Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : February | Volume : 16 | Issue : 2 | Page : ZC35 - ZC40 Full Version

Impact of School-based Online Oral Health Education Programme during COVID-19 Pandemic: A Cross-sectional Study in Riyadh, Saudi Arabia


Published: February 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52611.16005
Rabaa Mahmoud Aboubakr, Abrar Tounsi

1. Associate Professor, Department of Paediatric Dentistry and Dental Public Health, Mansoura University, Mansoura, Egypt. 2. Assistant Professor, Department of Periodontics and Community Dentistry, King Saud University, Riyadh, Saudi Arabia.

Correspondence Address :
Dr. Rabaa Mahmoud Aboubakr,
Associate Professor, Department of Paediatric Dentistry and Dental Public Health, Mansoura University, Mansoura, Egypt.
E-mail: rabaa4444mahmoud@gmail.com

Abstract

Introduction: Oral Health (OH) is essential to general health and quality of life. It is affected by the individual’s experiences and perceptions.

Aim: To evaluate the effect of online Oral Health Education (OHE) programme on OH knowledge level on school students in Riyadh, Saudi Arabia.

Materials and Methods: This cross-sectional study was conducted virtually on school students in Riyadh city, Saudi Arabia, between February 2021 and May 2021. The sample was based on non probability convenience sampling technique in which 489 students participated in the study. The electronic survey consisted of questions about demographics, school characteristics, and OH knowledge. Online OHE was conducted by dental students of Vision colleges via Zoom and Microsoft teams. Collected data were analysed using using IBM, Statistical Package for the Social Sciences (SPSS) version 20.0, IL, USA. Comparison of differences in the mean knowledge scores across different variables was done using Independent t-test for two means and one-way Analysis of Variance (ANOVA) for more than two means. Linear regression analysis was used to analyse the association between knowledge and other variables in a multivariate environment, and presented by β coefficients and 95% Confidence Interval (95% CI). Significance level was set at p-value <0.05.

Results: Online education had significantly increased the level of knowledge about OH compared to no education (β: 0.46, 95% CI: 0.01, 0.89, p-value=0.04). Students in public schools had significantly higher level of knowledge about OH compared to private schools (β: 0.60, 95% CI: 0.10, 1.11, p-value=0.02). Compared to ‘1st to 3rd grade’, students in ‘middle to high grades’ had significantly lower knowledge about OH (β:-1.17, 95% CI:-1.87,-0.47, p-value=0.001).

Conclusion: It was concluded that the online health education programme increased the OH knowledge of school students. Students in public schools had higher level about OH compared to private schools’ students. Additionally, primary schools’ children had higher knowledge than middle and higher schools’ children.

Keywords

Coronavirus disease 2019, Distance, Kindergarten, School health promotion

The Oral Health (OH) is an essential part of general health. Growing evidence ascertain the connection between general health and OH (1),(2). Common oral diseases, such as dental caries affect 60-90% of school children worldwide (3). Now-a-days, communities everywhere are in persistent need for dental public health services to reduce this high level of oral diseases.

Oral Health Education (OHE) was defined as “any educational activity which aims to achieve a health-related goal” (4). Knowledge is a mixture of comprehension, experience, judgment, and skill. It refers to the persons’ ability to gain, retain, and utilise information correctly (5). It was found that persons with good OH knowledge had better oral care practices (6). Health education enables people, especially the younger generation, to take more effective control over their own health. Behavioural modification or OHE helps individuals to reduce their OH problems and maintain good OH condition (7). Health education activities are powerful tools that affect the behavioural characteristics of individuals, such as OH knowledge, attitude, practice, eating habits, dental caries, periodontal diseases, and oral hygiene practice (8).

For many decades children were considered as an important target group for dental health education programmes, and schools were the prime places for these programmes, as about one billion children worldwide spend most of their daytime there (8),(9). Schools are considered good places to deliver OHE in combination with other preventive services to achieve optimum OH (10). School dental education programmes can be conducted by dental practitioners using several educational aids, such: charts, leaflets, posters, brochures, models, audio-visual aids, and powerpoint presentations (11).

E-learning is a “broad term that includes any use of computers to support learning process, whether online or offline” (12). E-learning was defined in many ways, one of these definitions is the use of “Internet technologies to deliver a broad array of solutions that enhance knowledge and performance” (13).

Due to Coronavirus disease 2019 (COVID-19) lockdown, the world’s view of education has been changed to replace the old teaching methods by newer ones. In the Kingdom of Saudi Arabia, several schools’ health education programmes were conducted physically (9),(14). However, there was no online OHE programmes performed there. To our best knowledge, this study is the first of its kind in the Kingdom of Saudi Arabia and Arab countries, which used an online OHE programme. Hence, aim of the study was to evaluate the effect of online OHE programmes on OH knowledge level among the school students in Riyadh, Saudi Arabia during COVID-19 pandemic.

Material and Methods

This cross-sectional study was conducted in Riyadh city, Saudi Arabia between February 2021 and May 2021. Approval was obtained from Ethical Committee at Vision colleges in Riyadh city (visi.dent-2021021). As a result of COVID-19 pandemic, the ministries of health and education restricted physical attendance of students to the schools during the previously specified period. Therefore, the programme was conducted online via Zoom and Microsoft teams.

Inclusion criteria: Kindergarten children, and students from ‘1st to 3rd grade’, ‘4th to 6th grade’, and ‘middle to high grades’ who accepted the participation via the activity links were included in the study.

Exclusion criteria: Students who did not accept participation or their families refused their participation were excluded from the study.

Sampling technique and sample size calculation: The sample was based on non probability convenience sampling technique, where schools and students of different grades who agreed and wished to participate were in the study. The required sample size for each group was 199 students which was estimated from the following inputs; two independent groups, with an effect size 0.25 at 5% significance level, and 80% power effect (15). A total of 489 students participated in the present study.

Preparation for the Study

Graduating dental students of Vision colleges in Riyadh city were assigned to conduct their community services among school’s students, and then the students were divided into nearly equal groups (four students each). By the help of the course coordinator of community dentistry and the college’s administrators, the dental students arranged randomly with about 11 public and private schools to implement their programmes.

The programme approvals were obtained from the college and sent by mails to the school Principals. School Principals gave their approval and arranged suitable times for the dental students to conduct their programmes. The school’s administrators sent messages to the children through their social media communication channels to inform them about the time and the programmes links on (Zoom or Microsoft teams). Then students who wished to participate attended our educational programme at the specified time.

Programme activities: The programme activities were offered to all participants, and started by a short animation video about the importance of OH to make the students more attentive during the activity. Then, lectures in the form of powerpoint presentations were given. At the end, two short videos (one about tooth flossing and the other about tooth brushing) were shown to the students. Finally, some interactive prepared questions about OH knowledge from the given lectures were discussed with the students.

Questionnaire

The student’s knowledge level was assessed by self-administered online questionnaire consisting of 17 close-ended questions which was created on Google forms. The students were assigned into two groups to assess the effect of the educational programme: no OHE group (n=288) who filled the questionnaire before the online education programme, and online OHE group (n=201) who filled the questionnaire after the educational programme. In other words, some students filled the questionnaire without receiving the educational programme (no OH education), while others filled it after the educational programme (online OH education).

The questionnaire comprised of two main sections:

1) Demographics and school characteristics, and
2) OH knowledge.

The first section included questions about gender, school type, and schooling grade. Schools were either private or public, and grades were grouped into: ‘kindergarten’, ‘1st to 3rd grade’, ‘4th to 6th grade’, and ‘middle to high grades’. OH knowledge was assessed using 14 multiple choices questions which covered basic information about OH, oral hygiene practice, and certain habits that affect the teeth. The knowledge questions included the number of permanent and primary teeth, foods and drinks that affect the teeth, frequency and duration of teeth brushing, the recommended type of tooth brush, frequency of its replacement, direction of tooth brushing, fluoride and the recommended frequency of dental visits. The questionnaire was obtained from previously published works after obtaining authors’ permission (14),(16),(17). Survey questions were pretested in previous studies (14),(16). Then, our questionnaire was also pretested on a sample of school students after Arabic translation of some questions. For kindergarten students, educators read and explained the questions. In addition, questionnaire for this group was supplemented by figures to help in improving their comprehension. Knowledge score was calculated as the number of correct questions out of the 14 knowledge questions [Annexure -1].

Statistical Analysis

Student’s responses were saved in spreadsheets and downloaded from Google forms, then these data were analysed using IBM, SPSS version 20.0, IL, USA. The level of significance was set at p-value <0.05. Descriptive analysis was conducted using frequency with percentage for nominal variables and mean with standard deviation for continuous variables. Differences in mean knowledge scores across different variables were done using Independent t-test for two means and one-way Analysis of Variance (ANOVA) to compare between more than two means. Linear regression analysis was used to analyse the association between knowledge and other variables in a multivariate environment and presented by β coefficients and 95% CI.

Results

Out of 636 students, a total of 489 students within age 5 to 18 years participated in this study with a response rate of 76.9%. Gender was equally distributed in the selected sample with 254 (51.94%) girls and 235 (48.06%) boys. About 60.33% (n=295) of the participants were from private schools while 39.67% (n=194) from public schools. For grades distribution, the highest number of participants was in ‘1st to 3rd grade’ (n=194, 39.67%), followed by ‘middle to high grades’ and ‘4th to 6th grade’ (n=180, 36.81% and n=98, 20.04%, respectively), and least was among ‘kindergarten’ (n=17, 3.48%).

About 58.89% (n=288) did not receive online OHE, and 41.10% (n=201) received the online OHE. The knowledge about OH score ranged between 2 and 14 with mean of 8.75±2.18. When compared by OHE (Table/Fig 1), significantly higher percentage of girls received online education compared to boys (58.66% and 22.13%, respectively; p-value <0.0001). In addition, significantly higher percentage of ‘middle to high grades’ students received the online education (70%) compared to ‘1st to 3rd grade’ (19.07%) and ‘4th to 6th grade’ (33.67%) at p-value <0.0001. Significantly lower percentage of students from private schools received online education compared to public schools (25.76% and 64.43%, respectively; p-value <0.0001).

The mean score for OH knowledge across variables of interest is presented in (Table/Fig 2). There was no statistically significant difference in knowledge between who received online education (8.83±2.36) and who did not (8.69±2.04). However, when this difference was stratified by gender, girls had significantly lower knowledge (8.63±2.37) compared to boys (9.38±2.27) among who received online OHE at p-value=0.04. There was no statistically significant difference among students who received online education by grade. Among online OH education, students from public schools scored significantly higher knowledge about OH compared to private schools (9.15±2.15 and 8.29±2.60, respectively) at p-value=0.01.

The relationship between OH knowledge and other variables was further assessed in a multivariate model (Table/Fig 3). The online education group had significantly higher level of knowledge about OH compared to no education (β coefficient 0.46, 95% CI: 0.01, 0.89, p-value=0.04) after accounting for other related variables in the model. Students in public schools had significantly higher level of knowledge about OH compared to private schools (β coefficient 0.60, 95% CI: 0.10, 1.11, p-value=0.02). Compared to ‘1st to 3rd grade’, students in ‘middle to high grades’ had significantly lower knowledge about OH (β coefficient -1.17, 95% CI: -1.87, -0.47, p-value=0.001) when other variables in the model were held constant.

Discussion

Schools’ dental health education programme is one of the easiest and cheapest OH promotion methods. OHE is the first level of the four levels of OH promotion intervention evaluation methods as reported by Nutbeam D (18). It was mentioned before that individuals’ behaviour can be changed by exposure to health educational messages (19). Several studies cleared the roles of OHE programmes and their effect on OH behaviour and attitude, especially for the primary school children which can be temporary improved irrespective of the educational method followed (20),(21),(22),(23).

According to our findings, online OH education was associated with higher mean knowledge score in comparison to no OH education (β: 0.46, 95%CI: 0.01, 0.89, p-value=0.04). This finding was supported by multiple previous studies (24),(25),(26). For example, D’Cruz AM and Aradhya S reported significant improvements in OH knowledge at different intervals among the experimental group who received OHE (change at 3 months: 58.61%, at 6 months: 105.91%, and at 9 months: 123.39%; p-value <0.001) (24). In addition, the present study results were in line with Swe KK et al., who reported that active participation of school children in repeated OHE programmes can improve their oral hygiene knowledge (percent change of intervention group at 1 year: 54.69%, and at 1.5 years: 66.12%; p-value <0.001) (25). Moreover, a study in Indonesia assessing the effect of school-based OHE programme showed a moderate positive effect on students’ OH knowledge (26). The improvement in OH knowledge is expected to lead to an enhancement in OH measures, which was supported by Hart E and Behr M who demonstrated that continual OHE programmes effectively maintained OH behaviour and regular dental check-ups (27).

A study was conducted in Pakistan and cleared that one-time teacher-centred OHE was insufficient to improve OH knowledge, behaviour, and oral hygiene status of school students when compared to repeated and reinforced programmes (28). This could partially explain our slight improvement in knowledge level between the two study groups (8.69 and 8.83, for no OH education and OH education groups, respectively). Ideally, schools OHE programmes should be repeated over a period to enhance the students’ health knowledge and behaviour as concluded from several studies (23),(24). Another point to clear here is the nature of our online programme with some technical problems like internet connection or interruption from participated young children. The present study findings emphasise also that online education is less effective than physical education for these age groups.

In the present study, the mean knowledge score of girls who received the OHE was significantly lower than boys (8.63±2.37 and 9.38±2.27, respectively; p-value=0.04). However, the multivariate analysis revealed insignificant difference in OH knowledge across gender. This finding was contradicted by Al Saffan AD et al., as they found that non Saudi females showed significantly higher mean knowledge at post-test assessment and explained their results by the higher interest in self-care and appearance of females than in males (9).

The findings of the present study revealed statistically significant difference in the knowledge score between students who received and did not receive OHE in the public schools. The mean knowledge score among those who received OH education in the public schools was also higher than that in the private schools (9.15±2.15 and 8.29±2.60, respectively; p-value=0.01). Public schools are more targeted by health education programmes conducted by dental schools or medical centres, as often students in public schools comes from lower socio-economic level compared to private schools. Thus, students in public schools are frequently exposed to OHE programmes and this explains their higher knowledge level than their counterparts.In the online OHE group, there were generally higher mean knowledge scores in all school grades compared to no education, except among kindergartens group. The present study finding matched with Halawany HS et al., who reported significant improvement in knowledge scores among their students from the 1st grade to the 3rd grades (14). Also, Hartono WA et al., revealed moderate improvement in the knowledge score among 8 to 12-year-old children (26). In addition, Sriarj W et al., reported an improvement among 3rd grade students after three follow-up months of their OHE programme (29).

Young children in kindergarten, due to parental involvement, are usually highly interactive and interested (30). However, there are several factors that may lead to the lack of difference in OH knowledge among kindergarten. First, their number in our sample was too small to make judgement; second, their limited ability to read without assistance could probably influence their ability to fill the questionnaire; third, the attention span using the online teaching for this age group is limited (31). Comparison of the findings of this study with previous studies has been done in (Table/Fig 4) (9),(14),(24),(25),(26),(27),(32),(33),(34),(35).

Limitation(s)

The present study has some limitations. The use of non random sample may affect the generalisability of the findings. In addition, future studies are recommended to use self-control (pre and post education) to clarify the effectiveness of online OH education after controlling for other factors related to OH knowledge, such as socio-economic status and parental education. The introduction of online OHE programmes was accompanied by technical issues related to the internet connection. Such unavoidable problem could have limited the effectiveness of the OHE programme.

Conclusion

Online health education programme improved the OH knowledge of school children. Students in public schools had higher knowledge level about OH compared to private schools’ students. Surprisingly, primary schools’ children had higher knowledge than middle and higher schools’ children. Within this study’s limitations, online health education can be considered as a useful tool for increasing OH knowledge for most of school students during the pandemic.

It is recommended to conduct longitudinal follow-up studies utilising a representative sample to improve the generalisability of study results. For kindergartens’ children, parents should be involved in OHE programmes to enhance children’s attention engagement.

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DOI and Others

DOI: 10.7860/JCDR/2022/52611.16005

Date of Submission: Sep 27, 2021
Date of Peer Review: Oct 30, 2021
Date of Acceptance: Dec 30, 2021
Date of Publishing: Feb 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

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