Shiraz E Medical Journal, Vol. 14, No.

1, January 2013

Shiraz E-Medical Journal

Vol. 14, No. 1, January 2013

The Effect of Digital Media Programs on the Oral Health Promotion in the
Health Office: A Quasi-Experimental Study

Fatemeh Mohamadkhah 1, Farkhondeh Amin Shokravi 1*, Sograt Faghihzadeh 2,

Saeideh Ghaffarifar 3

1
Department of Health Education, Faculty of Medical Sciences, Tarbiat Modares Uni-
versity, Tehran, IR Iran
2
Department of Biostatistic, Faculty of Medical Sciences, Tarbiat Modares Univer-
sity, Tehran, IR Iran
3
Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz,
IR Iran

*
Corresponding Author: Farkhondeh Amin Shokravi, Faculty of Medicine, Depart-
ment of Health Education, Tarbiat Modares University, Tehran, IR Iran, Tel: +98-
9122505977, Fax: +98-21 82883817, E-mail: [email protected]

Received for Publication: November 19, 2012, Accepted for Publication: March 23, 2013

Abstract
Introduction: Regular using of the toothbrush, mouthwash and dental floss is useful
in prevention and treatment of the oral diseases.
Aims: This paper examines the impact of an educational film on the promotion of the
student’s oral health behavior.
Methods and Material: This research was conducted in Chabahar in 2011-2012, on
10-12 year old girls .Three hundred students were randomly assigned to three groups
of 100. The type of the intervention included film and lecture. Post tests were con-
ducted in two phases: immediately and 3 months after the first intervention.
Statistical analysis used: The research data from valid and reliable researcher-made
questionnaire was analyzed by the SPSS Version 16 using One-way Analysis of
Variance (ANOVA) and Mann-Whitney U tests. The study was approved by the
ethical committee of Tarbiat Modares University.
Results: The highest rate of the birth order in the study population was two, mean age
of students was 11 years, and the mean number in each family was five. The average
education level of mothers and fathers was illiterate and literacy respectively. The ma-
jority of fathers were unemployed and mothers were housewives. Most of the families
had private housing. Mean decayed missed filled teeth (DMFT) was: 1.46 + 1.66 .The
level of the knowledge and attitude about teeth brushing was increased immediately

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 Shiraz E Medical Journal, Vol. 14, No. 1, January 2013

and after the intervention (P-value < 0/001).The rate of practice increased after 3
months (P < 0/001). The level of the knowledge and attitude about dental flossing
increased immediately and after 3 months. The rate of the practice did not increase
after 3 months (P < 0/46) .
The level of the Knowledge about using the mouthwash increased immediately after
the intervetion and after 3 months(P < 0/003). The rate of the practice did not increase
immediately after the intervetion (P < 0/43). The film intervention was effective on
the students’ Knowledge immediately and 3 months after the intervention(P < 0/025).
The film effectivelly influenced students’ attitude both immediately and 3 months
after the intervention(P < 0/028). Taken all together the study shows that the oral
health practice is worse in the families with the lower socio-economic situation.
Conclusions: Using educational film could be effective in promoting students’ self-
care behaviors.

Keywords: Education; Educational Lecture; Digital Media.

KeyMessages: Oral health self-care methods like using dental floss, brushing and
fluoride therapy are effective techniques for preventing the dental decay and
periodontal diseases. It seems educational interventions could change unhealthy habits
and prevent oral diseases in people who may not brush and floss routinely. In this re-
gard, some scholars and experts have introduced media, especially visual media as
one of the most important methods in oral health education. The results of this study
confirmed the effectiveness of educational film in promoting students’ self-care
behaviors.

Introduction Despite the considerable efforts in the

Oral health is an integral part of public developing countries, the level of the
health as well as one of the most im- dental decay has increased because of
portant cores in health education (1, 2). dietary changes and has remained more
Oral health level significantly affects prevalent in some developing countries
the quality of one’s life and enables (5).
him/her to be self-confident, well Self-care methods pertaining to oral
communicate with others, chew food health like using dental floss, brushing
with any problem and socialize without and fluoride therapy are effective
any diseases, discomfort and embar- techniques for preventing the dental
rassment (3). Because the oral diseases decay and periodontal diseases (6).
can lead to irreversible damages and Changing unhealthy habits and prevent-
unnecessary pains and the severe con- ing oral diseases seems to have a cru-
sequences including dental, public cial role in educational interventions
health problems, low self-esteem, poor with a special focus on the people who
quality of life and chronic infections may not brush and floss regularly. The
(2, 4). health education is one of the most im-

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 Shiraz E Medical Journal, Vol. 14, No. 1, January 2013

portant responsibilities of health educa- Videos related to the children develop-

tors in preventing the oral health dis- ment stages are appropriate for educa-
eases (7). In this regard, the use of me- tional purposes in students (13).
dia, especially visual media has been In order to achieve objectives in the
introduced by some scholars and ex- psychomotor domain, the application
perts, all over in the world, as one of of moving pictures could be useful in
the most important methods in health terms of: (14)
education (8). 1- Significant educational objectives
Ascending trend in the use of technol- have been set, and film content is
ogy gives the necessary opportunity to educational.
the learners to learn more , better per- 2- The content of the film has been
form, accelerate their learning pace, synchronized with students’ previ-
and have great experience of satisfac- ous information.
tion when attending the training ses- 3- Students’ educational and recrea-
sions (9). A multimedia training pack- tional interests and needs have been
age for learners' with low knowledge considered in providing of the film.
and skills in the field of learning has 4- The film message has been propor-
been proven to be effective (10). Video tionally tailored to the target group
tutorial is a communication multimedia of students.
that actually provides facts, ideas, atti- 5- The film is able to force the students
tudes and experiences to the public in to think about and reflect on it.
the form of a drama or simulation. 6- The film motivates students to do
Film education is very effective in some pertinent researches in order
adult education. A film that is de- to learn more and share their infor-
scribed as the premier instructor which, mation with the peers.
trains with both verbal and none - ver- 7- The film should be flexible with
bal cues (11). Many universities in- students’ free time.
clude using some educational films in Researchers have demonstrated that
their curriculums. Besides, some re- short videos will have higher educa-
ports have been published to help the tional impacts (13). In this regard, Ira-
teachers in using the films in the class- nian ministry of Health seeks to evalu-
rooms, like the recent book of “Why ate the impact of educational digital
and how do we use educational films?” media that have been prepared by dif-
(12). ferent universities across the country.
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 Shiraz E Medical Journal, Vol. 14, No. 1, January 2013

contents of using the self-preventive

oral behavior (necessity of brushing,
flossing and mouthwash after food and
regular visits of a dentist) in group 2.
Subjects and Methods The film in this study had been
This quasi-experimental intervention previously approved by Iraninan
conducted on the 300 female students Ministry of Health in order to promote
who were in Chabahars’ primary the oral health among the students of
schools .The sample size was calcu- elementary schools, but its educational
lated by α = 0.05; power = 0.8; vari- impact had not been evaluated before.
ance: 6.35 according to Taslimi M’s The impact of the educational media
study using this equation1. on students’ knowledge, attitude and
practice was evaluated after giving the
education to the elementary students in
Chabahar and its effectiveness was
Equation 1. Pocock and simon method
compared with the impact of the
The students were selected by cluster
lecture with exactly the same content
sampling from the fourth and fifth-
of the film. In This article, only the
graders in the primary schools in Cha-
impacts of the educational film are
bahar, and were randomly assigned to
discussed.
3 different groups: control group; in-
Pre-tests were conducted in all 3
tervention group 1, and intervention
groups. Then intervention was com-
group 2.
pleted in intervention groups with no
Considering the level of the question-
interference in the control group. The
naire the students in grade 4 and 5
impacts of the educational oral health
were selected for this study. The three
program were measured on the aspects
groups were matched in the demo-
of the health knowledge, attitude and
graphic variables such as; family back-
practice immediately and 3 months af-
ground, the father's job and the living
ter the intervention. The data collected
areas.
by researcher-made validated and reli-
The intervention consisted of 23
able questionnaire (α = 0/80, CVR =
minutes and 7 seconds of showing the
0.52 and CVI = 0.83).
educational film in group 1 and the
The questionnaire was composed of
lecture about the oral health whit the
five sections:
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 Shiraz E Medical Journal, Vol. 14, No. 1, January 2013

1- The demographic data: This section for conducting, the researcher at-
included the questions about birth tempted to use a laptop to show the
orders, family size, parental literacy film, and a board and markers to have
level, occupation and living area of a description on students’ questions. In
the parents. order to make the students fully under-
2- Seven Questions relating to the stand the objectives of the project was
knowledge: to measure the knowl- fully read and explained for the stu-
edge with 7 multiple choice ques- dents.
tions with the same weight in terms The data was collected at three differ-
of scoring. ent times: prior to intervention, imme-
3- Questions about the attitude: This diately and 3 months after the interven-
section included 7 questions to tions. The results were analyzed using
measure students’ attitude based on SPSS (Statistical Package for Social
a three-part Likert scale. Sciences) version 16. With the level of
4- Questions related to the practice: significance: P < 0/05 in the statistical
This section included 4 multiple tests of ANOVA, the Mann-Whitney U
choice questions with the same val- and the Pearson Correlation Coeffi-
ue in terms of scoring to document cients’. This paper examines the effect
students’ practice. of the educational film on the promo-
5- The final section included a ques- tion of the student’s oral health behav-
tion about the source of students’ ior.
information in the oral health be- Results
haviors. The highest rate of the birth order in
The intervention included an eight the study population was two, mean
minute film based on the concepts of a age of students was 11 years, and the
product called Gandomak Zalzalak de- mean number in each family was five.
veloped by Golestan University. The The average education level of mothers
second part of this study was done to and fathers was illiterate and literacy
compare the same educational content respectively. The majority of fathers
which was transferred via a lecture. were unemployed and more than half
Considering the people poverty in the of the mothers were housewives. Most
study area and lack of access to mod- of the families had private housing.
ern aid educational tools, and students’ Mean DMFT was: 1.46 + 1.66
classroom as the only space available
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 Shiraz E Medical Journal, Vol. 14, No. 1, January 2013

The demographic variables of the intervention and it was reduced to 1.79

study population are shown in Table 1. after 3 months of the intervention
According to Mann -Whitney U test, which was statistically significant (P <
the level of the Knowledge about 0/001). The same trend happened for
brushing was 1.94 before the educa- flossing (Table 2) and using the
tional film and it was increased imme- mouthwash (Table 3).
diately after the intervention to 2.11. About visiting the dentist the knowl-
Then it was reduced to 1.96 after 3 edge changed from 1.93 to 2 and 2.06;
months which was not statistically sig- the rate of the attitude from 1.86 to
nificant. The level of attitude was 2.34 2.05 and to 2.08 (P < 0/028), also, the
before the intervention and it was in- rate of the practice from 2.07 to 2.02
creased to 2.55 immediately after the and to 1.92 (P < 0/034) (Table 4).
intervention. Then it was reduced to Totally, 79/6% of the students, didn’t
1.10 after 3 months. This reduction use dental floss and79%, didn’t use
was statistically significant (P < mouth wash because didn’t have those.
0/001). The level of the practice was The majority of the students (87/6%)
2.04 before the intervention and it was were not able to afford visiting a den-
increased to 2.18 immediately after the tist.

Table 1. The Demographic Variales of the Study Population

Variable Number or attribute (percent %)

10 year old (46/3%)
Students’ age
11 year old (53/7%)
1 (20%)
2 (23.3%)
Birth order of the students
3 (20.3%)
4 OR 5 (19.7%)
6 And more (16.4%)
3 or less (16.7%)
4 (14.3%)
5 (17%)
The family number
6 (14.7%)
7 (11%)
8 or more (12%)
Illiterate (21.3%)
Primary (26%)
The level of fathers’ education
Guidance (20%)
Diploma and above (32.6%)
Illiterate (43.7%)
The level of mothers’ education
Primary (31.7%)

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 Table 2. Distribution of the Mean and SD of the Knowledge, Attitude and Practice of

Table 3. Distribution of the Mean and SD of the Knowledge, Attitude and Practice of

8
0/79
1/96

The rate of the practice 3 The rate of the practice 3

months after the intervention months after the intervention
0/75
2/08
The rate of the practice imme- The rate of the practice imme-
Diploma and above (11.6%)

diately after the intervention diately after the intervention

Non- Housewives (23.6%)

P < 0/46
Private housing (51.7%)

0/80
1/96
The rate of the practice before The rate of the practice before
Housewives (76.3%)
Shiraz E Medical Journal, Vol. 14, No. 1, January 2013

Unemployed (25%)

the intervention the intervention

Employee (25.7%)
Guidance (13%)

Worker (19.7%)

Other (15.7%)

0/83
2/08
The rate of the attitude 3 The rate of the attitude 3
Rent (32.7%)
Free (29.7%)

months after the intervention months after the intervention

1/13
2/10
The rate of the attitude imme-

Using Mouthwash in the Educational Film Group

The rate of the attitude imme-

P < 0/008
diately after the intervention
diately after the intervention

0/93
1/82
The rate of the attitude before
The rate of the attitude before
the intervention
Flossing In the Educational Film Group the intervention
The rate of the knowledge 3

0/86
2/10
months after the intervention The rate of the knowledge 3
months after the intervention
The rate of the knowledge
The rate of the knowledge

2/17

0/82
immediately after the inter-
immediately after the inter-

The P < 0/001

vention
vention

1/73
The rate of the knowledge be-
The rate of the knowledge be-

1
fore the intervention
Mothers’ Job
fore the intervention
Fathers’ job

Result
Mean
Housing

The

The
SD
The educational film group Flossing
The educational film group
 Shiraz E Medical Journal, Vol. 14, No. 1, January 2013

Using the mouth- The 1/93 2/07 2/01 1/92 2/13 1/95 2/01 2/14 1/85
Mean
The 0/60 0/48 0/64 0/64 0/59 0/70 0/67 0/75 0/77
wash

SD
The P < 0/003 P < 0/049 P < 0/43
Result

Table 4. Distribution of the Mean and SD of the Knowledge, Attitude and Practice of
Regularly Visiting the Dentist in the Educational Film Group.
The educational film group

fore the intervention

The rate of the knowledge be-

vention
immediately after the inter-
The rate of the knowledge
months after the intervention
The rate of the knowledge 3

the intervention
The rate of the attitude before

diately after the intervention

The rate of the attitude imme-

months after the intervention

The rate of the attitude 3

the intervention
The rate of the practice before

diately after the intervention

The rate of the practice imme-

months after the intervention

The rate of the practice 3
The 1/93 2 2/06 1/86 2/05 2/08 2/07 2/02 1/92
Visiting the

Mean
The 0/62 0/55 0/53 0/67 0/67 0/57 1/02 1/06 1/04
SD
The P < 0/25 P < 0/028 P < 0/34
Result

Discussion revealed the efficacy of education in

The results of this study represented reducing the plaque index (16). Or the
that there was a significant difference study of Malek Afzali and collegues in
between the health behavior of the stu- 2001 which reported that the health
dents who had received the health edu- education by the health volunteers
cation in the school and those who had could increase the health knowledge in
been deprived of health-related ser- the villages (17).
vices and activities in the school. This The Results of Birang and colleagues’
was in concordance with the conclu- study showed that students' knowledge
sion of Ilia and Ibonos’ study which about the oral health had significantly
showed that the health education had increased immediately and a month
positively changed the behavior of the after watching the educational film.
intervention group (15). As the study (18). The level of the Knowledge and
of Lafzi A and colleagues in 2005, this Atitute about flossing and brushing the

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 Shiraz E Medical Journal, Vol. 14, No. 1, January 2013

teeth had been increased immediately In this study population, the mean
and 3 months after the intervention (P DMFT was 1.46 + 1.66. This index in
< 0/001). The rate of practice had been Iran globally among students at all lev-
increased after 3 months (P < 0/001). els of education was 1.5 in 1379-1380
The result of the present study (24). According to the students in our
supported by PRIDEAUX study (19). study, 79.6% of them didn’t use dental
Dennis and colleagues’ study in 2002 floss and 79% of them didn’t use
revealed that the use of multimedia mouth wash because didn’t have them.
methods was effective on the change of 87/6% didn’t go to see the dentist be-
the learners’ attitude. Because the cause they could not afford it. Taken
learners ccould take the advantage of altogether the results of this study
the educational CD based on their best showed that oral health performance is
time at any time (20). worse in the families with the lower
Another study titled showed that media socio-economic situation. Also, Oliver
can play an important role in creating a in Brazil (25) Zarringhalam in Mash-
realistic and high quality learning had (26) Albander (27) and McDoland
environment. Besides, it allows the (4) found that the oral health status of
teacher to have greater control over the the students with the lower socioeco-
learner, especially over the educational nomic status were worse than the oth-
classes with a large number of learners, ers. Aida in Japan showed that there
and it increases the learner ability in was a significant relationship between
learning new sciences an skills (21). the parent’s occupation and the As,
In Marilan’ study Learners could Fallahinadjad stated that there was a
remind 56 percent of all the content in significant relationship between the
an tailored educational video and 36 amount of the students’ knowledge and
percent of all the information while attitude and their parent’s occupation
watching TV. It means eductional and in Zahedan (28). Henrie Treadwell
films could bring long-term effects on believes that 80 percent of the tooth
learners’ knowledge (22). Also, the decay occurs in children who are poor
studies by Kolz in 1996 and Aley in (27).
2004 confirmed the usefulness of vis- A study in Ahvaz showed that students
ual media such as showing a film on who had received the heath informa-
changing the knowledge and attitude of tion from their teachers had better oral
the audience (23). health behaviors (29).
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 Shiraz E Medical Journal, Vol. 14, No. 1, January 2013

According to Zafarmand’s research in health for the year 2010*. International

Dental Journal. 2000;50(5):245-9.
Tehran the most important sources of 4. Dean JA, Avery DR, McDonald RE.
McDonald and Avery dentistry for the
students’ information were their school child and adolescent: Mosby; 2010.
5. Petersen PE, Lennon MA. Effective use of
and teachers (30). fluorides for the prevention of dental caries
Conclusions in the 21st century: the WHO approach.
Community dentistry and oral epidemiol-
It is hoped that the results of this study ogy. 2004;32(5):319-21.
6. Bratthall D, Hansel-Petersson G, Sundberg
could help the relevant authorities to H. Reasons for the caries decline: what do
the experts believe? Eur J Oral Sci.
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5, 30-2. Epub 1996/08/01.
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learning: using the same instructional de-
Therefore, it is recommended to use sign methods across different media.
Learning and instruction. 2003;13(2):125-
the educational intervention to improve 39.
11. Schultheis MT, Rizzo AA. The application
the oral health status of the students. It of virtual reality technology in rehabilita-
tion. Rehabilitation Psychology.
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Acknowledgments multimedia mathematics learning. Journal
of Educational Psychology.
This article has been extracted from the 2004;96(3):492-503.
master's thesis in Tarbiat Modares 14. Fleming ML. Instructional message design:
Principles from the behavioral and cogni-
University. Hereby; we appreciate all tive sciences: Educational Technology;
1993.
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