Health Education of School-Aged Children

1. Health Education of School-Aged Children Suzanne Marks, Director Albuquerque Area Dental Support Center

2. Overview The effectiveness of oral health education Factors that help or hinder health messaging Resources that are readily available to support your efforts to educate your patients

3. “A rose by any other name . . . “ • Health education • Anticipatory guidance • Health communication all refer to some aspect of the process of informing and influencing individual and/or community decisions intended to enhance health

4. Health education can . . . • Increase the intended audience’s knowledge and awareness of a health issue, problem or solution • Influence perceptions, beliefs or attitudes that may change social norms • Prompt action • Demonstrate or illustrate healthy skills

5. Health education can also . . . • Reinforce knowledge, attitudes or behavior • Show the benefit of behavior change • Advocate a position on a health issue or policy • Increase demand or support for health services • Refute myths or misconceptions

6. Health Education (by itself) cannot . . . • Compensate for inadequate health care or access to health care services • Produce sustained change in complex health behaviors without the support of a larger program for change • Be equally effective in addressing all issues or relaying all messages

7. Is health education effective as a preventive strategy?

8. Efficacy of an oral health promotion intervention in the prevention of early childhood caries • In a 2008 Australian study, Plutzer and Spencer tested the efficacy of an oral health promotion intervention in the prevention of ECC • Conclusion: an oral health promotion programme based on repeated rounds of anticipatory guidanceinitiated during the mother’s pregnancy was successful in reducing the incidence of ECC in very young children.

9. Oral health promotion for schoolchildren • In a 2007 study Livny et al. evaluated the effect of a pragmatic education program on tooth brushing skills among young schoolchildren • Conclusion: behavioral instruction emphasizing improvement of personal manual skills successfully increased the average number of dental areas brushed

10. The Effectiveness of Evidence-Based Oral Hygiene Advice and Instruction Upon Patient Oral Hygiene • In a 2006 randomized controlled trial, Clarkson et al. evaluated the effectiveness of providing evidence based oral hygiene advice and instruction • Patients who received the evidence based oral hygiene advice and instruction were significantly more confident about their ability to toothbrush effectively and had significantly less plaque and gingival bleeding

11. Are these studies as revolutionary as those demonstrating the impact of community water fluoridation? Are these studies as compelling as those demonstrating the efficacy of fluoride varnish? Probably not Doubtful

12. Cochran Database of Systematic Reviews A recent Cochrane review looked at school-based interventions aimed at changing behavior related to tooth brushing habits and the frequency of consumption of cariogenic food and drink in children between the ages of 4 and 12 years.

13. Randomized or cluster randomized controlled trials were included. • Studies had to include behavioral interventions addressing both tooth brushing and consumption of cariogenic foods or drinks and have a primary school as a focus for delivery of the intervention.  • The primary outcomes were changes in caries or plaque levels.

14. 4 studies were reviewed involving 2,302 children . . . 1study was at unclear risk of bias and 3 were at high risk of bias.

15. Only 1 small study . . . with an unclear risk of bias, reported on caries. This found a prevented fraction of 0.65 in the intervention group.

16. 3 studies found less plaque . . . in children receiving the program but they were not combined in a meta-analysis due to differences in study designs and in the details of the interventions.

17. Secondary outcome measures from one study reported that the intervention had a positive impact upon children’s oral health knowledge.

18. The reviewers concluded • Currently, there is insufficient evidence for the efficacy of primary school-based behavioral interventions for reducing caries. • There is limited evidence for the effectiveness of these interventions on plaque outcomes and on children’s oral health knowledge acquisition. .

19. None of the included interventions were reported as being based on or derived from behavioral theory. • There is a need for further high quality research utilizing theory in the design and evaluation of interventions for changing oral health related behaviors in children and their parents

20. Does health education still have a place in the comprehensive prevention and treatment of oral disease? ABSOLUTELY!!

21. American Dental Association ADA announced another new initiative, Action for Dental Health, designed to reduce the numbers of adults and children with untreated dental disease through ORAL HEALTH EDUCATION, prevention and treatment for those in need

22. The American Academy of Pediatric Dentistry “Appropriate discussion and counseling should be an integral part of each visit.”

23. American Academy of Pediatrics “Oral health anticipatory guidance can reduce dental expenditures. In light of this evidence, oral health anticipatory guidance should be integrated as a part of comprehensive counseling during well-child visits.”

24. American Academy of Nurse Practitioners “The importance of . . . anticipatory guidance during well-child care visits cannot be overestimated.”

25. Factors affecting health communications

26. Factors that are likely outside the provider’s control • Poverty • Socioeconomic status • Geography • Education levels

27. Factors that can be accommodated by the provider • Influence of culture and family • Developmental learning stages • Health literacy

28. The Influence of Culture

29. Is there a difference? The Ortegas The Tsosies

30. How might culture express itself in health communications between provider and Native patient? May be more likely to regard concepts holistically and visually/symbolically

31. How might culture express itself in health communications between provider and Native patient? May be more likely to value "wait" time

32. How might culture express itself in health communications between provider and Native patient? May be more likely to observe before acting or questioning

33. How might culture express itself in health communications between provider and Native patient? May be more likely to speak softly

34. How might culture express itself in health communications between provider and Native patient? May be more likely to avoid eye contact out of respect

35. The influence of family

36. Who should we be educating?

37. Research indicates . . . Mother’s perceptions influence their children’s oral hygiene practices

38. At least initially . . . Oral hygiene is the responsibility of the parent

39. As the child develops home care will likely be performed jointly by parent and child.

40. School Age Children Begin to demonstrate the understanding and ability to perform personal hygiene techniques independently.

41. The Influence of Developmental Learning Stages

42. The School Age Child • Physical development is relatively problem free making it easy to master new skills • Most children are able to think logically provided the topic is not too abstract • Eager to learn: enthusiastic, perseverant and curious

43. The School Age Child • Can clearly distinguish right and wrong • Still believes their parents are helpful, their teachers are fair and their friends are loyal

44. Oral Health Education Topics for School-Age Children and their Families • Changes in the teeth and the mouth • Oral hygiene practices (frequency, problems) • Use of fluoridated water for drinking or cooking • Fluoride use (fluoridated toothpaste, fluoride supplements) • Dental sealant use • Eating practices • Non-nutritive sucking (pacifier, thumb, finger) • Illnesses or infections • Medications • Physical activity and sport participation • Injuries to the teeth or the mouth • Use of tobacco by parents or child

45. Adolescents • The transition from child- to adulthood • The most challenging and complicated period of life • Biological changes are universal but their expression, timing and extent is extremely variable

46. Adolescents • Cognitive development varies as well from egocentric to logical, hypothetical and theoretical • Adjusting to changing body sizes, shapes and feelings

47. Oral Health Education Topics for Adolescents and their Families • Changes in the teeth or the mouth • Oral hygiene practices (frequency, problems) • Use of fluoridated water for drinking or cooking • Fluoride use (fluoridated toothpaste, fluoride supplements) • Dental sealant use • Eating practices • Illnesses or infections • Medications • Physical activity and sports participation • Injuries to the teeth or the mouth • Use of tobacco by adolescent

48. The Influence of Health Literacy

49. Health Literacy “is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”

50. Who’s responsible for improving health literacy? We are!!