This interventional study was conducted in 82 primary school students .Multi-stage cluster sampling was applied to select the participants. After receiving the required clearance for conducting the research and coordination with local authorities, two girls’ schools and two boys’ schools were randomly selected from governmental schools. Each grade was considered a cluster and 4 subjects were randomly selected from each grade using class rosters. In the next stage, using simple randomization, one boys’ school was selected as the case school and the other school was considered as the control school. The same process was applied to girls’ schools. The sample size, with regards to previous studies, α = 0.01, β = 0.1, and attrition of 20% was 48 subjects in the case group and 48 participants in the control group(13) .
Fourteen students did not complete the study; therefore, the data of 82 students, 38 in the case group and 44 in the control group, were analyzed. The inclusion criteria were willingness to participate in the study, having the consent form signed by parents, and studying in the primary schools of X city. The exclusion criteria were withdrawal from the study, missing more than one educational session, and immigration from X city.
The data collection tool was a researcher-made questionnaire containing questions on self-care, knowledge, attitude, behavior, and self-efficacy that was developed using the questionnaires applied by Mohammadi Zeidi et al (14)and Samiee Roudi et al(15). To determine the content validity of the questionnaire (CVI and CVR), a panel of experts including 10 experts in health education, school health, oral and dental health, and dentists evaluated its validity qualitatively and qualitatively. A CVR of above 0.62 was considered acceptable. For CVI, the experts evaluated each item in terms of relevance, clarity, and simplicity, and since all values were above 0.79, they were considered acceptable(16). The reliability of the questionnaire was measured through the Cronbach’s alpha coefficient in 30 students aged 6–12 years whose demographic characteristics were similar to those of the study population using the Stata 14 software(17) .
The questionnaire was designed in six sections. The variables like age, grade, sex, height, weight, etc. were collected in the demographics section. Private and personal questions were avoided in this part. The self-care section contained 5 questions with “yes”, “no”, and “I don’t know” as answers. Each correct answer received a score of 1 and a score of 0 was given to wrong and “I don’t know” answers. The total score of this section was 5. The knowledge section contained 10 questions with three-choice answers. A score of 1 was given to correct answers, totaling a score of 10. The attitude section had 13 questions in a 5-point Likert scale from 1 to 5 with a total score of 65. Behavior was assessed with 8 questions in a 5-poinyt Likert scale from 0 to 4 with a total score of 32. Fourteen questions were used to assess self-efficacy in a 5-point Likert scale from 1 to 5, scoring a total of 70 points. After coordination with schools principals and conducting a pretest, two schools were randomly selected as cases and received training in 4 sessions of 45–60 minutes according to Table 1. The control schools received routine school training. This study caused no conflicts of interest for any persons or organizations.
In this study, watching animations was used as a substitute for traditional training techniques. Exercising and recalling the learned material during games in a simple and child-friendly atmosphere causes an emotional arousal in children. Children’s involvement in practical education of oral and dental health behaviors, their success in correct performance, and regular display of the behavior based on a plan can be source of self-efficacy. Moreover, positive feedback and encouragement of the instructors and parents provide a Source of verbal persuasion for children
Table 1
Educational content and methods of training sessions in case group
Session | Topic | Training method |
One | Primary information about dental and oral health and attitude | Film, photographic slides, educational booklet, question and answer |
Two | Self-care: assessing oral and dental health, determining the objectives, setting a timetable, learning necessary skills | Group discussion, lecture, animation |
Three | Behavior: Brushing technique, use of dental floss and mouthwash, etc. | Practical education, game, animation |
Four | Self-efficacy: in addition to educational animation, games were used to practice oral and dental health skills in different situations like tiredness, disease, party, etc. | Animation, game, group discussion |
Pre and post-intervention data were collected using a questionnaire and entered into SPSS version 20. The Kolmogorov-Smirnov test was applied to check normal data distribution and proper statistics were used accordingly. Chi square test, paired and independent t test, Mann-Whitney U test, and Wilcoxon signed-rank test were used for statistical analysis.