The study was carried out for 6 months in special schools in Rohtak, Haryana which cater to the needs of the children with special health care need (CSHCN). To enroll in such centers, a medical diagnosis of their condition is required. The most common diagnoses of the ID subjects are Down syndrome, cerebral palsy or autism. Five schools were included in study; out of which three were in urban areas and two were in rural areas. Ethical clearance ( PGIDS/IEC/2016/117 dated 27/12/16) had been sought from the Institution Ethics committee of Post Graduate institute of dental sciences, Rohtak, Haryana. Permission from the concerned authorities of the selected schools will be taken prior to the study. Information sheet regarding the study will be provided to the each subject before taking information consent from them prior to examination.
The study population was two cohorts in which one group includes children with special health care need (CSHCN) and other group their parents. Parents were contacted and written consent forms were sent to them through the school authorities. Data collection was done in two stages which included a combination of questionnaire administration for parents and clinical examination of their child on same day. A self-structured questionnaire was administered by using the interview methods by single interviewer. The questionnaire has 4 domains which include demographics, knowledge, attitude, and practice questions. Socio-demographic variables were considered predictors which are measured by BJ Prasad scale. 15 ,16Knowledge, attitude and practices questions were based on previous research done in this area. The questionnaire was tested in 25 parents (12 fathers, 13 mothers) to assess feasibility and clarity. No issues were reported with respect to wording, concepts, number of items, and time needed to complete the questionnaire. Construct validity could not be tested in relation to KAP, as they were not psychosocial constructs in which psychometric properties need to be tested. The final questionnaire consisted of 10 knowledge (The ranges of possible scores = 0–10), 13 attitude and 12 practice questions. We categorized the knowledge score in good, fair, and poor based on correct answers. The knowledge scores from 0–5 indicated poor, scores 6–7 indicated moderate, and scores 8–10 indicated high knowledge level. In the attitude domain, each answer choice could be scored based on a 1–5 Likert scale. Score 1 indicated completely disagree, and score 5 indicated completely agree. Since the total number of questions in this section was 13 the total domain score ranged from 0 to 13. Regarding performance, the responses to the questions were tabulated and reported.
Dental caries experience was scored using the Decayed, Missing and Filled Teeth Index (DMF-T), following the standard methodology of the World Health Organization. A single examiner conducted the examination using the WHO methods (2013), the clinical examination was carried out at special school premises in classrooms, using a regular chair, artificial light, mouth mirror and explorer. The sample size was calculated using open epi software. The DMFT pooled data indicated that the standard difference in the means was 0.441.17At a 95% confidence interval with power 90% the sample size was calculated to be 116 for each cohort.
STATISTICAL ANALYSIS
For statistical analysis SPSS 21 (Statistical Package for Social Sciences) was used after entering the data into Microsoft Excel sheet. For descriptive statistics, frequency of distribution in relation to socio-demographic and practice question responses was presented. For analytical statistics, associations between the independent variables and KAP were used using Chi-square test. The scoring of KAP was based on the mean score of the correct answers. Univariate logistic analysis was used to assess the relationship between knowledge, attitude, practices of parents and dental caries among children. For the logistic regression analysis model, the dental caries was dichotomized as present or absent.