Meta-analysis of the effectiveness of educational interventions on dental and oral health promotion in Iran
Department of Dental, Isfahan Medical Science University, Isfahan, Iran
|Date of Submission||15-Sep-2018|
|Date of Acceptance||23-Oct-2018|
|Date of Web Publication||15-Feb-2019|
Ms. Niloufar Abedi
Department of Dental, Isfahan Medical Science University, Isfahan
Source of Support: None, Conflict of Interest: None
INTRODUCTION: Dental and oral health is a core component of general health and well-being. Few aspects of health are as accessible to personal control as oral hygiene which can be improved by simple behavioral changes. In recent years, dentists in the field of oral and dental health improvement have been research doing for measurement of validity and efficiency of available educational interventions. In this regard, meta-analysis integrates the results of different studies then determines the effect size of educational interventions. This study seeks to investigate the effective educational interventions on improving oral and dental health improvement in Iran by following the meta-analysis model.
MATERIALS AND METHODS: The present research was a meta-analysis study. This research by using the technique of meta-analysis to integrate the results of different studies, to determine the effect size of an educational intervention on improving oral and dental health improvement in Iran. Seventeen studies accepted in methodology were collected in Iran during 2001–2018, and analyzed through meta-analysis. The research tool was meta-analysis checklist. Effect size for each study was manually calculated.
RESULTS: The study findings showed that the rate of the effect size of educational intervention on Improving Oral and Dental Health Improvement in Iran was 0.62 (P ≤ 0.008) which according to Cohen's table was intermediate.
CONCLUSION: Findings of this meta-analysis support of the effectiveness of educational interventions on improving oral and dental health improvement in Iran. It seems that the educational interventions on improving dental and oral health can be used as a method for improving oral and dental health in Iran.
Keywords: Dental and oral health, educational intervention, meta-analysis
|How to cite this article:|
Abedi N. Meta-analysis of the effectiveness of educational interventions on dental and oral health promotion in Iran. J Edu Health Promot 2019;8:29
|How to cite this URL:|
Abedi N. Meta-analysis of the effectiveness of educational interventions on dental and oral health promotion in Iran. J Edu Health Promot [serial online] 2019 [cited 2019 Aug 21];8:29. Available from: http://www.jehp.net/text.asp?2019/8/1/29/252340
| Introduction|| |
One of the important development indicators of countries is the level of health and well-being of the population so that the healthy and capable people are the largest national capital of a society., The World Health Organization (WHO) considers oral hygiene as a necessity and part of a general health system throughout life, stating that poor oral health can have an impact on quality of life., Oral hygiene can also be defined as no chronic pain in the mouth and face, head-and-neck cancers, respiratory failure such as cleft lip and palate, gum diseases, tooth decay, and their loss, and other diseases and defects affecting the oral cavity. A healthy mouth can make talking, eating and feeling well in a community without discomfort. Oral problems are divided into several groups, the most common of which are decay and periodontal diseases. Usually, the human mouth is more likely to develop disease than the other organs and tissues in the body and needs care more than other parts of the body. Tooth decay is the most common human disease that affects more than 99% of humans. To control tooth decay, mechanical and chemical methods are used. The mechanical methods include the use of dental floss and toothbrushes, and chemical methods consist of using different types of mouthwash and gels.
Tooth decay (also known as dental caries) is an infectious and multi-functional disease-causing damages to the calcareous tissues of the teeth. It is also the most important factor in tooth loss. Dental and oral health problems are the most important public health concerns in advanced countries and have recently become worrisome in developing countries. Therefore, the WHO has strategies on the agenda to prevent oral diseases and improve oral hygiene needs to enhance global awareness of dental and oral health. Nowadays, in all medical and dental schools in the world, prevention is prior to treatment, and it has been concluded that health education can be the best and most convenient way to ensure the health of the community. Oral and oral health is a step that its main elements are as follows: informing, motivating, and helping people to gain and maintain healthy behaviors and lead to healthy lifestyles. Oral health education can take place in different places, including schools, public places, and homes for the elderly. The goal of oral education is to increase knowledge in a field that may affect health behaviors that reduce dental and oral disability and diseases. Nowadays, with the advancement of science and technology, new materials and methods have been developed for replacing the lost lining of the tissue, none of which have normal tissue function. Therefore, prevention for keeping teeth healthy is considered essential. To achieve this goal, there are theories and methods in health education that can be used to create correct hygiene habits and prevent the development and even progression of dental diseases. Prevention is the only way to prevent tooth decay. Various methods have been proposed in the field of dental and oral health such as brushing using toothpastes-containing fluoride, dental floss, fluoride supplement, and regular referral to dentists. Maintaining oral health is part of the general health aspect, which is simply achieved by changing behavior and education. Poor access to services and poor service quality are challenges for the oral health system. Limited capacity and unjust distribution of education by oral health professionals have led to the prevalence of treatment and dental pain control over prevention. Recent studies in the United States have shown that teaching preventive behaviors such as the use of toothbrushes and dental floss as well as regular examinations, in recent decades in the American community has increased the percentage of people who have been able to maintain their natural teeth at older ages. Due to the increase in immigration from different countries to the United States, the rate of dental caries in people is progressing well; thus understanding and providing a system with regard to the development of oral hygiene are needed. Preventing tooth decay depends on changes in behaviors and attitudes as well as access to services.
Yousefvand et al., Andarkhora et al., Shirzad et al.,
Papurhaji Aqa et al., Mohammadzadeh et al., Amiri et al., Pakpour Hajiagha et al., Karami et al., Heidarnia et al., Heidari et al., Moini et al., Amidi Mazaheri et al. and Zaeri are among the studies have been conducted in the field of oral health improvement in Iran. The above studies have pointed to the effectiveness of educational interventions.
Although educational interventions have had a beneficial effect on dental and oral health, their effects have been reported from low-to-moderate levels. It seems that conducting a meta-analysis will help clarify the real value of the effectiveness of educational interventions on promoting dental and oral health. More straightforwardly, by performing a meta-analysis method, an overview is made on the effectiveness of educational-based interventions on the improvement of oral hygiene and health behaviors in Iran. In fact, this study uses a meta-analysis method to answer the question how is the effectiveness of educational interventions on improving dental and oral health in Iran. Meta-analysis is a statistical technique combining the size of the effects of various researches instead of a particular research hypothesis. Therefore, the present study aims to investigate the effect size of educational interventions on dental and oral health improvement using the meta-analysis research method.
| Materials and Methods|| |
In this research, the meta-analysis method was used based on the research type. Using the meta-analysis method, the results of the research can be combined. The research population consisted of articles published in scientific and research journals that were conducted on the effectiveness of educational interventions on the improvement of dental and oral health in Iran from 2007 to 2017. The search resources were research and scientific journals, the Information Resources Database of Jihad Daneshgahi, and the Iran Documentation Center. The key terms used for searching was dental and oral health and educational interventions. Only Persian sources and researches conducted in Iran were studied. Thirteen studies were included in the study, but some studies had two interventions. Hence, a total of 17 pieces of research entered into the meta-analysis.
The studies must had the following inclusion criteria for meta-analysis: the necessary requirements in terms of methodology (hypothesis, research method, population, sample size, sampling method, measuring instrument, validity and reliability of measurement instruments, statistical hypotheses, statistical analysis, and statistical accuracy); research subjects of educational interventions for dental and oral health improvement; the studies must be conducted in the form of a group research; they must be conducted using the experimental and semi-experimental research designs; and they must report the effect size or the data necessary for its calculation. The exclusion criteria were as follows: not having methodological conditions; case studies, review studies, correlational and descriptive studies, and not reporting the effect size or the data necessary for its calculation.
The data were collected using a content analysis checklist for meta-analysis that included the components such as the research title, the researchers' characteristics, year of publication, place of publication, hypotheses, research instruments, statistical population, sample size, and significance level. The steps to conduct this meta-analysis are based on comprehensive meta-analysis software, Meta-Analysis V2.0 statiscal software.developed by Biosta-Inc-in, USA. Therefore, according to the list of research in the field and referring to them, as well as considering the mentioned criteria, 17 studies were approved. The effect size of each research was calculated by having a mean, variance, and standard deviation values of the groups. The effect size represents the standardized difference between the means of the test and control groups. For calculating the effect size, the ratio of the difference between the mean scores of the test and control groups has to be obtained on the merged variance of total scores.,
Descriptive characteristics and results of the studies conducted on the effectiveness of educational interventions on dental and oral health improvement in Iran are presented in [Table 1].
|Table 1: Characteristics of the studies having been investigated in the meta-analysis|
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| Results|| |
The characteristics of the studies used in the meta-analysis of the effectiveness of educational interventions on the dental and oral health improvement in Iran are reported in [Table 1]. The results of the meta-analysis of the effectiveness of educational interventions on the dental and oral health improvement in Iran are reported in [Table 2].
|Table 2: The results of the meta-analysis of the effectiveness of educational interventions on the dental and oral health improvement in Iran|
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[Table 2] shows the meta-analysis study of educational interventions on the dental and oral health improvement based on 17 pieces of research. The average overall effect size of studies regarding the effectiveness of educational interventions on the dental and oral health improvement in Iran is 0.31, which is statistically significant at 0.001. This effect size was interpreted in accordance with the interpretation of Cohen's d table.
To investigate the heterogeneity of the studies, the Q index was used [Table 3]. The Q index was calculated as 11.541 for 17 studies with a degree of freedom as 16 and significance level as 0.001. Therefore, the zero hypothesis is confirmed, and we conclude that the studies are heterogeneous. Thus, the studies are common in the true effect size and difference is due to the sampling error. Moreover, the calculations related to the random effect were also significant. Therefore, the heterogeneity of the studies is not due to the statistical method; therefore, the fixed effects model was employed and compared with the search for moderating variables.
|Table 3: Investigating the heterogeneity of educational interventions on the of dental and oral health improvement in Iran|
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The most common and simplest method of detecting the publication bias is the use of a two-dimensional dispersion diagram called the Funnel chart, in which the estimated intervention effect from each study is plotted against the sample size of the study. If there is no publication, it is expected that the chart is symmetric and the amount of dispersion around the effect of intervention decreases with increasing sample size. Interpretively, in Funnel charts, studies that have a low standard error and accumulate above the funnel-do not have a publication bias. But as the studies go down the funnel, their standard error goes up and the publication bias increases. Any meta-analysis has some bias due to the criteria for the selection and deletion of studies, which is shown in this paper by the funnel chart. Therefore, according to the Funnel chart of the research is based on the fact that the studies are aggregated above the chart, indicating that there is no publication bias [Chart 1].
| Discussion and Conclusion|| |
The findings of this meta-analysis showed that the effect size of educational interventions on dental and oral health improvement is 0.31, which is in accordance with the average interpretation of Cohen's d table. This finding confirms some of the previous researches, including those done by Yousefvand, Andarkhu et al., Mirza et al., Pakpour Hajiagha, Amiri et al., Heidari et al., Moini et al., Mazaheri et al., and Zarei. In explaining these results, it can be said that the meta-analysis or integration of the results of various studies conducted on numerous samples, provides a more comprehensive view of the effect size of the variables. In fact, the results of this meta-analysis indicate that early education of individuals can prevent them from occurring some oral problems. In addition, choosing appropriate teaching methods for learners is a task whose need is always felt. It can also be claimed that training people in different ways, especially via the health belief model, can be effective in promoting dental and oral health. In other words, when the cognitive, attitude, and behavioral aspects are considered in educational programs, the effectiveness of education can be enhanced.
The research results also illustrated that among the researches that were analyzed, the largest size of the calculated effect (0.48) was the research done by Moini et al. This research shows that child-to-child education based on the health belief model (behavior is a function of knowledge and attitudes of an individual), and according to the components that it is based on this idea that it makes people perceive a health threat and pushes their behaviors to health. In this way, it can raise the perceived sensitivity and severity of individuals to dental caries and direct them to oral health with regard to perceived benefits and barriers, it can lead to students' dental and oral health improvement, and be used in schools. Moreover, in the research of Moini et al., the perception of tooth decay and its problems were raised, which shows that the examined participants more seriously understood the risk of tooth decay. The results of Moini et al. also indicate an increase in the perceived severity of the child-to-child group, which indicates a positive effect. Children are more successful than the coach in terms of the familiarity of the world of each other and the greater commonality of each other in describing the dimension of deterioration and severity of the problem.
Generally speaking, considering the effect size of this meta-analysis (0.31), it can be said that educational interventions were used to improve dental and oral health at a moderate level. Therefore, in addition to these methods and models for training individuals, others methods have also used for dental and oral health.
It is recommended that the health belief model be used for training children and students in schools. Experts also need to test game practices and models, including the use of multimedia, theatres, performing arts, storytelling, and training on modeling and game apps appropriate to individuals' ages. Finally, it is suggested that special attention should be paid to improving the education of oral health and increasing the effect on behavior change in the design of the training program in addition to selecting the appropriate educational method for the cultural, economic, and environmental issues of each region.
Limitations of research include the lack of a coherent database in Iran and little access to resources and research in this field.
We are grateful for those who helped us in conducting this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ghorbani Birgani AR, Gholizadeh L. An assessment of some physical health indexes among 12-14 year old secondary school male students in Gachsaran, Iran during the academic year of 2009-2010. Q J Med Sci Islamic Azad Univ Mashhad 2009;5:99-106.
Moodi M, Sharifzadeh GH, Ramezani S. Predictive power of health promotion model constructs in relation to oral health behaviors among students in elementary school students year 2016-17. J Birjand Univ Med Sci 2018;24:324-35.
Shamsi M, Heidarnia AR, Niknami SH, Rafiei M, Karimi M. The effects of educational programs based on health belief model on oral health behavior of pregnant women in Arak city. Sci J Hamadan Nurs Midwifery Fac 2012;20:12-22.
Asdagh S, Nuroloyuni S, Amani F, SadeghiMazidi T. Dental caries prevalence among 6-12 years old school children in Ardabil city, 2012. J Ardabil Univ Med Sci 2015;15:39-45.
Dini EL, Silva SR. Prevalence of caries and dental care status of school children from Ukban and Rukal (areas in AruraQuarasp, Brazil). Int Dent J 1994;44:613-6.
Behrouzi S, Tahmasebi R. Assesment the prevalance of gingivitis and its related factors among (6-18) years studentes of Boushehr. Iranian South Medical Journal TebeJonoub. Sci J Boushehr Univ Med Sci 2002;5:152-60.
Fallahi A, Morowatisharifabad M. Between tooth cleaning behaviors of the transtheoretical model-based pre-university students in Yazd. Tehran Uni Med Sci J 2010;4:45-8.
Petersen PE. World Health Organization global policy for improvement of oral health – World Health Assembly 2007. Int Dent J 2008;58:115-21.
Young B, Kelly PJ, Lewis JL. The child to child approach in health. Scouts Education and Healthy. Vol. 5. Oxford: Pergamum Press; 1987. p. 155-6.
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.
Nakre PD, Harikiran AG. Effectiveness of oral health education programs: A systematic review. J Int Soc Prev Community Dent 2013;3:103-15.
Yousofi M, Behrouzpour K, Kazemi S, Afroughi S. Dental caries and related factors among 7-12 year-old school children in Yasuj, Iran, in 2014. Armaghan e Danesh 2015;20:836-47.
Badri Gargari R, Salek Hadadian N. The role of self-efficacy and factors of health belief model in dental patients' brushing and flossing. J Urmia Nurs Midwifery Fac 2011;9:130-8.
Wagner Y, Heinrich-Weltzien R. Midwives' oral health recommendations for pregnant women, infants and young children: Results of a nationwide survey in Germany. BMC Oral Health 2016;16:36.
Lubon AJ, Erchick DJ, Khatry SK, LeClerq SC, Agrawal NK, Reynolds MA, et al.
Oral health knowledge, behavior, and care seeking among pregnant and recently-delivered women in rural Nepal: A qualitative study. BMC Oral Health 2018;18:97.
Peyman N, Samiee Roudi KH. The effect of education based on the theory of planned behavior on caries prevention of permanent teeth in fifth grade students in Khaf city. J Mash Dent Sch 2015;39:123-36.
Walker KK, Martínez-Mier EA, Soto-Rojas AE, Jackson RD, Stelzner SM, Galvez LC, et al.
Midwestern Latino caregivers' knowledge, attitudes and sense making of the oral health etiology, prevention and barriers that inhibit their children's oral health: A CBPR approach. BMC Oral Health 2017;17:61.
Yousefvand H, Faezi M, Taleghani F, Bahrami T, Reje N. Comparison of the efficacy of electronic and moulage dental training models on adolescents. J Nurs Educ 2018;6:33-9.
Andarkhora F, Bohrani M, Goodarzi A. Comparison of the effect of lecture and multimedia screening on oral health behavior of students in Tehran. Ann Mil Health Sci Res 2017;4:213-20.
Shirzad M, Taghdisi MH, Dehdari T, Abolghasemi J. The effect of educational intervention in changing mothers' attitudes, perceived self-efficacy and perceived barriers regarding oral health of preschool children. Iran J Health Educ Health Promot 2015;3:181-7.
Mohammadi Zeidi I, Pakpour Haji Agha A, Karbord A, Mohammadi Zeidi B. Effect of an educational intervention based on the trans-theoretical model on oral health behaviors in pregnant women. J Isfahan Dent Sch 2015;11:329-45.
Ebrahimipour H, Mohamadzadeh M, Niknami SH, Esmaeili H, Vafaei A. The effect of educational programs based on the theory of planned behavior to improve the oral health behavior of pregnant women attending urban health facilities Ashkhaneh city in 2014. J North Khorasan Univ 2015;7:7-18.
Amiri M, Haerian A, Malekmohammadi T, Farahat F, Asarzadeh H, Zarezadeh Z. Effects of oral health training on dental plaque index. J Shahid Sadoughi Univ Med Sci 2016;23:1039-48.
Pakpour Hajiagha A, Mohammadi Zeidi I. Effect of educational intervention on oral health self-care behaviors in diabetic patients. J Isfahan Dent Sch 2014;10:202-14.
Karami K, Shakerinejad G, Kabiry B, Ahmadi K. Effect of education based on health belief model on the alteration of oral health behaviors among students. Sci J Ilam Univ Med Sci 2013;21:134-41.
Shamsi M, Heidarnia A, Niknami SH. The effect of educational program based on health belief model on adopting preventive behaviors in dental caries in pregnant women of Arak city. J Fac Nurs Midwifery Hamedan 2012;38:12-21.
Heidari K, Mojahedi M, Seyed Moalemi Z, Golshahi H. Comparison of scrub and roll brushing techniques in controlling dental plaque in 8-11 year-old children. J Isfahan Dent Sch 2012;8:322-9.
Amidi Mazaheri M, Sharifirad GR. The effect of educational posters on knowledge and attitude of selective apartment residents in Isfahan about oro-dental health. J Health Syst Res 2010;6:383-8.
Zarei F. Effect of health education on oral health through role playing and painting on awareness and function of children. J Qazvin Univ Med Sci 2010;14:92-4.
Moini B, Ghaderi A, Hazavehie SM, Allahverdipour H, Moghimbeigi H, Jalilian F. A comparative study of peer education and trainer education on the basis of health belief model (HBM) in improving oral health in Sanandaj boys' elementary schools. Toloue Behdasht 2013;39:1-12.
[Table 1], [Table 2], [Table 3]