A total of 2100 students were approached for the study, of which 2097 (99.9%) consented to participate in the study. There were 1126 (53.7%) males and 971 (46.3%) females. The mean age of the students was 15.3 ± 1.4 years. The majority of their parents, 1809 (86.3%), belonged to the unskilled occupational class (Table 1).
Table 1
Association between participants’ characteristics and mean OHK scores
Variable | Mean (SD) | Mean difference | 95% CI | t statistic | p value |
Gender | | | | | |
Female = 971 | 15.6 (6.6) | 0.8 | 0.2–1.4 | 2.760 | 0.006* |
Male = 1126 | 14.8 (6.6) | | | | |
Age (years) | | | | | |
12–15 = 1285 | 15.8 (6.7) | 1.8 | 1.2–2.4 | 6.064 | < 0.001* |
16–18 = 812 | 14.0 (6.3) | | | | |
Parent’s occupational class | | | | | |
Skilled = 200 | 16.3 (6.6) | 1.3 | 0.4–2.2 | 2.686 | 0.007* |
Others (unskilled and dependents) = 1897 | 15.0 (6.6) | | | | |
Previous oral health education | | | | | |
Yes = 331 | 16.8 (6.7) | 2.0 | 1.3–2.8 | 5.197 | < 0.001* |
No = 1766 | 14.8 (6.6) | | | | |
Previous dental consultation | | | | | |
Yes = 79 | 16.3 (4.9) | 1.2 | 0.3–2.4 | 1.594 | 0.111 |
No = 2018 | 15.1 (6.7) | | | | |
CI – Confidence Interval; *Statistically significant |
Capabilities
Less than 50% Oral Health Knowledge (OHK), Attitude (OHA) and Practice (OHP) scores were recorded among 2096 (99.9%), 1288 (61.4%) and 1519 (72.4%) students respectively. The oral health knowledge (OHK) score ranged from 0 to 60%; the mean OHK score was 15.1 (± 6.6)%. The oral health attitude (OHA) score ranged from 0 to 91.3%; the mean OHA score was 44.5 (± 14.3)%. The oral health practice (OHP) score ranged from 0 to 88.9% and the mean OHP score was 42.5 (± 13.8)%. Females, students in the younger age group (12–15 years old), those whose parents were skilled workers and students who had previously received oral health education had higher mean OHK scores (Table 1).
Table 2
Association between participants’ characteristics and mean OHA scores
Variable | Mean (SD) | Mean difference | 95% CI | t statistic | p value |
Gender | | | | | |
Female = 971 | 44.9 (14.0) | 0.8 | 0.4–2.0 | 1.293 | 0.196 |
Male = 1126 | 44.1 (14.5) | | | | |
Age (years) | | | | | |
12–15 = 1285 | 45.9 (13.6) | 3.7 | 2.4–4.9 | 5.715 | < 0.001* |
16–18 = 812 | 42.2 (15.1) | | | | |
Parent’s occupational class | | | | | |
Skilled = 200 | 46.7 (13.6) | 2.4 | 0.3–4.5 | 2.268 | 0.023* |
Others (unskilled and dependents) = 1897 | 44.2 (14.4) | | | | |
Previous oral health education | | | | | |
Yes = 331 | 48.0 (13.0) | 4.2 | 2.6–5.9 | 4.984 | < 0.001* |
No = 1766 | 43.8 (13.7) | | | | |
Previous dental consultation | | | | | |
Yes = 79 | 46.8 (13.9) | 2.4 | 0.8–5.6 | 1.462 | 0.144 |
No = 2018 | 44.4 (14.3) | | | | |
CI – Confidence Interval; *Statistically significant |
Higher OHA scores were associated with age 12 to 15 years, parents being skilled workers and previous oral health education (Table 2). Female students, those aged 12 to 15 years, those whose parents were skilled workers or who had received previous oral health education or seen a dentist in the past had higher mean OHP scores (Table 3).
Table 3
Association between participants’ characteristics and mean OHP scores
Variable | Mean (SD) | Mean difference | 95% CI | t statistic | p value |
Gender | | | | | |
Female = 971 | 43.5 (14.2) | 1.9 | 0.7–3.0 | 3.113 | 0.002* |
Male = 1126 | 41.6 (13.4) | | | | |
Age (years) | | | | | |
12–15 = 1285 | 44 (13.5) | 4.1 | 2.9–5.3 | 6.689 | < 0.001* |
16–18 = 812 | 40 (13.8) | | | | |
Parent’s occupational class | | | | | |
Skilled = 200 | 44.4 (14.6) | 2.2 | 0.2–4.2 | 2.149 | 0.032* |
Others (unskilled and dependents) = 1897 | 42.2(13.7) | | | | |
Previous oral health education | | | | | |
Yes = 331 | 45.4 (13.9) | 3.5 | 1.9–5.1 | 4.230 | < 0.001* |
No = 1766 | 41.9 (13.7) | | | | |
Previous dental consultation | | | | | |
Yes = 79 | 56.1 (14.7) | 14.2 | 11.2–17.2 | 9.149 | < 0.001* |
No = 2018 | 41.9 (13.5) | | | | |
CI – Confidence Interval; *Statistically significant |
The Oral Health Knowledge, Attitude and Practice (KAP) score ranged from 0 to 77.3% with a mean score of 43.8 (± 11.4)%; 1377 (65.7%) students had a total KAP score below 50%. Bivariate analysis of the sociodemographic factors and categories of total KAP scores about the mean class score (≤ 44% and > 44%) showed that age group, occupational class of parents, previous oral health education and dental consultation were significantly associated with KAP scores (Table 4).
Table 4
Bivariate analysis of association between oral KAP score and participants’ characteristics
Characteristics | Mean Oral KAP score (%) | X2 | P value |
| < 44 | ≥ 44 | | |
Age (years) | | | | |
12–15 | 543 (42.3) | 742 (57.7) | 44.904 | < 0.001* |
16–18 | 465 (57.3) | 347 (42.7) | | |
Gender | | | | |
Female | 436 (44.9) | 535 (55.1) | 7.264 | 0.007* |
Male | 572 (50.8) | 554 (49.2) | | |
Occupational class | | | | |
Skilled | 74 (37.0) | 126 (63.0) | 13.522 | 0.001* |
Unskilled | 880 (48.8) | 923 (51.2) | | |
Dependent | 54 (57.4) | 40 (42.6) | | |
Previous oral health education | | | | |
Yes | 129 (39.0) | 202 (61.0) | 13.027 | < 0.001* |
No | 879 (49.8) | 887 (50.2) | | |
Previous dental consultation | | | | |
Yes | 23 (29.1) | 56 (70.9) | 11.815 | < 0.001* |
No | 985 (48.8) | 1033 (51.2) | | |
*Statistically significant, X2- Chi square statistics |
Multiple logistic regression showed that age (12–15 years), parental occupational class, previous oral health education and previous dental consultation were significant predictors of higher KAP scores among the students (Table 5).
Table 5
Multivariate logistic regression analysis of association between mean oral KAP score and participants’ characteristics (with KAP score as dependent variable and > 44% as reference)
Variable | Category | OR | 95% CI | p value |
Age (years) | | | | |
| 12–15 | 1.7 | 1.4–2.1 | < 0.001* |
| 16–18 | 1.0 | | |
Gender | | | | |
| Female | 1.2 | 1.0–1.4 | 0.065 |
| Male | 1.0 | | |
Occupational class | | | | |
| Skilled | 2.1 | 1.3–3.4 | 0.005* |
| Unskilled | 1.4 | 0.9–2.2 | 0.105 |
| Dependent | 1.0 | | |
Previous oral health education | | | | |
| Yes | 1.4 | 1.1–1.8 | 0.011* |
| No | 1.0 | | |
Previous dental consultation | | | | |
| Yes | 2.1 | 1.3–3.5 | 0.004* |
| No | 1.0 | | |
OR – Odds Ratio; CI – Confidence Interval; *Statistically significant |
Opportunities
There was no oral health promotional material in any of the schools. The only oral health promotional activity documented was oral health education, which had been conducted in 8 (26.7%) schools; only 331 (15.8%) students had been educated about their oral health. Teachers 202 (61.0%), dentists 128 (38.7%) and a nurse 1 (0.3%) were the educators. Previous oral health education was associated with better OHK, OHA and OHP scores (Tables 1, 2 and 3). It was also a significant predictor of KAP scores being higher than 44% (Table 5). All the schools had tuck shops within the school premises; all had cariogenic foods and drinks, water and fruits for sale.
Motivation
About half 1161 (55.4%) of the respondents were motivated and will participate in an oral health promotion programme, 128 (6.1%) had negative views/were not interested, and 808 (38.5%) were indifferent.
Many 1628 (77.7%) agreed or strongly agreed that caring for the teeth makes them healthy and contributes to their general health. A total of 779 (37.1%) students indicated that cariogenic foods should be restricted from the school’s tuck shops.
Association between capabilities, opportunities and motivation
Bivariate analysis showed that a higher proportion of students with total KAP score > 44% i.e. above the class mean KAP score (better capabilities) were more exposed to opportunities (been educated about their oral health) than those with KAP score ≤ 44%. (61.0% vs 39.0%, X2 = 13.027, p < 0.001). Students who were more motivated (positive views about school oral health programs) had higher capabilities than those who were not motivated (those who had negative views or were indifferent) (60.1% vs 39.9%, X2 = 6.227, p = 0.013).
Multivariate analysis showed that having total KAP score higher than class mean score (capability scores) and previous oral health education (opportunity) were significant predictors of being positively motivated (Table 6). Students with higher total KAP scores (i.e. > 44%, the class mean score) were nearly six times (OR = 5.6, 95%CI = 4.2–7.4, p < 0.001) more likely to agree that caring for the teeth makes one healthy and more likely to agree that tuck shops in schools should be restricted from sales of cariogenic foods (OR = 1.3, 95%CI = 1.1–1.6, p = 0.002) than those with lower capabilities (≤ 44% KAP scores).
Variable
|
Category
|
OR
|
95% CI
|
p value
|
KAP score
|
>44%
|
1.2
|
1.0 –1.5
|
0.018*
|
|
≤44%
|
1.0
|
|
|
Previous oral health education
|
|
|
|
|
|
Yes
|
1.5
|
1.2 – 2.0
|
< 0.001*
|
|
No
|
1.0
|
|
|
*Statistically significant
Table 6
Multivariate logistic regression analysis of association between capability, Opportunities and variable assessing motivation (with motivation variable as dependent variable and lack of motivation as reference)
Students who had been educated about their oral health (opportunity) had higher odds (OR = 1.9, 95%CI = 1.3–2.8, p = 0.001) of indicating that caring for the teeth prevents oral diseases and makes one healthy or agreeing to restriction of sales of cariogenic food in the tuck shops in schools (OR = 1.9, 95%CI = 1.4–2.4, p < 0.001) than those who had not been educated about their oral health.