Process and impact evaluations preschool oral healthcare programme (POHP) in Selangor / Muhammad Farid Nurdin
Preschools provide an efficient setting to promote the oral health of young children as children attend preschools on daily basis, the structures and system at preschools are established, and vital facilities for conducive oral health environment such as clean water supply and sanitation are al...
| Main Author: | |
|---|---|
| Format: | Thesis |
| Published: |
2021
|
| Subjects: | |
| Online Access: | http://studentsrepo.um.edu.my/13687/ http://studentsrepo.um.edu.my/13687/4/farid.pdf |
| Summary: | Preschools provide an efficient setting to promote the oral health of young children as
children attend preschools on daily basis, the structures and system at preschools are
established, and vital facilities for conducive oral health environment such as clean water
supply and sanitation are already in place. Because of these promising potentials, the
Ministry of Health (MOH), Malaysia has introduced the Preschool Oral Healthcare
Programme (POHP) in 1984. This programme aims to improve the oral health status of
children aged 5 to 6 years who attend preschools. To date, there has been no evaluation
conducted on the POHP in terms of its process implementation and potential impacts on
the oral health parameters of preschool children. Such evaluations are important because
the findings will inform policymakers on the extent to which the POHP has contributed
towards preschool children’s oral health. The findings could also be used to address any
shortcomings of the POHP in order to achieve the National Oral Health Plan (NOHP)
targets for preschool children. Objectives: The study consisted of process and impact
evaluations of the POHP. For the process evaluation, the specific objectives were: i) to
explore the effectiveness, feasibility, and suggestions for improvement of the POHP in
Selangor state from the perspectives of dental therapists (DT), ii) to explore the
effectiveness, feasibility, and suggestions for improvement of the oral health-related
activities (OHRA) and oral health-related facilities (OHRF) at preschools in Selangor as
recommended in the Guidelines on Oral Health Care for Preschool Children (2003) using
the perspectives of preschool teachers. For the impact evaluation, the specific objectives
were: iii) to compare between preschools with POHP and preschools without POHP in
terms of oral health and related behaviours of preschool children, oral health literacy
(OHL) of preschool teachers, OHRA at preschool, and OHRF at preschool, and iv) to
iii
evaluate factors associated with preschool children’s oral health and related behaviours,
and OHRA and OHRF at preschools. Methods: The study consisted of 2 phases; Phase
1 and Phase 2. Phase 1 was a qualitative study involving 2 sample populations; DT from
9 districts in Selangor state using focus group discussion (FGD) as method of data
collection, and preschool teachers from 4 districts in Selangor state using in-depth
interview (IDI) as method of data collection. Both FGDs and IDIs were conducted using
an interview schedule developed by the researcher and a dental public health specialist
(DPHS). The qualitative data were transcribed verbatim and analysed using the
framework method analysis. Phase 2 was a cross-sectional study involving preschool
children and preschool teachers as sample populations from preschools with POHP and
preschools without POHP. Sample size for preschool children was 1082 (teachers were
recruited using convenience sampling). Multistage cluster sampling method
proportionate to size was employed to collect preschool children sample. Preschool
children were randomly selected from 2 districts in Selangor, which were Petaling (urban)
and Sepang (rural) districts. Study tools included a parent self-administered questionnaire
(proxy) which assessed socio-demographic characteristics of parents and child, parent’s
oral health knowledge (OHK), parent’s oral health behaviours (OHB), global self-rating
items of oral health, and child OHB at home. Teacher self-administered questionnaire
assessed socio-demographic characteristics, OHL using the Malay version of Dental
Health Literacy Assessment Instrument (DHLAI), OHRA, and OHRF at preschools. Data
were assessed using the SPSS version 23 software. Results: 114 DTs were involved in
13 FGDs. In terms of POHP effectiveness, DTs felt the POHP was effective to improve
OHK of the children and teachers, promote oral health monitoring by teachers, promote
healthy diet at school, inculcate toothbrushing habit in children, control caries, well
accepted by children, promote oral health lessons in class, and provide toothbrushing
facility at preschool. In terms of facilitators to implement POHP, the factors were good
iv
dental workforce teamwork, monitoring and support from dental administration,
provision of financial aid, availability of transportation, sufficient time to implement
programme, cooperation form school administration, cooperation from preschool
teachers and preschool children, availability of dental materials, and training in dealing
with preschool children. In terms of barriers to implement the POHP, the factors were
lack of manpower, lack of support from dental administration, uncooperative preschool
administration, availability of sugary food and drinks at school, lack of transportation and
driver, lack of time, uncooperative teachers, uncooperative children, lack of space for
OHRA, lack of dental materials, and uncooperative parents. For suggestions to improve
the POHP, the DTs suggested to improve oral health education (OHE) materials and
facilities, provide financial support, provide further training, involve parents in the
programme, monitor OHRA and OHRF at preschool, include oral health in teacher’s
training, increase number of DTs and assistants, introduce a dedicated team for preschool,
provide additional dental equipment, collaborate with dental industry, use social media in
OHE, and pay honorarium for dental visits to non-governmental preschools. With regards
to IDI, 15 teachers were interviewed. In terms of effectiveness, the OHRA and OHRF
were effective to instil positive attitudes among children and teachers, improve OHK of
children and teachers, instil toothbrushing habit in children, and control caries. In terms
of facilitators for OHRA and OHRF at preschools, the factors were good cooperation
from school administration, provision of financial aid, availability of oral health-related
materials, cooperation from parents, oral health seminar for teachers, helpful teacher’s
assistant, good relationship with dental personnel, cooperation from preschool children,
and good time management. In terms of barriers to implement OHRA and OHRF, the
factors were lack of financial support, lack of oral health learning materials, lack of space,
uncooperative children, environmental factors, extensive teaching duties, uncooperative
parents, accessibility to sugary food and drinks at school, and insufficient number of
v
assistants. For suggestions to improve OHRA and OHRF at preschools, the teachers
suggested to provide them with oral hygiene kit and OHE materials, improve oral hygiene
kit storage and tooth brushing area, increase parental involvement, increase frequency of
oral health seminar for teachers, reinstate dental treatment at school, provide financial aid
for oral health, and conduct OHE exhibition at preschool. For impact evaluation of POHP,
the response rate was 69.8% for preschool children and 76.5% for preschool teachers. A
significantly higher proportion of children from the preschools with POHP used fluoride
toothpaste at home than children from the preschools without POHP (p = 0.021).In terms
of teacher’s OHL, a significantly higher proportion of teachers who worked at the
preschool with POHP had a higher mean score of knowledge domain of the DHLAI than
teachers who worked at the preschools without POHP (p = 0.033) and more teachers who
worked at the preschools with POHP had good level of knowledge domain of DLAI than
teachers who worked at the preschools without POHP (p <0.001) . In terms of OHRA
and OHRF at preschools, a significantly higher proportion of teachers who worked at
preschool with POHP taught oral health syllabus at preschool (p = 0.009), displayed oral
health-related posters/pamphlets at preschool (p = 0.029), performed oral health-related
role play at preschool (p <0.001), performed toothbrushing activity (p <0.001),
performed toothbrushing activity everyday/alternate days (p = 0.042), brushed teeth using
toothpaste (p = 0.001), used fluoridated toothpaste (p <0.001), examined children’s teeth
(p = 0.046), examined children’s teeth ≥1x/6 months (p = 0.043), provided toothbrush
storage at preschool (p <0.001), provided toothbrushing facilities at preschool (p <0.001),
and provided a mirror for children to use after toothbrushing (p <0.001) than teachers
who worked at preschools without POHP. In terms of significant factors associated with
children having “more good” OHB at home when other factors were controlled were
children living in urban location (p = 0.025), parents with good OHK (p = 0.001), parents
who brushed ≥2/day (p <0.001), parents who visited dentist <6 months (p = 0.015),
vi
parents with no oral health problem in the past 3 months (p = 0.001), parents who had
low perceived oral health impact on daily life (p = 0.006), and female children (p =
0.022). A significantly higher proportion of teachers who worked at the preschools with
POHP implemented “more good” OHRA and OHRF at preschools than teachers who
worked at the preschools without POHP when other factors were controlled (p <0.001).
Conclusion: The DTs and preschool teachers perceived that the POHP, OHRA and
OHRF at the preschools could help to control caries and suggested that parents should be
involved in the programme. However, lack of financial support is a barrier for the DT to
implement POHP and the teachers to implement OHRA and OHRF at the preschools.
Nevertheless, the POHP in Selangor has positive impact in providing conducive oral
health environment at the preschools. Further improvement of POHP to include parents
should be considered as parents’ factors were significant factors for children’s OHB apart
from location and child’s gender.
Keywords: School-based oral health programme, preschool oral healthcare programme,
children’s OHB, OHL, conducive oral health environment.
|
|---|