|Year : 2017 | Volume
| Issue : 2 | Page : 72-77
Oral health knowledge and attitudes of primary school teachers toward school-based oral health programs in Abha-Khamis, Saudi Arabia
Shreyas Tikare, Nabeeh A AlQahtani
Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
|Date of Web Publication||25-Jul-2017|
Department of Periodontics and Community Dental Sciences, College of Dentistry, King Khalid University, Abha, PO Box No. 3263
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: The effectiveness of school-based dental health programs has been vastly reported. The objective of the present study was to assess the oral health knowledge and attitudes of primary school teachers in Saudi Arabia and to identify any barriers in implementing school oral health programs.
Methodology: A pretested self-administered questionnaire was used to assess the oral health knowledge and attitudes of primary school teachers including barriers in implementing school oral health programs.
Results: A total of 61 primary schools were included in the present study with responses from 1186 teachers. The mean oral health knowledge score among primary school teacher of Abha-Khamis was found to be 16 ± 2.7. The overall attitude of primary school teachers regarding implementing school-based oral health program was found to be positive on Likert scale. The responses for barriers in implementing school oral health program were almost equally distributed: lack of material resources (21%), lack of professional training (25%), lack of availability of time (25%), lack of support from school administration (22%), and teacher's attitude was least perceived as a barriers (7%).
Conclusions: The oral health knowledge among primary school teachers was found to be good with positive attitudes toward school-based oral health programs. The most significant barriers in implementing a school oral health program were administrative barriers. There is a need for concerned school authorities and health policy makers to address these barriers and to promote oral health in the community.
Keywords: Oral health promotion, policy makers, school administration
|How to cite this article:|
Tikare S, AlQahtani NA. Oral health knowledge and attitudes of primary school teachers toward school-based oral health programs in Abha-Khamis, Saudi Arabia. Saudi J Oral Sci 2017;4:72-7
|How to cite this URL:|
Tikare S, AlQahtani NA. Oral health knowledge and attitudes of primary school teachers toward school-based oral health programs in Abha-Khamis, Saudi Arabia. Saudi J Oral Sci [serial online] 2017 [cited 2018 Feb 24];4:72-7. Available from: http://www.saudijos.org/text.asp?2017/4/2/72/211561
| Introduction|| |
Good health and education are both fundamental rights of children. A school is not merely a place for formal education, but an institute which shapes children's behavior, attitude, and perceptions toward life. Healthy lifestyles inculcated during school age are carried over to adulthood. Children spend approximately 1/3rd of their day at schools. The role of schools in promoting children's health has been recognized since long. The World Health Organization's Global School Health Initiative encourages “health-promoting schools” to create healthy setting for living, learning, and working. This initiative is designed to improve the health of students, school personnel, families, and other members of the community through schools.
The significance and effectiveness of school-based dental health programs have been vastly reported in health-related literature.,, Poor oral health may lead to school absenteeism, difficulty in chewing food, lower nutritional intake, poor quality of life, and retarded growth and development in children.,,,, School teachers can play an effective role in health promotion as they interact with children on a daily basis, and also have close contacts with children's families. However, lack of training and support for teachers in this regard creates a great barrier for effective implementation of school health education programs.
Studies in the past have identified several other teacher-related factors that influence implementation, effectiveness, and maintenance of school health programs.,,, Some important factors include administrative support and facilities provided by higher administration, teacher's environment, attitude toward school health programs, and perceptions of their role in health education and effectiveness of such interventions. Therefore, it is important to determine viewpoint of the school teachers regarding facilities provided to them and challenges they face implementing oral health programs in their schools.
Oral diseases are highly prevalent in the Kingdom of Saudi Arabia.,, Several surveys have been conducted in various provinces of the Kingdom to determine the nature and magnitude of oral health problems in children. The majority of the surveys reported poor oral health status in the children.,,, Although there are some private schools also operating, primary education in Saudi Arabia is largely by governmental schools. The Saudi Commission for Health Specialties (SCHS) recognizes the importance of health education and Article 15/11 of SCHS guidelines includes “school health education” as a subspecialty. The first school-based health program in Saudi Arabia was introduced by the Ministry of Health in 1954 which focused mainly on health education. In 1998, the program was expanded to cover various health services including oral health education and treatment. In addition, few short-term school-based programs were introduced locally., A high prevalence of oral diseases along with limited information on the effectiveness of school oral health programs prompted us to investigate oral health knowledge and attitude among primary school teachers in Saudi Arabia and to identify the possible barriers in implementing school-based oral health program. The results of this study would help understand the readiness of primary school teachers in implementing coordinated school oral health program and develop strategies to overcome possible barriers.
| Methodology|| |
A questionnaire was designed to investigate oral health knowledge, attitude, and barriers in implementing school-based oral health program among primary school teachers in Abha-Khamis city. The questionnaire consisted of 23 questions (knowledge-based = 17, attitude-based = 5, and barriers in implementing school-based oral health program = 1) [Table 1]. The knowledge-based questions were comprehensive, consisting of items on parts and functions of teeth, significance of primary teeth and important aspects such as etiology, signs and symptoms, and management and preventive strategies of oral diseases. The responses for knowledge-based items designed in multiple choice questions form and attitude-based items were based on Likert scale. A single item on barriers in implementing school-based oral health program consisted of a response list of barriers (both at individual and administrative level) with possibility to choose multiple responses.
All the questions were primarily constructed in English and later translated into Arabic language. Both the copies were checked by the language expert for clarity in the translated version and the questionnaire was verified for face validity by Dental Public Health faculty. The final version of the questionnaire contained both languages for easy understanding of all questions. The questionnaire was checked for its internal consistency on 20 primary school teachers who were not included in the main study (Cronbach's alpha = 0.773).
Ethical approval was obtained from the Institutional Review Board at King Khalid University, College of Dentistry (SRC/ETH/2015-16/007). A list of all primary schools in Abha-Khamis city was obtained. The quota sampling method was adopted for collecting responses from primary school teachers. Fifty volunteers were given a target of 20 filled questionnaires from any school randomly from the list. The names of schools from which questionnaires were already collected were taken out of the list to avoid duplication. All teachers present on the day of data collection were considered for the study. Informed consent was obtained from primary school teachers after explaining them the importance of the study. The names of teachers were not asked to ensure confidentiality of information collected.
Data collection and analysis
The selected teachers were requested to complete the questionnaire during their free time of the day and the questionnaires were collected back the same day. The respondents were asked to give their responses as tick mark on the options provided with each item. The data were entered into the computer (MS-Excel) and statistical analysis carried out using SPSS version 16.0 (Chicago, SPSS Inc). Each correct response for knowledge-based items would carry the score of 1. Two questions under the knowledge domain contained partially correct and absolutely correct responses and were given relative weightages (score 1 and score 2, respectively) during the evaluation. Therefore, the possible score for 17 items under knowledge domain obtained would range from 0 to 19. The quartile values were calculated and used as cutoff scores to categorize knowledge levels. The first, second, and third quartile (Q1, Q2, and Q3) values were found to be 5, 10, and 15, respectively. Accordingly, the teacher's knowledge was categorized as very good (score 16 and above), average (score 11–15), inadequate (score 6–10), and poor (score 5 and below).
| Results|| |
A total of 61 primary schools (38 male and 23 female) were included in the present study. Only three out of 61 schools were found to be private. With a quota of 20 filled questionnaires by each volunteer, the expected total was 1220 questionnaires. At the end of the study, 1186 (97.2%) questionnaires were found to be completely filled without any errors. The male school teachers were 662 (55.8%) and female 524 (44.2%). The mean oral health knowledge score among the primary school teacher of Abha-Khamis was 16 ± 2.7. The majority (65.4%) of the school teachers had very good oral health knowledge followed by average knowledge scores (29.6%). There were only few teachers with inadequate and poor knowledge scores (5%) [Table 2]. The mean oral health knowledge scores were significantly higher in female than male school teachers (P = 0.000). Furthermore, there was no statistically significant difference in mean knowledge scores between government and private primary school teachers (P = 0.058) [Table 3].
|Table 2: Distribution of oral health knowledge scores among primary school teachers|
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|Table 3: Comparison of oral health knowledge scores by gender and type of school using Student's t-test|
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The overall attitude of primary school teachers regarding implementing school-based oral health program was found to be positive on Likert scale. There was moderate disagreement on the negative statement about general health to be more important than oral health (strongly disagree = 14.2% and disagree = 31.5%). The majority of the teachers agreed that oral diseases could be prevented (strongly agree = 34.3% and agree = 54.7%). Most of school teachers believed and agreed that they have an important role to be played in dental health education (strongly agree = 43.7% and agree = 44.7%). More than half (53.5%) of teachers strongly felt and more than one-third (35.3%) positively agreed that dental health education should be included in the primary school curriculum. The majority of the teachers agreed that there is a need for teacher's training in dental health education (strongly agree = 43.5% and agree = 41.6%) [Table 4].
|Table 4: Attitude of primary school teachers on school-based oral health program|
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The responses for barriers in implementing school oral health program were almost equally distributed: lack of material resources (21%), professional training (25%), support from school administration (22%), and time (25%). The least felt barriers was teacher's attitude in conducting an oral health program (7%) [Table 5].
| Discussion|| |
A comprehensive school health program is defined as “an integrated set of planned, sequential, school-affiliated strategies, activities, and services designed to promote the optimal physical, emotional, social, and educational development of students. The program involves and is supportive of families and is determined by the local community based on community needs, resources, standards, and requirements. It is coordinated by a multidisciplinary team and accountable to the community for program quality and effectiveness.” Both now and into the future, the comprehensive or coordinated school health approach provides a promising model for better student's health and academic outcomes. Some studies suggest that major health gains for children can occur if specific health issues such as smoking, tobacco, alcohol, and physical activity are addressed which relate to postprimary or postschools age.,, However, in most countries, the school health services are limited to periodic health check-ups with little or no importance to oral health.
Undoubtedly, teachers are most important personnel to be involved in any school oral health activities. It is also important for a teacher to have adequate background knowledge about oral health and a supportive attitude toward extra-curricular activities. The majority (95%) teachers in the present study had an overall good oral health knowledge (under “very good” and “average” categories). Nearly, all of them recognized the importance of primary teeth, etiology, management, and preventive aspects of dental caries and periodontal disease. The figure was much higher than those reported in the previous studies.,, It becomes very interesting to note that in spite of lack of training, primary school teachers in the region are well informed about oral health. The high oral health knowledge could be attributed to multiple information sources available such as internet, newspapers, television, and radio. The participant teachers of the present study had a positive attitude toward school oral health programs. In contrast, some studies have shown “lack of interest” and “unfavorable attitude” of school teachers in conducting school oral health programs.,, In the present study, majority of the respondents believed that oral diseases to a large extent are preventable. They also believed that they have a significant role in the prevention and that dental health education should be included in the primary school curriculum. Nearly, all the teachers agreed to participate in dental health training if conducted in future. In addition, “staff attitude” was least perceived as a barrier to school oral health programs. Such well-informed teachers with positive attitude regarding oral health provide an ideal setting for any school-based oral health programs.
School teachers are no exceptions for occupational stress and their academic schedules are usually tight. The school teachers share multiple responsibilities. Heavy workload together with lack of time are the common reasons given when any new extra-curricular activities are recommended. Teachers in our study also felt that availability of time is a barrier for oral health programs. Some researchers have suggested that “making time” within fixed schedules was not effective in bringing the school reforms, rather more flexibility in teachers' schedules and employment contract, allowed more teacher-directed time for learning and sharing. In addition, our research found “lack of resources,” “lack of training opportunities,” and “administrative support” at the school to be important barriers. Restricted budgets are also likely to affect overall provision of school oral health services. Evidence also suggests that school oral health policies have great influence on oral health of students. These administrative barriers calls for a stronger cooperation and support from the concerned authorities and policy makers at the level of institution and higher administration.
Reaching out through school teachers could possibly be the best way of educating children regarding oral health. School teachers who lack adequate knowledge about oral health or misinformed about the same cannot develop well-informed students. Overall, primary school teachers in this study have a fairly good awareness of dental health and positive attitude toward school-based oral health programs. With the existing challenges in implementing a coordinated school program, this helps create a supportive environment and greatly reduce the time and effort required to train school teachers. Regular oral health promotional activities in the form of health education, dental screenings, demonstration of brushing techniques, and preventive treatment can be undertaken at the school level. The coordinated school oral health program which is promising will only be successful if it is accepted and well-practiced by teachers and schools. For this to occur, the education and health sectors will need to restructure their policies to include oral health more comprehensively at schools.
| Conclusions|| |
- The oral health knowledge among primary school teachers was found to be good with positive attitudes toward school-based oral health programs
- The most significant barriers in implementing a school oral health program were administrative related such as lack of material resources, professional training, availability of time, and support from school management
- There is a need for concerned school authorities and health policy makers to address these barriers and to promote oral health in the community.
The authors are grateful to all volunteers for their support in collecting filled questionnaires from primary schools across Abha-Khamis city without which this study would not be possible.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Promoting health through schools. Report of a WHO Expert Committee on Comprehensive School Health Education and Promotion. World Health Organ Tech Rep Ser 1997;870:i-vi, 1-93.
Goel P, Sehgal M, Mittal R. Evaluating the effectiveness of school-based dental health education program among children of different socioeconomic groups. J Indian Soc Pedod Prev Dent 2005;23:131-3.
] [Full text]
Habbu SG, Krishnappa P. Effectiveness of oral health education in children – A systematic review of current evidence (2005-2011). Int Dent J 2015;65:57-64.
Garbin C, Garbin A, Dos Santos K, Lima D. Oral health education in schools: Promoting health agents. Int J Dent Hyg 2009;7:212-6.
Locker D. Concepts of oral health, disease and the quality of life. In: Slade GD, editor. Measuring Oral Health and Quality of life. Chapel Hill: University of North Carolina, Dental Ecology; 1997. p. 11-23.
Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st
century – The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23.
Jackson SL, Vann WF Jr., Kotch JB, Pahel BT, Lee JY. Impact of poor oral health on children's school attendance and performance. Am J Public Health 2011;101:1900-6.
Naito M, Yuasa H, Nomura Y, Nakayama T, Hamajima N, Hanada N. Oral health status and health-related quality of life: A systematic review. J Oral Sci 2006;48:1-7.
Sheiham A. Dental caries affects body weight, growth and quality of life in pre-school children. Br Dent J 2006;201:625-6.
St. Leger L. Reducing the barriers to the expansion of health promoting schools by focusing on teachers. Health Educ 2000;100:81-7.
Smith BJ, Potts-Datema W, Nolte AE. Challenges in teacher preparation for school health education and promotion. Promot Educ 2005;12:162-4.
Jourdan D, Mannix McNamara P, Simar C, Geary T, Pommier J. Factors influencing the contribution of staff to health education in schools. Health Educ Res 2010;25:519-30.
Ramroop V, Wright D, Naidu R. Dental health knowledge and attitudes of primary school teachers toward developing dental health education. West Indian Med J 2011;60:576-80.
Al Dosari AM, Wyne AH, Akpata ES, Khan NB. Caries prevalence and its relation to water fluoride levels among schoolchildren in central province of Saudi Arabia. Int Dent J 2004;54:424-8.
Al Agili DE. A systematic review of population-based dental caries studies among children in Saudi Arabia. Saudi Dent J 2013;25:3-11.
Idrees MM, Azzeghaiby SN, Hammad MM, Kujan OB. Prevalence and severity of plaque-induced gingivitis in a Saudi adult population. Saudi Med J 2014;35:1373-7.
Ammar Ahmed Siddiqui, Hazza Al Hobeira, Asaad Javaid Mirza, Adel Khalid Alshammari, Bader Ayed Alshammari, Nawaf Hamoud Alsalwah, et al.
Dental fluorosis in Saudi Arabia: A review of current literature. Ann Int Med Den Res 2017;3:DE44-9.
Al-Malik MI, Rehbini YA. Prevalence of dental caries, severity, and pattern in age 6 to 7-year-old children in a selected community in Saudi Arabia. J Contemp Dent Pract 2006;7:46-54.
Khan NB. Treatment needs for dental caries in schoolchildren in Riyadh, Saudi Arabia. A follow up study of the oral health survey. Saudi Med J 2003;24:1081-6.
Natto S, Baljoon M, Bergström J. Tobacco smoking and periodontal health in a Saudi Arabian population. J Periodontol 2005;76:1919-26.
Sabbagh HJ, Mossey PA, Innes NP. Prevalence of orofacial clefts in Saudi Arabia and neighboring countries: A systematic review. Saudi Dent J 2012;24:3-10.
Al-Hashem A. Health education in Saudi Arabia: Historical overview. Sultan Qaboos Univ Med J 2016;16:e286-92.
Baghdadi ZD. Improving oral health status of children in Tabuk, Saudi Arabia. Dent J 2014;2:22-40.
Allensworth D, Wyche J, Bradley BJ, Caldwell DR, Dryfoos JG, Lawson E, et al
. eds. Defining a Comprehensive School Health Program: An Interim Statement Washington, DC: Institute of Medicine, National Academy Press; 1995. Availabal from: https://www.ncbi.nlm.nih.gov/books/NBK231146
. [Last accessed on 2017 Jan 28].
Perry CL, Kelder SH, Murray DM, Klepp KI. Communitywide smoking prevention: Long-term outcomes of the Minnesota Heart Health Program and the class of 1989 study. Am J Public Health 1992;82:1210-6.
Ellickson PL, Hays RD. On becoming involved with drugs: Modeling adolescent drug use over time. Health Psychol 1992;11:377-85.
Tell GS, Klepp KI, Vellar OD, McAlister A. Preventing the onset of cigarette smoking in Norwegian adolescents: The Oslo youth study. Prev Med 1984;13:256-75.
Petersen PE, Mzee MO. Oral health profile of schoolchildren, mothers and schoolteachers in Zanzibar. Community Dent Health 1998;15:256-62.
Mangalore S, Venkata PK, Basavantappa JS, Preetha S. Knowledge about prevention of oral cancer and gum disease among school teachers in Dharwad, India. Indian J Dent Res 2013;24:279-83.
] [Full text]
Lawal FB, Bankole OO. Oral health awareness and practices of primary school teachers in Ibadan, Nigeria. J West Afr Coll Surg 2014;4:47-65.
Vanka A, Yadav NS, Saxena V, Sahana S, Shanti G, Shivakumar GC. Oral health acquaintance, approach and practices among school teachers in Bhopal, central India. J Orofac Res 2012;2:15-9.
Vidya Sekhar, Sivsankar P, Easwaran MA, Subitha L, Bharath N, Rajeswary K, Jeyalakshmi S, et al.
Knowledge, attitude and practice of school teachers towards oral health in Pondicherry. J Clin Diagn Res 2014;8:ZC12-5.
Sofola OO, Agbelusi GA, Jeboda SO. Oral health knowledge, attitude and practices of primary school teachers in Lagos State. Niger J Med 2002;11:73-6.
Borg MG, Riding RJ. Occupational stress and satisfaction in teaching. Br Educ Res J 1991;17:263-81.
Nyandindi U, Palin-Palokas T, Milén A, Robison V, Kombe N, Mwakasagule S. Participation, willingness and abilities of school-teachers in oral health education in Tanzania. Community Dent Health 1994;11:101-4.
Vivienne C, Tanya FC. I don't have enough time – Teachers' interpretations of time as a key to learning and school change. J Educ Adm 2001;39:266-81.
Ramroop V, Wright D, Naidu R. Dental health knowledge and attitudes of primary school teachers toward developing dental health education. West Indian Med J 2011;60:576-80.
Kwan SY, Petersen PE, Pine CM, Borutta A. Health-promoting schools: An opportunity for oral health promotion. Bull World Health Organ 2005;83:677-85.
Moysés ST, Moysés SJ, Watt RG, Sheiham A. Associations between health promoting schools' policies and indicators of oral health in Brazil. Health Promot Int 2003;18:209-18.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]