The effectiveness of computer based interactive oral health education.
MSc(R) thesis, University of Glasgow.
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The Western Isles of Scotland have historically high levels of dental disease in the five year old age group amongst the worst in the UK. The “Action Plan for Scotland” has implemented a multidisciplinary approach to deal with this problem. This includes a major role for schools in supporting and improving oral health, by reducing the availability of cariogenic produce in schools and actively promoting healthier diets.
In light of this the researcher created an interactive computer programme, designed to educate children about healthy eating and improve their ability to identify cariogenic foods. The interactive computer programme was designed to integrate into the school curriculum providing a combined teaching tool and learning resource; for elements of both the health curriculum and IT attainment targets.
To assess the efficacy of the interactive computer programme a blind randomised controlled trial was designed to measure:
• Its ability to teach children the difference between healthy and unhealthy food.
• If it could positively influence the children’s selection of playtime snack.
The computer programme was initially assessed by a peer group consisting of Primary School Teachers, Dental staff (Glasgow University Dental School) and Dieticians (Western Isles Health Board). This was to ensure the content contained the correct nutritional and oral health message and that the interactive computer programme was educationally appropriate, for the age group within the study.
The computer programme was then assessed by a user group, consisting of pupils from Sandwick Hill Primary School, aged from four and a half to seven. Changes were then made in relation to the format and content of the programme to improve and refine it.
An initial pilot study was undertaken within Sandwick Hill Primary School to assess the methodology of the controlled trial and the randomisation and blinding of the participants. This also allowed refinement of the assessment tool to be used within the study. The assessment tool was designed to determine the children’s ability to identify healthy and unhealthy foods and to record their playtime snack.
Two schools were involved in the controlled trial, Stornoway Primary School and Laxdale Primary School. Positive consent was received for Eighty-six pupils in total. There were forty five boys (52.3%) and forty one girls (47.7%). The mean age was 5.7, (range 4 to 7 years). The teaching staff involved within the study were given a tutorial to explain the use of the programme and the protocols relating to randomisation and blinding. The participants were then randomly allocated to one of two groups, the intervention or control group. Both groups were then assessed to provide a comparative baseline. The intervention group were provided with the interactive computer programme. They were to use the programme for fifteen minutes a time over three weeks. The teachers were encouraged to allow the children to access the programme at least five to six times during this period. The control group were provided with traditional paper based educational material which was completed during class time. After three weeks the children were reassessed and the educational materials removed. The children were then assessed again after three months to assess longevity and retention of the acquired knowledge. The researcher remained blind to group allocation until the key was broken after analysis of the results.
Regarding identification of healthy food, regression analysis showed significant improvement in both groups, but t-tests revealed no significant difference between them. The groups matched well at baseline [Two- Sample T-test for means, p=0.979 95% CI -4.88, 4.76]; the intervention group showed greater improvement at 3 weeks but this was not significant [Two- Sample T-test for means, p= 0.135 95% CI -7.56, 1.04]. There was no difference seen at 3 months [Two- Sample T-test for means. P= 0.547, 95% CI -5.12, 2.74]. There was neither an improvement nor a difference between the two groups in snack selection.
This study provides evidence as to the effectiveness of interactive technology in relation to oral health education. It shows that interactive computer technology can provide an alternative to paper based educational materials. This study does not however show it to be significantly more effective. The study also shows that the use of the interactive computer programme was ineffective in modifying behaviour, in relation to diet, in this age group.
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