| Abstract|| |
Background: Communication plays a vital role in breaking down barriers between the patient and dental health professional, thereby strengthening treatment alliance. The proliferation of modes, speed of communication and reflexivity of knowledge have implications for health promotion. Aim: To evaluate the effect of social media-based oral health promotion programme in improving oral health among 18-20-year-old college students in Chennai city. Material and Methods: The interventional study consisted of college students between 18-20 years in Chennai city. A total of 140 participants with an allocation ratio of 1:1 were randomly assigned to the intervention and control group. Oral health education was provided to all the students using various oral health education aids. Status of participants for WhatsApp addiction, oral health Knowledge, Attitude and Practice (KAP) and oral health status (Simplified Oral Hygiene Index [OHI-S] and Modified Gingival Index [MGI]) were assessed. The intervention was given to the interventional group through WhatsApp using pictures, videos and text messages at first, second and third months. Follow up examinations were carried out for both the groups at the first, third and sixth month. Independent sample t-test to compare the mean values and Chi-Square to compare proportions between groups were used. Results: Statistically significant difference was seen in OHI-S [Mean- 2.52 (T0) to 0.77 (T3) P 0.001] and MGI [Mean- 1.58 (T0) to 0.58 (T3) P 0.001] scores among the intervention group. The percentage change in the KAP score from baseline to sixth month was comparatively higher among the intervention group. Conclusions: The intervention given through the WhatsApp application significantly improved the oral health status and KAP among its users.
Keywords: Health communication, health education, mHealth, oral health, social media
|How to cite this article:|
Subburaman N, Parangimalai DM, Iyer K, Sukumaran A. Effectiveness of social media based oral health promotion programme among 18-20 year old city college students - A comparative study. Indian J Dent Res 2021;32:467-71
|How to cite this URL:|
Subburaman N, Parangimalai DM, Iyer K, Sukumaran A. Effectiveness of social media based oral health promotion programme among 18-20 year old city college students - A comparative study. Indian J Dent Res [serial online] 2021 [cited 2022 Jun 29];32:467-71. Available from: https://www.ijdr.in/text.asp?2021/32/4/467/345415
| Introduction|| |
India has the world's largest youth population with 356 million in the age of 10-24 age group, despite having a smaller population than China with 269 million young people. Young age is a period of life with specific health and developmental needs and rights. It is the time to develop knowledge and skills and acquire attributes and abilities that are important for assuming adult roles.
Currently, untreated decay of permanent teeth is the most prevalent condition that affects up to seven in ten children and young adults in India. Aggressive periodontitis affects about two percent of youth leading to premature tooth loss. All these diseases have taken a toll on people's health due to their lack of awareness of oral hygiene. The values and behaviour of their peers essentially contribute while parents and other family members continue to be influential. Factors within the wider environment like mass media also play a very important role.
Mobile technology has the potential to cater health messages to large groups. The number of smartphone users in India is expected to rise by 84% to 859 million by 2022 from 468 million in 2017. Motivational messages, monitoring, and behaviour change tools used in face-to-face support can be modified for delivery via mobile phones., Recently, multimedia message service (MMS) and voice messaging greatly help to impart health education to people who are unable to comprehend a written message. It also allows formatted text, photographs, drawings, graphics, animations, PowerPoint presentations, audio samples and video clips to be included in the message. According to a HIMSS Mobile Technology Survey 2015, more than 200 healthcare provider employees found that nearly 90% of respondents are utilising mobile devices within their organizations to engage patients in their healthcare. Among the various social networking sites, the most commonly used is WhatsApp- having enormous market reach, especially among the younger generation. WhatsApp's user base in India has amassed more than 400 million users, reaffirming its gigantic reach in its biggest market. Research have been conducted using this recently developed mobile application in the field of medical science for clinical and academic endorsements. However, very few studies,,, have been carried out to understand the oral health aspect of the people using this mass medium of communication. The aim of the present study was to evaluate the effect of social media based oral health promotion programme in the improvement of oral health among 18-20-year-old college students in Chennai city. The objective of the study was to compare the change in the oral hygiene index-simplified (OHI-S) scores, modified gingival index (MGI) scores and Knowledge Attitude and Practice (KAP) scores between the interventional and the control group.
| Materials and Methods|| |
The pre-post interventional study was conducted for a period of 6 months (January 2017 to June 2017) to assess the change in the OHI-S scores and MGI scores and mean KAP scores pre- and post-intervention using WhatsApp application, among college students aged 18 to 20 years at Chennai. The study design was approved by the Ethics Committee of Ragas Dental College and Hospital. Permission was obtained from college authorities before initiating the study. The clinical trial was registered in the clinical trial registry, India (CTRI/2020/02/023535).
Study participants and sample size
Initially, three arts and science colleges in Chennai were approached and the nature and purpose of the study were explained, out of which one college gave permission to conduct the study. After sample size calculation, using G-power analysis (alpha error set at 5% [0.05] with 80% [0.08] as the power of the study and the effect size 0.5), 140 subjects were estimated to be the minimum sample size. Hence, 250 participants were initially recruited for the study. After obtaining their informed consent, a single calibrated examiner screened all the students between 18–20 years.
Based on the eligibility criteria, participants with baseline OHI-S score and MGI scores more than one and those who had sound knowledge in the use of WhatsApp application technology were included in the study. Participants who suffered from acute infectious dental conditions or systemic illness, participants undergoing/underwent orthodontic treatment (or) other dental procedures three months prior to the start of the study, and participants who have visual/hearing impairment were excluded. About 170 students who met the inclusion and the exclusion criteria were explained the nature and the purpose of the study. Finally, 140 subjects who gave consent to participate were included in the study.
WhatsApp Addiction Scale was used to assess their level of addiction. In addition to the OHI-S score and MGI score, data regarding the KAP towards oral health were collected using a pre-validated, self-administered 22-item questionnaire. The questionnaire was tested on 25 participants who were not included in the study, to check for ease of completion, clarity and questionnaire relevance. Content validity was calculated by content validity ratio after distributing to a panel of three subject matter experts and the content validity index score was found to be 0.8 (adequate agreement). The first seven items in the questionnaire were based on their knowledge of the basic structure and functions of the oral cavity and diseases caused due to poor oral health. The next five items denoted their attitude towards oral health and the last ten items on their oral health practices, dietary habits and the use of other oral hygiene aids.
The baseline OHI-S score, MGI score and KAP scores were collected from the participants to assess their oral health status and awareness. Subsequently, a research collaborator who did not take part in the later stages of the study allocated all the participants into intervention and control groups, with a ratio of 1:1 [70 in each group], based on the coin toss method [Figure 1]. Before the commencement of the study, oral health education was provided using various methods such as lectures, peer teaching and demonstrations using tooth models to all the 140 participants. The control group was restrained from any form of oral health education, thereafter. The interventional group received oral health education through WhatsApp in the form of pictures, videos and text messages.
|Figure 1: Flowchart chart of the phases of the two study groups in the trial (n, number of participants)|
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After baseline examination, the intervention was given during the first three months.
During the first month [T1], the intervention was based on detailing the various parts of the tooth, types of dentition and functional role of teeth and other oral structures through pictures and text messages. Discussions were made on stressing the importance of “Oral Systemic Health”.
During the second month [T2], participants were made aware of the etiology, occurrence, progression of dental caries and periodontal diseases. Pictures illustrating the mechanism and sequelae of plaque accumulation were elaborated. Also, information regarding improper diet habits, the effects of carbonated drinks and other sugar-coated substances were explained through video messages.
In the third month [T3], emphasis was laid on good oral hygiene practices. Proper brushing, flossing, tongue cleaning and mouth gargling methods were taught through video demonstrations. Their doubts on the use of oral hygiene aids like toothbrushes and toothpaste, mouthwashes, dental floss were sorted. Also, the necessity of visiting a dentist for a regular dental checkup was thoroughly explained.
Follow up examinations using the OHI-S index and MGI were carried out among both the groups at the third T2 and the sixth month T3. Also, at the end of the sixth month, their KAP scores were assessed using the pre-tested questionnaire.
The data collected were entered in the Microsoft Excel sheet following which statistical analyses were carried out using SPSS (v 22)TM (SPSS Inc., Chicago, IL., USA). For variables that followed a normal distribution, an independent sample t-test was applied to compare the mean values between groups. To compare mean values within the groups at different time points, Repeated measures Analysis of Variance (ANOVA) was performed. To compare proportions between groups Chi-Square test was used and when the expected cell frequency was less than 5, Fisher's Exact test was applied. To compare proportions between time points, McNemar's Chi-Square was applied.
| Results|| |
The distribution of baseline characteristics of the study participants between the groups suggests that randomization was fair. Overall, 110 boys and 30 girls from the first and second year participated in the study. Most of the students had a moderate level of WhatsApp addiction [Table 1].
|Table 1: Distribution of study participants based on their gender, year of study and Level of WhatsApp addiction|
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The mean OHI-S and MGI scores gradually reduced from baseline [T0] to the first [T1], third [T2] and sixth month [T3] in the intervention group. In the control group, the mean OHI-S score was reduced in the first month [T1]. However, there was an increase in the mean OHI-S score during the third [T2] and the sixth month [T3] [Table 2].
|Table 2: The Mean Oral Hygiene Index – Simplified (OHI-S) scores and Modified Gingival Index (MGI) scores between the two groups at baseline [T0] and at various time intervals of the study period [T1, T2, T3]|
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Furthermore, the results of the Questionnaire on KAP towards oral health pre- and post- intervention revealed that there was a drastic increase in the mean scores and mean percentage difference of the KAP scores, pre- and post-intervention in the intervention group (170.73%, 73.38%, 60.19%) when compared to the control group (46.19%, 36.45%, 35.67%) [Table 3].
|Table 3: Comparison of mean Knowledge, Attitude & Practice scores between the two groups at Baseline [T0] and after six months [T3]|
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| Discussion|| |
The present study was undertaken among 140 college students to evaluate and compare the effectiveness of social media-based oral health education programme in the improvement of oral health among 18–20-year-old college students in Chennai. The rationale of the study was to use the mHealth tools to promote behavioral change in oral hygiene and dental health-seeking behavior among the youth population. The design was specifically tailored to evaluate the direct impacts of the intervention on the oral health of the individual. There is rapid technological progress globally with India not being an exception, therefore allowing newer, lower-cost and more easily distributed approaches for health promotion and education. Mobile phone-based interventions are one possible approach to be harnessed. Social networking sites have invariably left a big impact on society in general and college students in particular. The usage of social networking sites among the college students in India revealed that the majority of the Indian students (62.6%) spent 1–10 hours per week using Social Networking Sites. In the recent past, WhatsApp has created a boom in mobile apps communication technology.
In medical research, studies have explored the acceptability of mHealth interventions for supporting adherence to antiretroviral therapy, smoking cessation and reduction in HBA1c levels for diabetes control., The potential of mHealth is being harnessed by the Indian government in the 'Mother and Child Tracking System' within the National Rural Health Mission. However, the risk of errors in entering the data, misinterpretation of the data, issues on data protection and confidentiality were some of the limitations of using SMS messaging. To overcome such difficulties, smartphone-based healthcare applications have evolved over time and created a tremendous breakthrough in the field of dentistry. Brush DJ oral health app was developed to motivate an evidence-based oral hygiene routine by playing music for two minutes while brushing and setting reminders to brush twice daily, fixing dental appointments and changing toothbrushes every 3 months. Recently, Smartphone video “selfies” have been identified to monitor, and determine the progression of diseases and to assess toothbrushing behavior.
The goal of oral health education through any method is to improve knowledge, which may lead to the adoption of favourable oral health behaviors that contribute to better oral health. Likewise, the present study showed a significant reduction in the post- OHI-S and MGI scores and an increase in the post- KAP scores among both groups irrespective of the method used for oral health education. A study by Ratika et al. comparing the effectiveness of two media (text messages and pamphlets) in imparting health education to mothers of preschool children revealed that there was a visible plaque scores reduction [VPI 45 to 33.5] and increased KAP among their children post-intervention. The present study used to picture and video messages to impart oral health information to the interventional group. Similarly, a study by Shah et al. used a 30-minute educational video among the patients in a hospital and found a significant increase in the mean knowledge score post-intervention. WhatsApp is an early-stage technology startup founded to build a better SMS alternative. The present study explored the communication method reflecting the latest mobile environment using a smartphone and WhatsApp. There were various inputs based on high quality information including photographs, videos and chats and also interactive communications and queries from the participants in the intervention group. The results showed a significant reduction in the mean OHI-S and MGI score at the end of sixth month. Though their knowledge about oral health improved tremendously, the adequate motivation to bring in a change in their attitude and practices were lacking. A study by Nayak et al. used WhatsApp as a tool for providing health education on tobacco and oral cancer as compared to the traditional health education via PowerPoint and found highly significant improvement in the intervention group (P value < 0.01).
The strength of the study was that it was a longitudinal study with a follow up period of 6 months. In addition to self-reported KAP questionnaire, objective assessment of the mean OHI-S and MGI scores were also evaluated. The advantages of using WhatsApp were that the messages were secured with end-to-end encryption so that third party access can be prevented. Interactive, interesting and fun filled sessions benefitted the students at large. Personal chats provided emotional support and enabled good dentist-participant rapport.
However, the limitations were the lack of generalisability as the study results could be applied only to those participants who owned a mobile, a WhatsApp account and were also aware of its operation. Since the follow up period for the intervention was long, the chances for the effect of the intervention to get diluted with time were higher. Also, since the participants of the intervention and the control group have been taken from the same college, dissemination of information from the intervention group to the control group could have affected the results of the study.
| Conclusion|| |
The results of the study concluded that the reduction in OHI-S and MGI scores, was more in the intervention group when compared to the control group during the 6 month period. Similarly, the KAP scores were also found to be higher in the intervention group when compared to the control group. Social media applications like WhatsApp, have massively influenced the healthcare sector in recent years. However, more research into the safety and security of the application should be conducted, particularly to address concerns about patient conﬁdentiality and safe, secure communications. The study provides the opportunity to carry out future research on longer follow-up time and among different age groups, gender, educational qualification and socio-economic status to find association of such factors in the improvement of oral health through WhatsApp and also, the other popular social networking sites such as Facebook, which provides a greater platform for dissemination of the oral health-related information to a relatively wider population in a short period of time.
Declaration of participants
The questioner was sent to the participants, the first question in the questioner was about their willingness to participate in the study. After obtaining their willingness as consent, the participants answered the other questions in the questioner and participated in the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. Nivedha Subburaman
Plot 4, Kubernagar Main Road, Opp 7th Street Extension, Madipakkam, Chennai - 91, Tamil Nadu
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]