health knowledge. Students were submitted to dental screening to

detect the clinically evident caries lesion. The result of the study was logistic regression analysis

revealed that maternal working conditions, large family size and poor oral hygiene practices

were the chief predictors for dental caries among the included school children. The poor oral

hygiene practices, lack of parental guidance and appropriate dental health knowledge with

frequent exposure to cariogenic foods in addition to socio-demographics are the main risk factors

for dental decay among the surveyed students9.

The study was conducted on USA to assess elementary school nutrition programs in a

rural county in southern Illinois. The researcher interviewed the food service managers of eight

schools and completed the School Health Index (SHI) based on their responses. The study

sample was eighty-seven percent of the schools did not have venues such as vending machines

outside the cafeteria. Three food service managers stated that from 75% to 80% of the students in

the district ate lunch in the cafeteria. The SHI corresponds to the eight components of a

coordinated school health program; nutrition services are just one of the eight components. The

result of the study was SHI is a tool that can be used to identify strengths and weaknesses in the

nutrition program. It covers items from healthy, low-fat choices to food preparation and cafeteria

practices. School nurses can work with teachers and food service personnel to create nutrition

programs and a curriculum related to healthy nutrition practices10.

The cross-sectional study was conducted on japan to investigated sex and age group

differences in attitudes to oral health among school-age children using an Oral Self-Care

Appraisal (OSCA) to systematically determine changes in oral health knowledge, attitude, and

behavior across developmental stages. The study sample was (n = 1584) were stratified after

random sampling so that each school grade analyzed contained 88 boys and 88 girls. Factor

analysis was undertaken to identify a set of underlying factors, with 10 factors considered in the

cross-sectional study. The results of the study showed that the factors tooth brushing, persistence,

and sociability were more predominant in primary school children than in junior high and senior

high school students. Furthermore, postponement of visiting the dentist and resignation to one's

own dental cavities became more predominant in proportion to the level of school education.

Girls had significantly higher scores than boys for desire to improve oral care, dental anxiety,

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dependency on snacks, tooth brushing, concern over number of cavities, and sociability/ the

results indicated that the oral health care behavior of girls was better than that of boys, and that

the tendency to postpone visiting the dentist and resignation to one's own dental cavities

increased markedly with age11.

The study was conducted on Turkey to present oral- and dental health-related knowledge

and behaviors of children who presented to Akdeniz University Medical Faculty Pediatric

Outpatient Clinic between March 1 and May 1, 2006 for non-dental health reasons. The study

sample was collected from a total of 173 children. A survey which contained questions about the

children's oral and dental health was completed using face-to-face interview technique. The

result of the study shown forty-eight percent of the children were 5-6 years old and 68.8% were

not going to school. It was determined that 43.3% of the mothers of the children in the study had

a primary-school level of education and 74.6% were housewives. It also was determined that

49.1% of the children had never had a cavity, 43.4% stated that they brushed their teeth after

meals, and 30.6% stated that they brushed at least once a day. More than sixty percent of the

children spent their allowance on chocolate, chips, cola, candy, and other acidic drinks. A

significant relationship was found between the children's ages and having a caries in this study.

There also was a statistically significant relationship between the parents' tooth-brushing habit

and the children's tooth brushing, and between the parents' frequency of tooth brushing and the

children's frequency of tooth brushing12.

The study was conducted on Sweden in investigate the knowledge of and attitudes to

oral health among 12- and 15-year-old students in Sweden among 85 schools in the County of

Uppsala, ten schools were randomly selected. In all, 993 students were offered the chance to

participate in the study. 793 (80%) individuals answered a questionnaire consisted of fifteen

structured questions about their knowledge and attitudes to oral health. The result showed that

the level of knowledge by adolescents is relatively high. A large majority of the subjects felt that

their teeth were important. Most of the adolescents had learned about oral health from the dental

team12.

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STATEMENT OF THE PROBLEM

A study to evaluate the effectiveness of information, education, and

communication program on knowledge, attitude and knowledge of practice regarding

dental hygiene among primary school children in selected schools of Bangalore.

6.3 OBJECTIVES

1. To assess the pre-test knowledge, attitude and knowledge of practice regarding dental

hygiene among primary school children.

2. To assess the post-test knowledge, attitude and knowledge of practice regarding dental

hygiene among primary school children.

3. To evaluate the effectiveness of information education communication program on

knowledge, attitude and knowledge of practice regarding dental hygiene among primary

school children.

4. To associate the post-test knowledge, attitude and knowledge of practice regarding

dental hygiene among primary school children with their selected demographic

variables.

6.4 RESEARCH HYPOTHESES H1- There is significant difference between the mean pre-test and post-test knowledge,

attitude and knowledge of practice regarding dental hygiene among primary school

children.

H2- There is significant association between the post test knowledge, attitude and

knowledge of practice regarding dental hygiene among primary school children with

their selected demographic variables.

6.5 ASSUMPTIONS

1. Primary school children may have inadequate knowledge, attitude and knowledge of

practice regarding dental hygiene.

2. Information education communication program may improve the knowledge, attitude

and knowledge of practice regarding dental hygiene among primary school children.

3. Primary school children knowledge, attitude and knowledge of practice may vary

with their selected demographic variables.7

6.6 OPERATIONAL DEFINITIONS

1. Effectiveness

It refers to the extent to information education communication program on knowledge,

attitude and knowledge of practice regarding dental hygiene improves knowledge of primary

school children.

2. Information

It refers knowledge acquired through study or experience or instruction.

3. Education

It refers to the development of all those capacities in the individual which will enable h m

to control his environment and fulfill his possibilities.

4. Communication

It refers to transfer of information from a sender to a receiver, with the information being

understand by the receiver.

5. Knowledge

It refers to the level of understanding regarding dental hygiene among primary school

children.

6. Attitude

It refers to a complex mental state involving beliefs and feelings and values

and dispositions to act in certain ways;

7. Practice

It refers to practice is the act of rehearsing a behavior over and over, or engaging in

an activity again and again, for the purpose of improving or mastering it, as in the phrase

"practice makes perfect".

8. Dental hygiene

It refers to the practice of keeping the mouth, teeth, and gums clean and healthy to

prevent disease, as by regular brushing and flossing and visits to a dentist.

9. Primary school Children

Between the ages of four and 12, children often copy the behaviour they most admire, so

it's an important time to work on self-esteem, before the onslaught of adolescence.

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7. MATERIALS AND METHODS

7.1 SOURCE OF DATA

The data will be collected from the primary school children who are living in the rural

communities, Bangalore.

7.2 METHODS OF DATA COLLECTION

i. Research design:

Pre experimental – one group pretest post test design.

ii. Variables:

Dependent variable

Level of knowledge, attitude and knowledge of practice of primary school children

regarding dental hygiene.

Independent variable Information education communication program on dental hygiene. 

iii. Setting

The study will be conducted in selected rural communities, Bangalore.

iv. Population

The population of the study will comprise all the primary school children in selected rural

communities, Bangalore.

v. Sample:

Primary school children who fulfill the inclusive criteria are considered as sample and the

sample size is 60.

vi. Criteria for sample selection:

Inclusion criteria:

The study includes

1. Primary school children who are living in the rural communities, Bangalore.

2. Primary school children of age group between 6-10 yrs.

3. Primary school children who can understand Kannada or English.

4. Primary school children who are attending the schooling.

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Exclusion criteria:

The study excludes

1. Primary school children who are not available at the time of data collection.

2. Primary school children who are willing to participate in the study.

vii. Sampling technique:

Non probability- convenience Sampling technique.

viii. Tool for data collection

The tool consists of the following sections:

Section A: Demographic data which gives base line information of Primary school

children such as age, sex, family income, occupation, type of brushing and source of

information.

Section B: Structured questionnaire on knowledge, attitude and knowledge of practice

regarding dental hygiene among primary school children.

ix. Method of data collection

After obtaining the official permission from concerned community leaders and informed

consent from the samples, the investigator personally, collect the baseline demographic data.

After which the data will be collected in the following 3 phases.

Phase I: Assess the existing knowledge, attitude and knowledge of practice regarding

dental hygiene among primary school children with the help of structured questionnaire.

Phase II: Information education communication program on knowledge, attitude and

knowledge of practice regarding dental hygiene will be given to the primary school children by

using Flash cards for 45 minutes on the same day.

Phase III: After a period of one-week post test knowledge, attitude and knowledge of

practice regarding dental hygiene will be assessed with in the same group using same

questionnaire.

   Duration of data collection: 4 -6 weeks.

x. Plan for data analysis

The data collected will be analyzed by using descriptive and inferential statistics.

Descriptive statistics:

Frequency, percentage distribution, means, standard deviation and mean score

percentage will be used to analyze the knowledge, attitude and knowledge of practice regarding

dental hygiene among primary school children.

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Inferential statistics:

Paired‘t’ test will be used to compare the pre test and post test knowledge, attitude and

knowledge on practice. Chi- square test will be used to analyze the associate between post test

knowledge, attitude and knowledge of practice regarding dental hygiene among primary school

children with their selected demographic variables.

7.3 Does the study require any investigation or interventions to the patients or other human

beings or animals?

Yes, information education communication program will be administered for the primary

school children regarding dental hygiene in selected rural communities, Bangalore.

7.4 Has ethical clearance obtained from your institution?

The permission will be obtained from the concerned authorities and the informed consent

from the sample. Confidentiality and privacy of the data will be maintained.

8. LIST OF REFERENCE

1. World Health Organization, Oral Health Promotion, An Essential Element of a     Health Promoting School, document eleven. Geneva, WHO 2003.2. Parkash H, Shah N. National Oral Health Care Programme,          Implementation Strategies. India. 2001. pp20.3. World Health Organization,The Status of School Health education and Promotion.     Geneva, WHO, 1996.4. K.Park Text book of Essential community Health Nursing 4th Edition M/sBanarsidas

Bhanot publishers Jabalpur 2004 Page 32.

5. Dr.B.T.Basavanthappa. Text book of Community Health Nursing 2nd Edition Japee

publishers,New delhi.2008 page.234

6. Denise F. Polit, Bernadette p. Hungler. Text book of nursing research principles and     

methods: Review of literature. New Delhi: congress  cataloging data; 1999.p. 300.

7. Abiola Adeniyi A, Eyitope Ogunbodede O, Sonny Jeboda O, Morenike Folayan   O .Dental

Department, Introduction Journal Pediatrics Dentistry, Lagos State University Teaching

Hospital Ikeja 2008, Lagos.biolawal@yahoo.com page 448-54.

8. Garbin C, Garbin A, Dos Santos K, Lima D, Int J Dent Hyg.Department of Pediatric and

Preventive Dentistry, Araçatuba School of Dentistry, UNESP-São Paulo State University,

Araçatuba, SP, Brazil. cgarbin@foa.unesp.br2009 Aug;7(3):212-6

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9. Garbin C, Garbin A, Dos Santos K, Lima D, Introduction Journal Pediatrics Dentistry,

Department of Pediatric and Preventive Dentistry, Araçatuba School of  Dentistry,

UNESP-São Paulo State University, Araçatuba, SP, Brazil.cgarbin@foa.unesp.br.

     page 212-16.

10. Amin TT, Al-Abad BM, Introduction Journal Pediatrics Dentistry,Family and

Community Medicine Department, College of Medicine, King Faisal University,       AlHassa,

Saudi Arabia 2008. amin55@myway.com page 361-70.

11. Sherry JS,J Sch Nursing, Dental Hygiene Program, School of Allied Health, Southern

Illinois University Carbondale,USA. 2008 pag.222-8.

12.Kawamura M, Takase N, Sasahara H, Okada, M J Oral Science,Preventive Dentistry,

Hiroshima University Hospital, Hiroshima, Japan 2008 page 167-74.

13. Efe E, Sarvan S, Kukulu K, Issues Compr Pediatr Nurse, Child Health Nursing

Department, Akdeniz University, School of Health, Antalya, Turkey2007.

eefe@akdeniz.edu.tr page 133-46.

14. Hedman E, Ringberg C, Gabre P, Swed Dent J,Department of Preventive Dentistry,

Public Dental Health, Uppsala County Council, Sweden. eva.hedman@lul.se.2006. Pag       147-

54.

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9. Signature of the candidate :

10. Remarks of the guide : The present study helps community health nurses

to maintain dental health in primary school                                                                          

children.

11.1 Name and designation of the Guide : DR.B.T.BASAVANTHAPPA, MN. PHD,

PRINCIPAL AND HOD, RAJARAJESWARI

COLLEGE OF NURSING, BANGALORE.

11.2 Signature :

11.3 Co-guide [if any] :MRS.JEBARNA KIRUBA MARY

LECTURER, RAJARAJESWARI COLLEGE OF

NURSING, BANGALORE.

11.4 Signature :

11.5 Head of the department : DR.B.T.BASAVANTHAPPA, MN. PHD,

       PRINCIPAL AND HOD, RAJARAJESWARI

COLLEGE OF NURSING, BANGALORE.

11.6 Signature :

12.1 Remarks of the principal :The topic selected for study is relevant and

forwarded for needful action

12.2 Signature :

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ETHICAL COMMITTEE CLEARANCE

13.TITLE OF THE DISSERTATION: A study to evaluate the effectiveness of information, education, and communication program on knowledge, attitude and knowledge of practice regarding                                                                    dental hygiene among primary school children in                                                                    selected schools of Bangalore”.

14. NAME OF THE CANDIDATE : MR.V.ESAKKIRAJ      AND ADDRESSS      1st Year M.Sc Nursing

     Rajarajeswari College Of Nursing Bangalore.

15. SUBJECT : M.Sc Nursing Community Health Nursing

16. NAME OF THE GUIDE : DR.B.T.BASAVANTHAPPA, MN.PHD,

17. APPROVED/NOT APPROVED : (if not approved, suggestion)

Head of the department of Head of the department ofCommunity Health Nursing Medical surgical NursingRajarajeswari College of nursing Rajarajeswari College of nursingBangalore. Bangalore.

Head of the department of Head of the department ofPeadiatric Nursing OBG NursingRajarajeswari College of nursing Rajarajeswari College of nursingBangalore. Bangalore.

Head of the department ofPsychiatric Nursing Principal Rajarajeswari College of nursing Rajarajeswari College of nursingBangalore. Bangalore.

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