A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED …

1

A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED

TEACHING PROGRAMME REGARDING KNOWLEDGE AND

ATTITUDE ON PREVENTION OF DENTAL CARIES AMONG

THE MOTHERS OF PRIMARY SCHOOL CHILDREN AT

ANEKAL DISTRICT, BANGALORE.

By

Ms. ANJU APPUKUTTAN

Dissertation Submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment of the requirements for the degree of

MASTER OF SCIENCE

In

CHILD HEALTH NURSING

Under the guidance of

Mrs. Pushpakumari K

Professor

Department of child health Nursing

SPURTHY COLLEGE OF NURSING

MARASUR GATE, BENGALURU.

2013

2

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis entitled. “A study to evaluate

the effectiveness of planned teaching programme regarding knowledge and attitude on

prevention of dental caries among mothers of primary school children at

AnekalDistrict Bangalore.” is a bonafide and genuine research work carried out by

me under the guidance of Mrs.pushpakumari k, Professor, Department of Child

Health Nursing.

Date: Signature of the Candidate

Place: Bangalore Ms. Anju Appukuttan

3

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A study to evaluate the

effectiveness of planned teaching programme regarding knowledge and attitude on


AnekalDistrict Bangalore.” Is a bonafide research work done by Ms. Anju

Appukuttan, in partial fulfillment of the requirement for the degree of Master of

Science in Child Health Nursing.

Signature of the Guide

Mrs.Pushpakumari K

Professor

Date: Place: Bangalore

4

ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE

INSTITUTION

This is to certify that the dissertation entitled “A study to evaluate the

effectiveness of planned teaching programme regarding knowledge and attitude on


AnekalDistrict Bangalore.” is a bonafide research work done by Ms. Anju

Appukuttan, in partial fulfillment of the requirement for the degree of Master of

Science in Child Health Nursing.

.

Seal & Signature of the HOD Seal & Signature of the Principal Name: Mrs. Pushpakumari K Name:Prof .N.Muralidhar M.N

Date: Date: Place; Bangalore Place: Bangalore

5

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences, Karnataka

shall have the rights to preserve, use and disseminate this dissertation / thesis in print

or electronic format for academic / research purpose.

© Rajiv Gandhi University of Health Sciences, Karnataka

Date: Place: Bangalore

Signature of the Candidate

Ms. Anju Appukuttan

6

ACKNOWLEDGMENT

"When you're chewing on life's gristle....

Don't grumble, give a whistle and this'll help things turn out for the

best…..

And always look on the bright side of life.... ……..

And Always look on the light side of the life"....

Life is like a coin. You can spent it anyway you wish, But you only spent it

ones along with all, God's wish is the first

"Praise and glory to the God Almighty who is the sources of strength,

inspiration and blessing in every walk of my life and the function of knowledge and

wisdom".

I raise my heart in gratitude to God almighty, who has been my shepherd and

guiding force behind my all efforts. His Omni presence has been my anchor through

the hard time

With profound sentiments and gratitude, I the investigator of this study own

my heartfelt gratitude to all those who have contributed for the successful completion

of this dissertation.

7

Any accomplishment requires the effort of many people. I feel it is a great

privilege to express my heartfelt thanks and gratitude to all who directly or indirectly

have given valuable guidance and timely suggestion throughout this dissertation

work.

It is my privilege to express my special thanks to MR. P. GOPALA REEDY,

CHAIRMAN, Spurthy Group of Institution,, Bangalore for giving me the opportunity

to undertake this study and avail facilities in this institution.

Grateful thanks to Mr.Vinay Secretary, Spurthy Group of Institutions of

nursing for his constant encouragement and help to complete this study.

It's my pleasure and privilege to express my deep sense of gratitude to our

respective PROF. N. MURALIDHAR.M.N Principal, the SPURTHY GROUP OF

INSTITUTIONS for his constant encouragement and support given to me during the

study.

Quality always makes difference through its generosity, richness, kindness and

intelligence. These quality aspects has been incorporated and accomplished in this

study through the effective, enriched, constant guidance and support from my guide

PROF. PUSPAKUMMARI. HOD, CHILD HEALTH NURSING, the Spurthy

Group of Institutions, Bangalore. I express my immense gratitude for her valuable

guidance and making this effort success.

8

I express my sincere thanks to all experts in the field of Child health nursing

for validating the content of the tool and providing valuable suggestions and guiding

in validating the tool.

I sincerely express my special thanks to all MSc Nursing Lecturer's in Spurthy

Group of Institutions for their timely help, co-operation, valuable guidance and

suggestions to successful completion of my desertion work.

I am grateful to MRS. USHAPRADEEP, Lecturer in English, for editing the

report of my dissertation.

I wish to express my thanks to MR. BHASKER RAJ bio statistician, for his

guidance in statistical analysis and presentation of data.

My heartfelt thanks to Principal of St.philominas high schoo, anekal, district,

for allowing me to conduct the study and also give greatful thanks for mother's of

Primary school children for their kind cooperation for conducting the study

I thank heartily to Librarians of the RGUHS and Spurthy College of Nursing

for their cooperation and support throughout the study.

A word of appreciation to MR. SUDHARSHAN REDDY C. V. and MR.

SRINATH for their enthusiastic help and sincere efforts in editing the manuscript

meticulously with much valued computer skills.

9

I extended my sincere gratitude to the NON-TEACHING STAFF of this

college for their cooperation.

I extent my thanks to my family, parents Mr. A P P U K U T T A N . P . R &

M r s . S A S I K A L A , mother-in-law Mrs. LAKSHMI & And Father-In-Law Mr.

RAMAKRISHNAN and brother in law Mr.SUJITH & Mr.SANTHOSH who gave

me meaning to my life in so many ways and for their full co-operation in completion

of my course

It is my proud privilege to express the deepest sense of gratitude to Mr.

RENJITH.T.M, for his continuous support, patience, encouragement and prayers

throughout my study period and life, without whom I would not undergone my

studies.

Next my heartfelt thanks to my dearest brother Mr. ROBIN.S and sister in

law Mrs ALBA, Mrs.RENU and my dearest friends Mrs BABITHA, Mrs.REKHA

for their support and prayer during the study period and it's my pleasure and privilege

to express my deep sense of gratitude.

My special heartfelt thanks to my classmates and friends Ms PRATHIBHA,

Mr.AJEESH, Ms JINCY, and my juniors of M.Sc. Nursing for their support in the

successful completion of the study.

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Last but not Least, I extend my thanks to all those who have been directly or

indirectly associated with my study at various levels, but not mentioned in this

acknowledgement.

Above all I bow my head in reverence to god almighty for guide me to reach

the steps and complete my study. Has omnipresence has been my anchor through the

fluctuating hard times and makes it all possible.

Thanks to all.

DATE: SIGNATURE OF THE CANDIDATE

PLACE: BANGALORE (MS.ANJUAPPUKUTTAN)

11

LIST OF ABBREVATIONS

1. M: Mean

2. PTP: planned Teaching Programme.

3. X2: Chi square.

4. NS: Non significant.

5. %: percent.

6. S: Significant.

7. df: Degree of freedom.

8. WHO: World Health Organization.

12

RESEARCH ABSTRACT

“Life’s not just being alive, but being well.”

BACKGROUND OF THE STUDY

Dental caries and periodontal disease, the most commonly seen oral disease

show striking geographic variation, socioeconomic patterns and severity of

distribution all over the World 1-5 Number of factors have been put forward to

explain the variation in prevalence and severity of dental caries and periodontal

disease that can be found between developing and technically developed countries,

but also between rural and urban communities.1

Assessing caries risk is important for all patients and the process has to be

repeated at intervals. Caries-promoting factors may change between visits and on a

population level the disease and its squeal are very widespread in adulthood. This

guideline seeks to identify those children who are at greatest risk of future dental

decay in time to prevent the ravages of dental caries. However, it must be appreciated

that primary prevention will be required in all children to maintain low caries risk

status.2

STATEMENT OF THE PROBLEM

“A study to evaluate the effectiveness of planned teaching programme regarding

knowledge and attitude on prevention of dental caries among mothers of

primary school children at AnekalDistrict Bangalore.”

13

Objectives of the study

1. To assess the pre and post test level of knowledge on prevention of dental

caries.

2. To assess the pre test practice on prevention of dental caries

3. To introduce the structured teaching program regarding prevention of dental

caries.

4. To find out the difference between the pre test and post test knowledge on

prevention of dental caries.

5. To find out the difference between the pre test and post test attitude on


6. To find out the association between the pre tests knowledge on prevention

of dental caries among mothers of primary school children with their

demographic variables.

Hypothesis;

H 1 – There will be a significant difference between the pre test and post test

knowledge on prevention of dental caries among mothers of primary school children.

H 2 - There will be a significant association between the pre test and post test

knowledge on prevention of dental caries among mothers of primary school children

with their secured demographic variables.


attitude on prevention of dental caries among mothers of primary school children with

their secured demographic variables.

14

CONCEPTUAL FRAME WORK

The conceptual frame work chosen for this study is based on the Health Belief

Model. The Pender’s health belief model affects the health promotion and behavior

practice. Persons have to initiate and do active roles and this behavior is goal directed

for raising health and good living. The Pender’s health promotion model, first appear

in nursing literature in early 1980s and later the revised health promotion model

appears in 1996. In revised health promotional model, Pender represents that raising

health status and avoiding illness are the major motivational significance in health

promotional behavioral practice.

METHODOLOGY

A research approach tells us so as to what data to collect and how to analyze it. It

also suggests possible conclusions to be drawn from the data. In view of the nature of

the problem selected for the study and the objectives to be accomplished, a evaluate

survey research approach was considered as the best way to assess the knowledge and

attitude of primary school children mothers regarding dental caries.Evaluate design

with survey method was used in this study.

Part-I Socio-Demographic Data

The investigator constructed the tool to collect the Socio - demographic data of the

study subjects. It consists of demographic variables

Part-II

Investigator prepared structured knowledge questionnaire containing 24 knowledge

questions regarding dental caries.

15

Part III:

Investigator prepared attitude rating scale regarding dental caries consisting of 16

statements, Attitude statements were given with the range score of 0 to 2 marks. The

data gathered was analyzed and interpreted interns of objectives of the study. The

mean, SD, Mean Percentage, mean difference percentage of knowledge and attitude

about the dental caries were analyzed by using descriptive and inferential statistics.

MAIN STUDY:

The total sample of the main study was consisted of 60 primary school children

mothers, data was collected from the sample by administering structured knowledge

questionnaire.

DATA COLLECTION METHOD:

A formal written permission was obtained from the principal of the primary

school, Bangalore. The data was collected from 60 primary school children mothers

who fulfilled inclusion criteria. Before conducted the study, consent was taken from

them by explaining purpose of the study.

DATA ANALYSIS:

The data was planned to analyze on the basis objective and hypothesis of study

.The obtained data was analyzed using descriptive are inferential statistics and

interpreted in the terms of objective and hypothesis of the study. The level of

significance was set at 0.01 and 0.05.

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MAJOR FINDINGS OF THE STUDY

Majority of the subjects were (25.0%) in the age group of 21-25years, 38.0%

had upto SSLC education and 25.0% were coolie orker. Most of the respondents

(37.0%) had family income fall beteen Rs 3000-4000 and majority of respondents

were belonged to Hindu religion (53.0%).They were belonged from rural area

(26.0%) ; majority of respondents are from nuclear family (36%) and majority of the

repondent got information from health personel about dental caries.

In this study out of 60 primary school children mothers, 78.3 (78.3%) had

inadequate knowledge, 18.3(18.3%) women had moderately knowledge and

3.4(3.4%) of the primary school children mothers had adequate knowledge regarding

dental caries. The respondent’s mean knowledge score is 97.96%. 73.3 (73.3%)

women had negative attitude, 15(15%) women had neutral attitude and 11.7 (11.7%)

had positive attitude regarding dental caries. The respondent’s mean attitude level

showed is 51.4%.

There is a significant association between Age and knowledge at the level of

5% (X2 =9.25 at P>0.05 level), Place of residence and knowledge at the level of 5%

(X2 = 5.568 at P<0.05 level), Type of family and knowledge at the level of 5% (X2 =

5.993 at P>0.05 level),Religion and knowledge at the level of 5%(X2 = 7.862 at

P>0.05 level),significant association between Age and attitude at the level 5%,(X2 =

18.72 at P>0.05 level), Place of residence and attitude at the level of 5%. (X2 =10.51at

P>0.05 level) and Source of information and attitude at the level of 5%. (X2 =24.98 at

P>0.05 level).

17

There is a positive significant relationship between knowledge and attitude of

respondents on dental caries (r = +.0.894274).So this is highly correlated with each

other.

CONCLUSION AND RECOMMENDATION

The overall findings of the study clearly showed that primary school mothers had

inadequate knowledge and negative attitude towards dental caries.

Thus to conclude the investigator has achieved the objective for assessing

knowledge and attitude towards dental caries based on the study finding planned

teaching programme has been developed.

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LIST OF CONTENTS

Sl.No TITLE Page no

1. Introduction.

21-28

2. Objectives.

29-37

3. Review of Literature.

38-51

4. Methodology.

52-62

5. Results.

63-82

6. Discussion.

83-89

7. Conclusion.

90-94

8. Summary.

95-101

9. Bibliography.

102-107

10. Annexure.

108-181

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LIST OF TABLES

Sl.No Tables Pages

1. Frequency and percentage ditribution of primary school children

mothers according to demographic variables such as age, type of

the family, family income, education, occupation, number of

children, source of information, history of oral disorders.

65-72

2. Frequency and percentage ditribution of primary school children

mother according to their pre test and post test knowledge

assessment.

73

3 Aspect wise Mean, S.D and mean % knowledge score related to

dental caries.

74

4 Aspect wise Mean, Mean% and standard deviation of attitude

Scores related to dental caries

75

5. Frequency and percentage distribution of primary school children

mothers according to their pre test and post test attitude

assessment

76

6. Association between pre test and post test Knowledge Level of

Respondents on dental caries with demographic variables

77-78

7. Relationship between Knowledge and Attitude Scores 79-80

8. Correlation between pre test and post test scores

81-82

20

LIST OF FIGURES

Sl.No. Figures Pages

1. Conceptual frame work. 37

2. Schematic representation of research design/ research study. 62

3. Pie Diagram showing the Classification of respondents by age 65

4. Cone Diagram showing the Classification of respondents by

education

66

5. Pie Diagram showing the Classification of respondents by

occupation

67

6. Bar Diagram showing the Classification of respondents by monthly

income

68

7. Bar Diagram showing the Classification of respondents by number

of children

69

8. Pie Diagram showing the Classification of respondents by history

of dental disorders

70

9. Bar Diagram showing the Classification ofRespondents by type of

family

71

10. Pie Diagram showing the Classification of respondents by source of

information

72

21

INTRODUCTION:-

22

Every tooth in a man's head is more valuable than a diamond.

~Miguel de Cervantes, Don Quixote, 1605

Children bring fragrance and meaning to life, they are a gift of God and we the

gardeners to meet their needs, we provide the best to them by proper care,

nourishment, love, attention and good health.3

Todays children are citizens of tomorrow and to have a strong shouldered

man, a child should be free from mortality. Mahler who was the Director general of

the WHO in 1984 stated that “children are a priceless resources and a nation which

neglects them does so at its peril”. Healthy children are the greatest resource and pride

of the nation, the children ought to be healthy and happy to become productive adults

of the future. To give them happy and healthy childhood we must safe guard their

total health right from the beginning.4

Oral health is an integral component of primary school children’s health and

well-being. The overall health, well being, education and development ofchildren,

families and communities can be affected by oral health.4

Dental caries and periodontal disease, the most commonly seen oral disease

show striking geographic variation, socioeconomic patterns and severity of

distribution all over the World 1-5 Number of factors have been put forward to

explain the variation in prevalence and severity of dental caries and periodontal

disease that can be found between developing and technically developed countries,

but also between rural and urban communities. Additionally, there is marked

variability in the pattern of many disease between different socio-economic groups in

23

the same country. In recent studies, socio-economic factors have been identified as

predisposing factors in the development of both dental caries and periodontal disease

6-9. Low income and poor education have been reported to influence periodontal

status 10. Reseach in industrialized countries has revealed that children of high

social class families experience less caries than those of lower social classes 11 .

However, this relationship appears to be reversed in the developing countries 3.

Hence an attempt has been made to determine the relationship of oral hygiene status

and dental caries experience with socio-economic status in Davangere, India.5

Though there has been considerable improvement in the oral health of children

in the last few decades, dental caries (tooth decay) still remains one of the most

commonly occurring oral health problems in the children all over the

globe.Unfortunately,many children are afflicted with dentalcaries at an early age.

Even those as young as12 months Decay at this age usually beginsin the deciduous

maxillary incisors but canlater progress to involve primary molars andcanines. Those

affected often suffer froma reduced oral health-related quality of lifewhen contrasted

with their caries-free peers (1,2). Children with rampant dental cariesmay also have

other associated health problems, ranging from local infections to oralpain that

manifests as difficulty eating andsleeping, reduced growth and altered behavior (2,3).

Primary tooth decay does not discriminate. It crosses ethnic and cultural groupingsbut

is generally concentrated among disadvantagedpopulations (4-7). Furthermore, there

is mounting evidence indicating thatchildren who exhibit ECC are more likely tohave

an increased caries experience along thecontinuum of childhood (8-14).6

An especially virulent form of caries is early childhood caries (ECC), affecting

infants and toddlers from 12 to 18 months of age. However, if appropriate measures

24

are applied early enough (beginning during pregnancy and infancy), this painful

condition can be prevented (Douglass, Douglass, & Silk, 2004; Finn & Wolpin,

2005). The first dental examination is now recommended between six months and one

year of age (AAPD, 2010c), but this is often unrealistic, especially among the poor

and underinsured. Therefore, there is a huge need for preventive efforts by nurses and

other health care providers who care for infants and young children. The purpose of

this article is to review the literature on the risk factors and prevention strategies for

ECC, and to discuss the role of nurses in preventing this disease process.7

The use of resin pit and fissure sealants has been shown to be an effective

barrier method of preventing caries in pits and fissures over a wide range of studies in

recent decades. Improvements in dental materials have increased retention and

improved technique sensitivity in high caries risk patients. A formal meta-analysis has

demonstrated their efficacy.8

Parents have a major role in preventing dentaldiseases in their children. In

addition, they have amajor role in any preventive measure. Parents'knowledge about

different preventive methodshas been studied previously. Children generally spend

most of their time with parents and guardians, especially mothers, even when they

attend primary-schools or nurseries. These early years involve "primary socialization"

during which the earliest childhood routines and habits are acquired. These include

dietary habits and healthy behaviours established as norms in the home and are

dependent on the knowledge and behaviour of parents and elder siblings. Studies have

reported that poor attitude of parents toward oral health of infants and young children

25

are associated with increased caries prevalence (Hind and Gregory, 1995).9

It has been found that the more positive is the parents' attitudes toward

dentistry, the better will be the dental health of their children.Young children's oral

health maintenance and outcomes are influenced by their parent's knowledge beliefs

and practices, which affect oral hygiene and healthy eating habits. Without basic

knowledge of caries risk factors, importance of the deciduous teeth and oral

maintenance, it is difficult to employ effective disease preventive strategies. Parent's

knowledge and positive attitude toward good dental care are very important in the

preventive cycle of dental caries.10

NEED FOR THE STUDY:-

Dental caries can be traced to be as old as civilization with its evidence seen

even in skeletal remnants of prehistoric humans.Dental caries remains the most

common disease affecting humans. Tooth decay is one of the most common of all

disorders, second only to the common cold. It usually occurs in children and young

adults but can affect any person.Numerous studies have reviewed the effectiveness of

different preventive measures in different populations. In spite of these studies,

children still suffer from high cariesincidence. In western countries, the prevalence of

dental caries is low compared to developing countries.11

In 1979, the World Health Assembly adopted a resolution calling for

attainment of "Health for all" by the year 2000. In line with this, the FDI

recommended the establishment of specific oral health schedule on the time scale. Of

the WHO goals for global oral health, the first goal is that 50% of 5-6 years old

26

children should be caries free and the second goal is that the global average should

not be more than 3 decayed, missing, or filled teeth at 12 years of age.12

Worldwide, most children and an estimated ninety percent of adults have

experienced caries, with the disease most prevalent in Latin American countries,

countries in the Middle East, and South Asia, and least prevalent in China. In the

United States, dental caries is the most common chronic childhood disease, being at

least five times more common than asthma. It is the primary pathological cause of

tooth loss in children.13

The number of cases has decreased in some developed countries, and this

decline is usually attributed to increasingly better oral hygiene practices and

preventive measures such as fluoride treatment. Nonetheless, countries that have

experienced an overall decrease in cases of tooth decay continue to have a disparity in

the distribution of the disease. Among children in the United States and Europe,

twenty percent of the population endures sixty to eighty percent of cases of dental

carries’ similarly skewed distribution of the disease is found throughout the world

with some children having none or very few caries and others having a high number.

Australia, Nepal, and Sweden have a low incidence of cases of dental caries among

children, whereas cases are more numerous in Costa Rica and Slovakia.14

In 1940, the prevalence of dental caries in India was 55.5% and it rose to 68%

in the 1960s. The prevalence of these diseases is continuously increasing with change

in dietary habit of peoples and increased consumption of sugar. The prevalence of

dental caries is approximately 60% – 65% in India.15

There is a dearth of information on the oral health of pre-school children in

India. Very few data are available on the oral health of pre-school children. Data from

27

NOHS 2000 reported a mean Decayed Missing Filled Teeth (DMFT) of 1.40, which

is quite highcompared to that of developed countries in Europe, North America and

Australia Dental caries is a transmissible infectious disease in which Streptococcus

mutans0 is generally considered to be the main etiological agent. Studies using

phenotyping and/or genotyping methods strongly suggest that mother is the major

primary source of infection for children. Improper feeding practices by

mothers/caregivers increase the risk for the development of early childhood caries in

infants and toddlers, by promoting the early establishment of S. mutans in the oral

cavity.16

Young children's oral health maintenance and outcomes are influenced by

their parent's knowledge and beliefs, which affect oral hygiene and healthy eating

habits. Without basic knowledge of caries risk factors, importance of the deciduous

teeth and oral maintenance, it is difficult to employ effective disease preventive

strategies. Parent's knowledge and positive attitude toward good dental care are very

important in the preventive cycle of dental caries.17

Researches showed that the degree to which mothers understand oral health

issues is significantly related to better oral health in their children. In addition,

mothers' knowledge about oral health had an important impact on their children's

future oral health-related practices.18

Based on several literatures and the personal experience of the investigator, it

was found that, mothers lack of knowledge and practices towards dental hygiene

contribute to the high prevalence of dental caries in primary school children.

28

Knowledge and practices modifiable factors. It can better modified through health

education and structured teaching programmes. Childhood Caries can be prevented by

successfully educating primary caregivers children about this disease and by thus

motivating them to engage in positive oral health promotion efforts. Researches

showed that the degree to which mothers understand oral health issues is significantly

related to better oral health in their children. In addition, mothers' knowledge about

oral health had an important impact on their children's future oral health-related

practices.19

Hence the investigator felt the need to investigate the effectiveness of a

planned teaching programme on knowledge and practices of dental hygiene on

prevention of dental carries.

29

30

OBJECTIVES

This chapter deals with the statement of the problem, objectives of the study,

operational definitions, assumptions, hypothesis of the study and conceptual

framework which provides a frame of reference. The statement of the study is as

follows

STATEMENT OF THE PROBLEM:

“A study to evaluate the effectiveness of planned teaching programme

regarding knowledge and attitude on prevention of dental caries among mothers of


OBJECTIVES OF THE STUDY;

The objective of the study were to,

1. To assess the pre and post test level of knowledge on prevention of dental caries.



caries.



5. To find out the difference between the pre test and post test attitude on prevention

of dental caries.

6. To find out the association between the pre tests knowledge on prevention of

dental caries among mothers of primary school children with their demographic

variables.

31

OPERATIONAL DEFINITIONS;

1. Evaluate

It refers to the careful appraisal, judgement or examining.

2. Effectiveness

It refers to the degree to which objectives are achieved and the extent to which

targeted problems are solved.

3. Planned Teaching Programme

It refers to the educational programme which is prior planned in an organized

manner.

4. Knowledge

It refers to the intellectual capacity of the mother.

5. Attitude

It refers to the way or manner in which the mother performs in relation to her

child oral hygiene.

6. Prevention

It refers to the measures intended to the protect the child from dental caries.

7. Dental Caries

It refers to the irreversible tooth decay or cavity due to bacterial infection.

32

8. Primary school children

It refers to the school children whose age is below 11 years of old.

9. Primay school children mother

It refers to the correct response or judgment of the Mothers of primary school

children on dental hygiene in prevention of dental caries which will be elicited by

administering self administered close ended Knowledge questionnaire.

HYPOTHESIS




knowledge on prevention of dental caries among mothers of primary school children

with their secured demographic variables.




DELIMITATIONS:

1. The study is delimited to the mothers of primary school children residing at

Anekal District Banglore.

2. The study is delimited to assess the knowledge and attitude on prevention of

dental caries among mothers of primary school children.

33

INCLUSION CRITERIA

1. Mothers of primary school children aged between 21- 40 years at selected areas of

Anekal District Bangalore.

2. Mothers of primary school children those who are willing to participate in the

study.

3. Mothers of primary school children who can able to read and write Kannada or

English.

EXCLUSION CRITERIA ;

1. Mothers of primary school children who have already attended IEC package on

dental hygiene.

2. Mothers of primary school children those who are not available during the data

collection period.

3. Mothers of children those who are not studying in primary school.

ASSUMPTIONS ;

1. The mothers of primary school children may have knowledge on prevention of

dental caries.

2. The mothers of primary school children having unfortunable attitude in prevention

of dental caries.

3. Structured teaching programme on prevention of dental caries may enhance the

knowledge and attitude of mothers of primary school children.

34

CONCEPTUAL FRAMEWORK:

Conceptual framework acts as building block for the research study. The

overall purpose of framework is to make the scientific finding, meaningful and

generalized. It provides a certain framework of reference for clinical practice,

education and research. Framework can guide the researcher’s undertaking of not only

‘what’ of natural phenomena but also ‘why’ of their occurrence. They also give

direction for relevant questions to practical problems. Conceptual framework is

defined as the frame of reference that serves to guide a research study and is

developed from theories, findings from a variety of other research studies, and the

authors personal experiences and values.

A conceptual model is a group of concepts that are broadly defined and

systematically organized to provide a focus, a rationale, and a tool for the integration

and interpretation of information.20 Conceptual model refers to set of values, beliefs

and preferences for research approach. Conceptual framework plays several

interrelated roles in the progress of science. There overall purpose is to make

scientific meaningful and generalisable. Conceptual frame work is a theoretical

approach to the study of the problem which is scientifically based on the emphasis,

the section arrangement and clarification of the concepts, dealing with the study.

According to Fowcet (1980) a conceptual framework can be defined as set of

concepts and those, assumptions that integrate in to a meaningful configuration.

The conceptual frame work chosen for this study is based on the Health

promotion Model. The Pender’s health promotional model about that affects health

promotion behaviour practice. Persons have to initiate and do active roles and this

35

behavior is goal directed for raising health and good living. The Pender’s health

promotion model first appears in nursing literature in early 1980s and later the revised

health promotion model appears in 1996. In revised health promotional model, Pender

represents that raising health status and avoiding illness are the major motivational

significance in health promotional behavioral practice.

The model comprised of three primary components, including

Client cognitive-Individual perceptions (perceptual factors)

Modifying factors

Participating in health promoting behaviours( likelihood of initiating or engaging

in action)

Individual Perceptions

Perceived susceptibility: An individual’s estimated probability if encountering a

specific health problem.

Perceived seriousness: The degree of concern on experiences created by the

thought of problem or disease associated with a given health condition. In the

present study perceived susceptibility and perceived seriousness referred to the

problem perceived by the primary school children mothers related to knowledge

and attitude towards dental caries.

Perceived threat: The combined impact of perceived susceptibility and perceived

seriousness refers to the study subjects i.e. primary school children mothers. To

identify the perceived threat, to assess their knowledge and attitude through pre-

tested instrument developed for the study.

36

Modifying Factors

A category of variable within the health promotional model is considered to be

of major motivational significance. Furthermore, these variables constitute a critical

care for intervention as they are subject to modification

These include a variety of selected demographic, socio-psychological and

structural factors that predispose the above factors of the primary school children

mothers age, type of the family, family income, education, occupation, number of children,

source of information, history of oral disorders.

The Likelihood of Action

It is the positive difference between perceived benefits and perceived barriers.

In this study perceived benefits is belief about effectiveness of planned teaching

programme recommended action such as adequate knowledge about and positive

attitude towards dental caries acceptances. Perceived barriers are hindrances to

engaging in actions include poor knowledge regarding dental caries and negative

attitude of primary school children mothers towards dental caries.

Likelihood of taking recommendations:

In this study likelihood of taking recommended action is the effectiveness of

planned teaching programme about dental caries in order to remove barrier to action

i.e., poor knowledge and unfavourable attitude towards dental caries.

Feed back: It refers to monitoring and evaluating health promotion activity. This is

not included in the study.

37

INDIVIDUAL PERCEPTION

MODIFYING FACTORS LIKELIHOOD ACTION

Knowledge &

Attitude of primary school

children mothers regarding dental

caries

Perceived Susceptibility Perceived Seriousness

Demographic variables include • Age

• Type of the family

• Income

• Education

• Occupation

• No.of children

• Source of information

• History of oral disorders

Perceived Threats Dental caries

Cues to Action Include Source of information

Perceived Benefits • Good knowledge • Favorable attitude

regarding dental caries Perceived Barriers

• Poor knowledge • Unfavorable attitude

regarding dental caries

Recommendation for Action

Effectiveness of planned teaching programme inorder

to remove the barrier

Included in the study Not included in the study

Figure 1: Health promotion model

38

39

REVIEW OF LITERATURE

A review of literature on the research topic makes research familiar with the

existing studies and provides information which helps to focus on a particular

problem and laid foundation up on base knowledge it creates accurate picture of

foundation on the subject. Review of literature done for the study is arranged under

the following headings.

Studies related to dental caries in primary school children

Studies related to mother’s knowledge and attitude on dental caries

Studies related to preventive measures of dental caries in primary school

children

Studies related to effectiveness of planned teaching programme

Studies related to dental caries in primary school children

A cross sectional study was conducted to describe the occurrence of dental

caries and periodontal conditions among standards three and four primary school

children in Morogoro municipality. A total of 1,297 standards three and four children

in five primary schools randomly selected from a list of 36 primary schools. Dental

caries and periodontal status were recorded using the criteria described in the WHO

manual for Oral health Surveys, Basic Methods (1997). Analysis and interpretation

showed that seventy six percent of the children were caries free. No fillings were

encountered. Remaining 29 % 0f the sample were affected with dental caries.20

A study was conducted to describe the Prevalence of dental caries in Italian

primary schoolchildren living in rural and urban areas. The number of surveyed

children were 5413, 8359, 8362 and 5026 in the 6-, 7-, 8- and 9-year-old groups

40

respectively. Analysis and interpretation of results showed that the percentages of

children positive for caries were 39.5, 48.3, 54.4 and 60.8 respectively21

A study was conducted to determine the prevalence, severity, and pattern of

dental caries in 6 to 7-year-old children in military primary schools in Jeddah city,

Saudi Arabia. A random sample of 300 children (6 to 7-year-olds) was drawn from

six schools. Clinical examinations were carried out. Caries were diagnosed using the

British Association for the Study of Community Dentistry (BASCD) criteria. Analysis

and interpretation of the results showed that Caries were diagnosed in 288 (96%) of

the children, and only 4% were clinically caries free22

A cross-sectional study of patients referred for a tooth extraction in

one dental surgery in south-east London. Statistical methods consisted of logistic and

ordinal regressions to model the likelihood of exposure to oral health promotion and

of obtaining higher levels of knowledge of oral health issues, respectively. Linear

regression was used to model the level of oral health and knowledge of oral health. In

our observational study, 34% of the patients reported exposure to a settings-based oral

health education programme: Sure Start (5%), NHS (7%) and other (22%). This

exposure was not influenced by age or gender, but an association with education was

detected. Although oral health promotion was not found to influence the actual

knowledge of oral health issues, it was found to influence some oral health-

related attitudes and perceptions.23

A study was conducted in Hawaii for analyzing and a social ecology model

was used to frame the discussion, recognizing family and community influences

on children's oral health. The context of oral health in early childhood contributes to

41

the changes in the concept vulnerability. The attributes are closely related to family

and community factors and identified as limited parental income, parental education,

community-based services and fluoride; and exposure to poor parental habits, parental

neglect and harmful toxins. The primary antecedent is identified as a form of limited

protection from exposure to various circumstances.24

A study was conducted in Greece to provide a review of the

existing literature on early childhood caries (ECC) with particular reference on the

nomenclature, case definition, epidemiology, etiology and risk assessment. An

electronic search was used to identify and critically review papers that have been

published and are pertinent to the above issues, evaluate and compile the reported

evidence. The term ECC has been adopted to more accurately describe dental

caries that affects primary dentitions, replacing previously used terminology that

associated the disease with the nursing habit. Suggested ECC case definition uses

caries patterns as defining criteria, however, further refinement to include different

clinical expressions of a varying severity is necessary. Significant percentages of

preschool child populations are affected by ECC today, with the disease concentrating

disproportionately in deprived families. Early colonization by mutants streptococci

(MS) is associated with increased ECC development, with bacteria being transmitted

in both vertical and horizontal ways. Dietary factors related to sugar consumption

predispose to early MS colonization and establishment and increase the risk for ECC

development, being part of the causal chain. Inappropriate bottle and breast-feeding

behaviors also increase the risk, without showing a direct causal relationship. High

risk children belong to ethnic minority groups and to low income families with poor

parental behaviors and attitudes.25

42

Studies related to mother’s knowledge and attitude on dental caries

A study was conducted to identify the knowledge of mothers regarding dental

hygiene. Results revealed that 26.7% of mothers of primary school children who

brought their children for extractions of teeth under general anaesthesia to a dental

school did not know how to prevent caries in their children26

A study was conducted to identify the Knowledge of practices on dental

hygiene of primary school children with dental carries. Samples of 139 mothers were

surveyed. Results revealed that 100 out of 139 mothers admitted giving their children

sweets to reward them for good behaviour, to pacify the child, or for no specific

reason27

A study concerning the prevention of caries demonstrated that 80% of the

mothers answered that tooth brushing can prevent dental decay. However, only 46%

of these respondents believed that fluoride could prevent decay. Few mothers

mentioned flossing when asked about oral hygiene practice in their households28

A study was conducted to explore mothers'/guardians' knowledge about how

to promote their children's oral health. Data were collected from 105 mothers/female

guardians.Results revealed that that mothers with lower incomes (under $1000 per

month) had less knowledge concerning the utilization of health care services than

mothers with higher incomes29

A study was conducted in lioyd to determine the effectiveness of providing

free toothpaste containing either 1450 or 440 ppm F on caries experience in 5-year-

old children living in areas with different levels of material deprivation. Toothpaste

containing either 440 or 1450 ppm F and dental health literature posted at 3-month

43

intervals and toothbrush provided annually from the age of 1-5 years. Comparison

group received no intervention. A total of 3467 children were included in the final

data analysis. The Townsend index was found to be useful in identifying groups

of children with increased caries risk. Overall, participants in the programmed using

the high-fluoride toothpaste had significantly (P < 0.002) less caries than the

comparison group with similar absolute reductions in mean dmft for the most- and

least-deprived groups. Relative to the comparison group the association between

deprivation and dental caries was changed so that in the most-deprived quartile those

using the low-fluoride toothpaste tended to have less dental caries than the

comparison group whereas in the least deprived they tended to have more. This

difference in the association (slope) was statistically significant (P < 0.05). Provision

of both low- and high-fluoride toothpaste appeared to reduce the risk of extractions

for participants in the most-deprived quartile (P < 0.05).30

A study was conducted in north Carolina to review the evidence for

effectiveness of five possible physician interventions- (1) screening and risk

assessment, (2) referral, (3) provision of dietary supplemental fluoride, (4) application

of fluoride varnish, and (5) counseling-for the prevention of dental caries for the U.S.

Preventive Services Task Force. For most key questions related to the five

interventions, the evidence for primary care clinician effectiveness was rated as poor

owing to the scarcity of studies. Ten surveys of physicians' knowledge and behavior

about fluoride supplementation provided fair evidence, suggesting that

supplementation decisions were often made without consideration of other fluoride

exposures. Reviews of the dental literature identified fair evidence supporting the

effectiveness of both fluoride supplements and varnish, although information

44

describing effectiveness and adverse outcomes of supplementation with the most

recent dosage schedule is not available31

A study was conducted to assess the knowledge, attitudes and practices of

caregivers in Kuwait in relation to the oral health of preschool children. Subjects and

Methods: Questionnaires with multiple-choice questions were distributed to 334

caregivers of children under the age of 6 years attending vaccination centers in

Kuwait. For each question, one of the multiple-choice answers was consistent with the

consensus in the pediatric dental literature in relation to early

childhood caries prevention, and was considered to be correct. The χ(2) test,

independent t test, ANOVA, and stepwise linear regression were used to assess the

associations between the variables in question and p ≤ 0.05 was accepted as

statistically significant. Results: Of the 334 participants, 234 (70%) were between 20

and 40 years of age with a high school diploma or higher degree and had between 2

and 5 children. The mean knowledge score was 4.68 ± 1.87, the mean attitude score

was 4.34 ± 0.88 and the mean practice score was 2.45 ± 0.99. Major weaknesses were

reported in infant oral health-related concepts. Mothers had better knowledge than

other caregivers (p < 0.001). Higher education was significantly associated with

better knowledge (p = 0.003) and better practices (p = 0.017). In addition, knowledge,

attitude and level of education were positively and significantly associated with

practices (p < 0.005). Conclusions: Our study showed that caregivers had

weak knowledge and practice in relation to the oral health of preschool

children. Mothers and caregivers with higher education had better knowledge and

practices. Education and attitude appeared to be favorable indicators of the caregivers'

practices with regard to the oral health of their preschool children.32

45

Studies related to preventive measures of dental caries in primary school

children

The paper provides a literature review focused on the current methodological

approach to psychosocial and behavioural factors (socioeconomic and demographic

status, education level, health-related attitudes, risk behaviour, stress, oral health and

quality of life) and oral-health indicators (DMFT--Decayed, Missing and Filled teeth;

CPI--Community Periodontal Index, proportion of edentulous subjects, proportion of

subjects in need for dental treatment and SiC Index--Significant Caries Index). The

selected factors are recognized as additional factors associated with oral health and a

detailed investigation thereof represents a novel approach to the prevention of dental

caries and periodontal diseases. The paper also specifies the type of research that is

needed in this branch of the preventive dentistry33

Relatively few health education interventions directed at preventive health

behaviors and management of chronic illness among Native Americans have been

reported in the literature. This article provides a selective review of health education

interventions among Native Americans that address the prevention and management

of chronic illnesses/conditions as well as preventive health behaviors. For each

intervention included in the review, a description of its cultural relevance, sample,

design, and evaluation is provided. Limitations are noted, as well as implications for

research and practice.34

This literature review reports the history and the current market of oral home-

care products. It provides information extending from the products used by our

46

ancestors to those currently available, as well as on the changes in the supply and

consumption of these products. Although the scientific knowledge about oral diseases

has improved greatly in recent years, our ancestors had already been concerned with

cleaning their teeth. A variety of rudimentary products and devices were used since

before recorded history, like chewing sticks, tree twigs, bird feathers, animal bones,

tooth powder and home-made mouth rinses. Today, due to technological

improvements of the cosmetic industry and market competition, home-use oral care

products available in the marketplace offer a great variety of options. An increase in

the consumption of oral care products has been observed in the last decades.

Estimates show that Latin America observed a 12% increase in hygiene and beauty

products sales between 2002 and 2003, whereas the observed global rate was

approximately 2%. A significant increase in the per capita consumption of toothpaste,

toothbrush, mouthrinse and dental floss has been estimated from 1992 to 2002,

respectively at rates of 38.3%, 138.3%, 618.8% and 177.2%. Pertaining to this

increased supply and consumption of oral care products, some related questions

remain unanswered, like the occurrence of changes in disease behavior due to the use

of new compounds, their actual efficacy and correct indications, and the extent of the

benefits to oral health35

A study was to determine the associations between changes in self-reported

tooth brushing frequency and the knowledge and attitudes related to oral health. The

study population consisted of all fifth and sixth graders who started the 2001-2002

school year in Pori (n = 1,691); of these, 1,362 were monitored throughout the 3.4-yr

study. Data were gathered by questionnaires before, in the middle, and after the

follow-up, which was divided into two periods. Associations between changes in

47

tooth brushing frequency, sum score of knowledge items, and sum scores of items in

attitudinal factors were studied. The attitudinal factor structure was determined by

principal component analyses. The associations were evaluated using mean values

and general linear models for repeated measures. Tooth brushing frequency and

knowledge and attitudes related to oral health improved among the same children

during the study, with the changes usually taking place in the same time-period. In

different time-periods, different children's tooth brushing and oral health-related

knowledge and attitudes improved. Based on our results, changes in knowledge,

attitudes, and behavior are related, but children are ready for change at different times.

Therefore, oral health promotion should be designed to be a continuous process rather

than a short-term intervention.36

A study was conducted in 5-yr double-blind fluoridated milk study has been

completed and, following baseline stratification, 94 children aged 4 1/2/5 1/2 yr were

allocated to the test group and 93 to the control. Each subject received 200 ml school

milk daily, identification between the test and control plastic packs being by colour-

coding alone with the former containing 1.5 mgF- giving a potential topical benefit of

approximately 7 ppmF- per school day. After 5 yr, 50 of the test children remained

and 56 of the controls. While the mean DMFT incremental data relating to permanent

teeth was always in favour of the test group, it was not until the fourth year that a

significant difference was obtained (P less than 0.01) between the fluoridated group

(mean, 1.65) and the non-fluoridated group (mean, 2.56). For permanent teeth which

were unerupted at baseline, the mean DMFS differences increased to 39.6% at the

same time and to 48.0% by the fifth year. No benefit was noted for previously erupted

primary teeth. Cavitation was less in the test group throughout the study. When the

48

third, fourth and fifth year DMFT reductions obtained were compared with previously

published artificial water fluoridated data where children were of comparable age at

the onset of water adjustment, similar caries inhibition data were noted.37

A study was conducted for the prevalence of dental caries in 3,6, 9, 12 and 15-

year-old school children of Chandigarh, selected on a randomized basis was evaluated

using Moller's criteria (1966) and correlated with the various risk factors. The mean

deft was found to be 4.0 ± 3.6 in 6 year old and 4.61 ± 3.14 in 9 year old, whereas the

mean DMFT in 12 and 15 year old was found to be 3.03 ± 2.52 and 3.82 ± 2.85

respectively. The high prevalence of dental caries in these children was attributed to

the lack of use of fluoride toothpaste (80% children), lack of knowledge about

etiology of dental caries (98%) and frequency of sugar exposures up to more than five

times per day (30%).38

A cross-sectional study of 1000 preschool children was conducted in Saddar

town, Karachi. Two-stage cluster sampling was used to select the sample. At first

stage, eight clusters were selected randomly from total 11 clusters. In second stage,

from the eight selected clusters, preschools were identified and children between 3- to

6-years age group were assessed for dental caries. Caries prevalence was 51% with a

mean dmft score being 2.08 (±2.97) of which decayed teeth constituted 1.95. The

mean dmft of males was 2.3 (±3.08) and of females was 1.90 (±2.90). The mean dmft

of 3, 4, 5 and 6- year olds was 1.65, 2.11, 2.16 and 3.11 respectively. A significant

association was found between dental caries and following variables: age group of 4-

years (p-value ² 0.029, RR = 1.248, 95% Bias corrected CI 0.029-0.437) and 5-years (p-

49

value ² 0.009, RR = 1.545, 95% Bias corrected CI 0.047-0.739), presence of dental

plaque (p-value ² 0.003, RR = 0.744, 95% Bias corrected CI (-0.433)-(-0.169)), poor

oral hygiene (p-value ² 0.000, RR = 0.661, 95% Bias corrected CI (-0.532)-(-0.284)), as

well as consumption of non-sweetened milk (p-value ² 0.049, RR = 1.232, 95% Bias

corrected CI 0.061-0.36739

Studies related to effectiveness of planned teaching programme on dental caries

A study was conducted for variations in tooth eruption patterns are supposed

to have multifactorial reasons and etiologic factors to explain variation in caries are

unsatisfactory. Prevalence of caries is comparatively higher in the children of

developing countries than that of the children of same age in developed countries.

Indian studies on the dental caries mostly in children related to prevalence and

treatment. However, nutritional effect on dental caries on Indian school going

children is yet to be carried out in eastern India. This study investigated the

prevalence of dental caries in permanent teeth and nutritional status among the 544

School going children (girls) of 6 - 19 years age group of Bengalee ethnicity of West

Bengal, India. Caries was recorded based on DMFT index following basic guidelines

for Oral Health Surveys guideline (WHO). Nutritional status was obtained using BMI

and classification of nutritional status was achieved using the standards of WHO and

CDC growth charts include an age- and sex-specific BMI reference for children aged

2 - 20 year. The overall prevalence of dental caries was 44.5% and mean DMFT was

0.45 ? 1.57. Nutritional status demonstrated, about 30% and 6.69% of schools going

girls were underweight and overweight respectively. Occurrence of dental caries was

50

found in all permanent teeth among the girls of underweight and normal according to

their BMI-for age status. Furthermore, a significant association (p < 0.05) with

occurrence of dental caries among the underweight girls has been found compared to

that of the overweight and normal. This study indicates a close relationship between

nutritional status and dental caries in this region.40

The study was a community-based, randomized, controlled trial in

schoolchildren aged 6-7 years with untreated dental caries. Participants were

randomly assigned to early (test) or regular (control) dental treatment. The primary

outcome was Weight-for-age Z-score. Secondary outcomes were Height-for-age and

BMI-for-age Z-scores, dental pain, dental sepsis, satisfaction with teeth and child’s

appetite. 86 children were randomly assigned to test (42 children) and control (44)

groups. Mean duration of follow-up was 34.8 (±1.1) weeks. There were insignificant

improvements in anthropometric outcomes between the groups after treatment of

caries. However, treated children had significantly less pain experience (P = 0.006)

(OR 0.09, [0.01-0.51]) and higher satisfaction with teeth (P = 0.001) (OR 9.91, [2.68-

36.51]) compared to controls. Controls had significantly poorer appetites (P = 0.01)

(OR 2.9, [1.24-6.82]) compared to treated children. All treated children were free of

clinical dental sepsis whereas 20% (9 of 44) of controls who were free of sepsis at

baseline had sepsis at follow-up.41

A study was conducted in Birmingham to determine the oral health status of

minority ethnic groups is a critical issue for practitioners in today's multicultural

society. The National Dental Health survey, conducted by the OPCS, provides

51

baseline information on the oral health and oral health related behavior of the

population in the United Kingdom but not specifically relating to the minority ethnic

communities. To date, little is known concerning oral health status and self-reported

oral health related behaviors among minority ethnic communities in this country.

Following a review of the published literature, this paper will address two questions:

how has ethnicity been used as a variable by dental researchers and, what is known of

the oral health status of minority ethnic groups Other background variables are

considered which might explain the differences in oral health status between these

communities and the indigenous population, and recommendations are made

concerning further research in this area42

A study was to compare the changes in children's oral health-related behavior,

knowledge, and attitudes obtained using an oral health-promotion approach, a risk-

strategy and promotion approach, and reference area, and to report changes in the

behavior of children between the experimental and the control groups of a randomized

clinical trial (RCT). The study population consisted of all fifth and sixth graders who

started the 2001-2002 school year in Pori, Finland (n = 1,691), where the RCT and

program of oral health promotion were implemented for 3.4 yr. Children with at least

one active caries lesion were randomly assigned to experimental (n = 250) and control

(n = 247) groups. Children in Rauma (n = 807) acted as the reference. Changes in

children's self-reported behavior, knowledge, and attitudes were compared between

groups. The subjects in the oral health-promotion group and in the risk-strategy and

promotion group in Pori tended to show greater improvement in most of their oral

health-related behaviors than those in the reference group, and children in the RCT

experimental group showed greater improvement in most of their oral health-related

52

behaviors than those in the RCT control group. Children can be helped to improve

their oral health-related behavior by intervention, including oral hygiene and dietary

counseling, or by implementing a multilevel-approach oral health-promotion

program.4

53

METHODOLOGY

Research methodology organizes all the components of the study deals with

the type of research approach used, the setting of the study, the population, sampling

technique, sample selection, the inclusion and exclusion criteria, the development of

54

the tool, collection of data, pilot study, procedure of data collection and plan for data

analysis.

RESEARCH APPROACH

The selection of research approach is the basic procedure for the conduction of

research enquiry. A research approach tells us so as to what data to collect and how to

analyze it. It also suggests possible conclusions to be drawn from the data. In view of

the nature of the problem selected for the study and the objectives to be accomplished,

a evaluate approach was considered as the best way to preparation of planned

teaching programme regarding dental caries among primary school children

mothers.Evaluate method was used in this study.

RESEARCH DESIGN

The research design refers to the researcher’s overall plan for obtaining

answers to the research question and its spells out strategies that the researcher

adopted to develop information that is accurate, objective and interpretable.

A evaluate design is used as a research design by the use of one group pre test

post test design in this study as there is a need to conduct pre test and post test of the

knowledge and attitude of primary school children mothers regarding

dental caries.

RESEARCH SETTINGS

Research Setting refers to the area where the study is conducted. It is the

physical location and condition in which data collection takes place in a study. The

55

study was conducted in Anekal Taluk st. philomena’s high school selected for the

study on the basis of:

Feasibility of conducting the study

Availability of the samples

POPULATION

Population is the entire aggregation of the cases that meet a designed set of

criteria. In the present study, the populations were primary school children mothers

for attending the PTP in st.philomena’s high school, Anekal, Bengaluru.

SAMPLE

Sample consists of the subject of the population selected to participate in a

research study. In the present study primary school children mothers are selected as

target population or samples of the study.

SAMPLE SIZE

The total sample size of the study consists of 60 primary school children

mothers.

SAMPLING TECHNIQUE;

Sampling refers to the process of selecting the portion of population to

represent the entire population. Subjects were selected from the sampling frame to

achieve non probability purposive sampling technique. In the present study non

probability purposive sampling technique was adopted for 60 primary school children

mothers.

56

CRITERIA FOR SAMPLING TECHNIQUE ;

The sampling frame structured by the researcher included the following criteria.

Inclusive Criteria

1. Mothers of primary school children aged between 21- 40 years at selected areas

of Anekal District Bangalore.

2. Mothers of primary school children those who are willing to participate in the

study.

3. Mothers of primary school children who can able to read and write Kannada or

English.

Exclusion criteria

1. Mothers of primary school children who have already attended IEC package on

dental caries.

2. Mothers of primary school children those who are not available during the data

collection period.

3. Mothers of children those who are not studying in primary school.

DATA COLLECTION INSTRUMENTS

Method of data collection includes selection and development of tool, for validity and

reliability and pretesting by administering on few samples, data collection procedure.

SELECTION OF TOOL

57

Tool is the instrument used by the researcher to collect the data. A structured

knowledge questionnaire and attitude rating scale was selected based on the objective

of the study as it was considered the best instrument to elicit the responses from the

participnts.

DEVELOPMENT OF TOOL

Based on the objectives of the study, a structured knowledge questionnaire and

attitude rating scales were prepared in order to assess the knowledge and attitude of

primary school children mothers regarding dental caries. After extensive and

systematic review, the investigator has developed the structured knowledge

questionnaire and attitude rating scale.

SOURCES OF TOOL CONSTRUCTION

• Review of literature from books, journals, news paper and on-line source reports

and other publications.

• Discussion with the experts, who included Child health nursing, Statistician, and

refined the investigator’s ideas about the tool preparation.

DESCRIPTION OF TOOL

• The tool consists of a structured knowledge questionnaire and 3 point attitude

scale (likert’s type). It is divided into 3 parts, they are as follows

Part I: The investigator constructed the tool to collect the Socio - demographic data

of the study subjects. It consists of demographic variables.

58

Part II: Investigator prepared structured knowledge questionnaire containing 24

knowledge questions regarding denal caries.

• Each correct response was given with score of ‘one’ and wrong answer was given

a score of ‘zero’. The maximum score was 24 and minimum score is Zero. The

respondents were given the questionnaires and placed a tick ( ) to their correct

response.

Part III: Investigator prepared attitude rating scale regarding dental caries consisting

of 16 statements, Attitude statements were given with the range score of 0 to 2 marks.

The maximum score was 32 and minimum score was 0. The respondents were asked

to put a tick ( ) mark to their response.

THE FOLLOWING STEPS WERE UNDERTAKEN FOR PREPARING TOOL

1. CONTENT VALIDITY

Content validity refers to the degree to which an instrument measures what it is

intended to measure. The prepared instrument along with the objectives, blue print

and criteria check list was submitted to 10 experts comprising of in the field of Child

Health Nursing(7), Statistician (1), Paediatrist (1) and Language expert(1) for

establishing the content validity. The tool was modified as per suggestions of the

experts and the final tool was constructed. Later the tool was translated into the local

language, Kannada, without changing the meaning of the tool and it was edited by a

Kannada expert.

2. RELIABILITY

59

Reliability of the research instrument was defined as the extent to which the

instrument yields the same results in repeated measures. It was then concerned with

the consistency, accuracy, precision, stability, equivalence and homogeneity.51

The tool after validation was subjected to test for its reliability. The structured

interview schedule was tested for reliability by administering it to 6 primary school

children mothers in Aekal st.philomena’s high school, Bangalore. The reliability of

the tool was computed by using split half Karl Pearson’s correlation formula (raw

score method).

N ∑ XY – (∑ X) (∑ Y)

r1/2 = ------------------------------------------------------

√ [N ∑ X2 - (∑ X) 2] [N ∑ Y2 – (∑ Y)2]

And Spearman Brawn prophecy formula was used.

2 r

rII=

1+ r

rII — reliability co-efficient of correlation of whole test

r — reliability co-efficient of correlation of half test

The reliability co-efficient on knowledge was found to be 0.72 revealing the

tool is feasible for administration for the main study. Since the knowledge reliability

co-efficient is r > 0.84. The tool was found to be reliable and feasible for the main

study.

60

The reliability co-efficient on attitude was found to be 0.70 revealing the tool

is feasible for administration for the main study. Since the knowledge reliability co-

efficient is r > 0.82. The tool was found to be reliable and feasible for the main study.

PILOT STUDY

“Pilot study is a small scale version, or trial run, done in preparation for a major

Study”.after obtaining formal administrative permission from Anekal st.philomena’s

high school, The pilot study was conducted from 15.09.12-16.09.12

DATA COLLECTION PROCEDURE

Prior to data collection, permission was obtained from the concerned

authority. The participants were informed about the purpose of the study and written

consent was taken from them. Knowledge and attitude was assessed by using

structured questionnaire on selected primary school children mothers.

THE PLAN FOR DATA ANALYSIS

The data collected from the participant were grouped and analyzed with the

help of statistical analysis. The data analysis was planned to include descriptive and

inferential statistics

DEVELOPMENT OF INFORMATION BOOKLET

The PTP on dental caries and preventive health behavior was developed for the

primary school children mothers in st.philomena’s high school anekal, Bangalore

61

The steps involved in the development of PTP were,

1. Preparation of the first draft of PTP

2. Development of attitude scale criteria

3. Pre test of PTP

4. Preparation of the final draft of PTP

Preparation of the first draft of PTP

The PTP was developed according to the objective prepared, the investigator

prepared the overall plan of the PTP and a.v aids, after reviewing the available of

literatures and consulting the experts.

Development of check list criteria

An evaluation criterion was prepared for the content validity of the PTP for

assessing the appropriateness, adequacy, accuracy for formulation of the objectives,

selection and organization of the content, presentation language, feasibility and

practicability.

Pre test of planned teaching programme

Pre testing of the PTP was done by administering the structured questionnaire

to the primary school children mothers in anekal st.philomena’s high school,

Bangaslore

Preparation of the final draft of PTP

The PTP covered the following content are,

Introduction

62

Anatomy and physiology of teeth

Definition of dental caries

Stages of dental caries

Pathological mechanism

Signs and symptoms

Diagnostic evaluation

Complication

Prevention

The final draft of PTP was prepared based on the suggestions of the experts after

ensuring the validity of the findings of the pre test

63

Target Purpose Setting Population Sample Technique Tool Assessment

Figure 2: Schematic Representation of Research Design

Assess the knowledge and attitude regarding

dental caries

Anekal st.philomenas high school Bangalore.

Primary school children

mothers in Anekal

st.philomenas high school Bangalore.

60 Primary school

children mothers in

Anekal st.philomenas high school Bangalore.

Non probability Purposive sampling technique

Criterion measure

knowledge and attitude

with selected variable

Structured questionnaire on knowledge and attitude rating scale

Evaluate planned teaching programme regarding dental

caries for primary school children mothers

64

65

RESULT

Analyzing collected data for the purposes of summarizing information to make

it more usable and/or making generalizations about a population based on a sample

drawn from that population.

This chapter deals with analysis and interpretation of data collected from 60

primary school children mothers regarding dental caries keeping in a view the

objectives of the study use evaluate research approach which was adopted to assess

the knowledge and attitude of the primary school children mothers regarding dental

caries

The data was collected from the respondents before conducting the planned

teaching programme. The collected information was organized, tabulated, analyzed

and interpreted using descriptive and inferential statistics. Analysis was done based on

the objectives and hypothesis of the study.

PRESENTATION OF THE DATA:

The data were presented under the following headings.

Section I : Assessment of knowledge regarding dental caries.

Section II : Assessment of attitude towards dental caries.

Section I11 : Association between pre test and post test of knowledge with


Section 1V : Relation between knowledge and attitude scores with

Demographic variables.

Section V : Correlation of pre test and post test scores.

66

SECTION I

Socio-demographic data

Findings related to socio- demographic variables as described in the study are

age, type of the family, family income, education, occupation, number of children,

source of information, history of oral disorders.

Table 5.1

Frequency and percentage distribution according to age

SL.NO Age (in yrs) Frequency Percentage

1. Below 20 12 12%

2. 21-25 25 25%

3. 26-30 10 10%

4. Above 30 13 13%

TOTAL 60 60%

FIGURE 3: DISTRIBUTION OF RESPONDENTS BY AGE

67

The above table shows that out of 60 subjects, 12% were in age group of

below 2 0 yrs,25% were 21 to 25 yrs, 10% were 26 to 30 yrs and 13% in above 30

yrs of age group. The above table shows that majority of the primary school children

mothers were 21-25yrs

Table 5.2

Frequency and percentage distribution according to education.

SL.No Education Frequency Percentage

1. Illiterate 0 0%

2. Up to SSLC 38 38%

3. PUC 14 14%

4. Graduation and above 8 8%

TOTAL 60 60%

68

The above table denotes that out of 60 primary school children mothers, 38%

have SSLC, 14% have PUC education and 8% have graduation and above education.

It is observed that majority of primary school children mothers have upto SSLC

education

Table-5.3

Frequency and percentage distribution of according to occupation

SL. No Occupation Frequency Percentage

1. Home maker 18 18%

2. Cooli worker 25 25%

3. Govt employee 10 10%

4. Private employee 7 7%

TOTAL 60 60%

The above table shows that out of 60 primary school children mothers 18%

were home maker, 25% were cooli workers, 10% were govt employes and 7% were

DIDTRIBUTION BASED ON OCCUPATION

69

private employees. It is observed that majority of primary school children mothers are

cooli workers

Table-5.4

Frequency and percentage distribution according to Income per month(in

rupees)

SL.No Income Frequency Percentage

1. 1001-2000 0 0

2. 2001-3000 0 0

3. 3001-4000 37 37%

4. 4001 and above 23 23%

TOTAL 60 60%

FIGURE 6: DISTRIBUTION OF RESPONDENTS BY MONTHLY INCOME

The above table shows that out of 60 subjects, 37% were from the income

group of Rs3001-4000 and 23% were from income group of 4001 and above. The

above table shows that majority of them are from income group of Rs 3001-4000.

70

The above table shows that out of 60 subjects, 37% were from the income group of

Rs3001-4000 and 23% were from income group of 4001 and above. The above table

shows that majority of them are from income group ofRs 3001-4000.

Table-5.5

Frequency and percentage distribution according to number of children

SL.No No. of children Frequency Percentage

1. 2 18 18%

2. 1 16 16%

3. 3 12 12%

4. Twins 14 14%

TOTAL 60 60%

FIGURE 7: DISTRIBUTION OF RESPONDENTS BY NUMBER OF

CHILDREN

71

The above table denotes that out of 60 subjects, 18% were have 2 children,

16% were have 1 child, 12% were have 3 children and 14% were have twins. The

above table shows that majority of them were have 2 children.

Table-5.6

Frequency and percentage distribution according to history of oral disorders.

SL.No Oral disorders Frequency Percentage

1. Mouth ulcer 18 18%

2. Oral sores 16 16%

3. Dental caries 26 26%

TOTAL 60 60%

FIGURE 8: DISTRIBUTION OF RESPONDENTS BY THE HISTORY OF

ORAL DISORDERS

72


have oral ulcers, 16% of them have oral sores, 26% of them have dental caries. The

above table shows that majority of them are having mouth ulcers.

Table-5.7

Frequency and percentage distribution according to type of family

SL.No Type of family Frequency Percentage

1. Nuclear 36 36%

2. Joint 16 16%

3. Extended 8 8%

TOTAL 60 60%

FIGURE 9: DISTRIBUTION OF RESPONDENTS BY TYPE OF FAMILY

73

The above table denotes that out of 60 primary school children mothers, 36% were

from nuclear family, 16% were from joint family, 8% were from extended family.

The above table shows that majority of them were from nuclear family

Table -5.8

Frequency and percentage distribution according to sources of information

FIGURE 11: DISTRIBUTION OF RESPONDENTS BY SOURCES OF

INFORMATION

SL.No Sources of information Frequency Percentage

1. Mass media 14 14%

2. Friends 13 13%

3. Relatives 10 9%

4. Parents 7 7%

5. Health personel 17 17%

TOTAL 60 60%

74


got information from mass media, 13% of them got from friends,9% got from

Relatives and 7% got from parents and.17% got information from health personels.

The above table shows that majority of them got sources of information from health

personnels.

SECTION-II

Findings related to assessment of knowledge regarding dental caries

It deals with the Item wise analysis of primary school children mothers. The

structured questionnaire is used for collecting and analyzing the data. The structured

questionnaire consists of 24 questions related to dental caries. The total scores allotted

were 24. The knowledge assessment is divided in to 3 levels.

Inadequate - below 50%

Moderate - 51-75%

Adequate - above 76%

Table-5.9

Frequency and percentage distribution of primary school children mothers

according to their knowledge assessment

SL.No Level of

knowledge

Frequency Percentage

1. Inadequate 78.3 78.3%

2. Moderate 18.3 18.3%

3. Adequate 3.3 3.3%

75

Table 5.10

Aspect wise Mean Knowledge Score related to dental caries

Knowledge Score

No Knowledge No. of questions

Maximum score Mean

Mean (%)

SD (%)

1 dental caries 24 24 23.5 97.96% 13.56

This denotes that the mean of the knowledge score is 23.5, mean % is 97.96

and the Standard deviation is 13.56.

TABLE- 5:11

Aspect wise Mean, S.D and mean% score for the knowledge level

No

AREA

NO OF

ITEMS

MAX

SCORE

MEAN

MEAN

SD

1 Dental

caries

4 4 26 650 1.5

2 stages 4 4 24.8 618.8 1.3

3 Signs and

symptoms

5 5 22.2 444 1.5

4 complication 5 5 22.6 452 1.2

5 prevention 6 6 23.3 388.9 1.8

Table-5-1 Reveals Aspects wise Mean knowledge score of respondents on

dental caries. Regarding introduction to dental caries the mean knowledge score was

76

26 & S.D was 1.5, In the aspect of stages the mean knowledge score was 24.8 & S.D

Score was 1.3, regarding signs and symptoms the mean knowledge score was 22.2,

and SD was 1.5, regarding complication the mean knowledge score was 22.6 and SD

was 1.2, regarding dental caries the knowledge score was 3,3 and SD was1.8.

SECTION-III

Findings related to assessment of attitude regarding dental caries

It deals with the Item wise analysis of primary school children mothers. The 3

point Likert’s scale is used for collecting and analyzing the data. This consists of 8

positive and 8 negative statements related to dental hygiene. The total scores allotted

were 32

Table5.12

Aspect wise Mean, Mean% and standard deviation of attitude Scores related to

dental caries

N=60

Score No

Attitude

Aspects Statements

maximum

score Mean Mean (%) SD

I Positive

statements

8 16 6.72 83.96% 10.77

II Negative

statements

8 16 6.37 79.63% 10.02

Combined 16 32 12.63 78.96 11.83

77

It reveals that in the positive statements, the mean attitude score was 6.72,

and in the negative statements mean attitude score was 6.37. The combined mean

attitude score is 12.63 and SD

Table5.13

Frequency and percentage distribution of primary school children mothers

according to their Attitude assessment

SL.No Degree of attitude Frequency Percentage

1. Positive

11.7 11.7%

2. Negative 73.3 73.3%

3. Neutral 15 15%

This shows that41% of respondents possessed Negative attitude.17%

possessed neutral and 2% possessed positive attitude.

SECTION IV

Findings related to association between pre test and post test knowledge levels of

primary school children mothers regarding dental caries.

This section deals about the association between knowledge score with the


78

Table 5.14

Association between demographic variables and pre test post test Knowledge

Level of Respondents on dental caries

N=60

Sl

No.

DEMOGRA

PHIC

VARIABLE

S

frequency ≤MEDI

AN

Value

>MED

IAN

Value

X2 DF P

VALU

E

REM

ARK

S

Below 20 7 5

21-25 2 1 4

26-30 5 6

1 Age

Above 30 8 5

9.25 3 7.815 S

Uneducated 0 0

Up to SSLC 27 11

PUC 8 6

Graduation 5 3

2 Education

Postgraduate 3 1

1.078 4 9.488 NS

House wife 13 5

Cooli worker 17 8

Government

employee

6 4

3 Occupation

Private

employee

4 3

0.793 3 7.815 NS

1001-2000 0 0

2001-3000 0 0

3001-5000 24 13

4 Monthly

income

>5000 16 7

0.149 3 7.815 NS

2 15 3

1 9 7

3 10 2

5 Number of

children

twins 6 8

7.95 3 7.815 S

79

NS: NON SIGNIFICANT S:SIGNIFICANT AT 5% LEVEL

Data is presented in the table indicated, association between demographic

variables and pre test post test knowledge level of respondents regarding dental caries.

There exists a significant association between knowledge score on dental caries

among primary school children mothers and the selected demographic variable such

as age, education,income, occupation,number of children,history of dental disorders,

type of family, and source of information found.

6 History of

oral

disorders

Mouth ulcers 10 8 5.568 2 5.991 S

Oral sores 9 7

Dental caries 21 5

Type of

family

Nuclear

family

28 8 5.998 2 5.991 S

Joint family

7 9

Extended

family

5 3

Sources of

information

Mass media

10 3 7.080 4 9.488 NS

Friends

5 8

Relatives

7 2

Parents

6 1

Health

personnels

12 5

80

SECTION V

Findings related to association between pre test post test attitude and

demographic variables

Table 5.15

Association between demographic variables and pre test post test attitude Level

of Respondents on dental caries,

no DEMOGRAP

HIC

VARIABLES

frequency ≤ME

DIA

N

value

>MEDI

AN

value

X2 DF P

VAL

UE

RE

MA

RKS

Below 20 0 8

21-25 14 5

26-30 18 4

1 Age

Above 30 8 3

18.72 3 7.815 S

Uneducated 0 0

Up to SSLC 15 7

PUC 17 9

Graduation 5 3

. Education

Postgraduate 3 1

0.2053 4 9.488 NS

House wife 23 8

Cooli worker 7 6

Government

employee

5 2

3. Occupation

Private employee 5 4

2.33 3 7.815 NS

1001-2000 0 0

2001-3000 0 0

3001-5000 25 10

4. Monthly

income

>5000

15 10

0.878 3 7.815 NS

81

NS: NON SIGNIFICANT S:SIGNIFICANT AT 5% LEVEL

Data is presented in the table in`icated, association between demographic

variables and pre test post test attitude level of respondents regarding dental caries.

There exists a significant association between attitude score on dental caries among

primary school children mothers and the selected demographic variable such as

age,number of children,history of dental disorders,type of family education,

occupation, monthly income and source of information found.

2 18 6

1 15 5

3 3 4

5. Number of

children

twins 4 5

5.75 3 7.815 NS

Mouth ulcer 11 13

Oral sores 9 5

6. History of

dental

disorders Dental caries 20 2

10.508 2 5.991 S

Nuclear family 25 20

Joint family 9 10

7.

Type of family

Extended family 6 18

0.565 2 5.991 NS

Mass media

6

7 23.73 4 9.488 S

Relative

15 1

Parent

10 3

8. Sources of

information

Health personnels

7 2

82

SECTION VI

Findings related to Correlation between knowledge score and attitude score

regarding dental caries

This deals with the findings related with the correlation between knowledge

score and attitude score.

Table 5.16

Distribution of Respondents and Relationship between Knowledge and Attitude

Scores

N=60

Knowledge Attitude

Category Number Percent Category Number Percent

Inadequate 78.3 78.3 Negative 73.3 73.3

Moderate 18.3 18.3 Neutral 11.7 11.7

Adequate 3.4 3.4 Positive 15 15.0

Combined 100 100.0 Combined 100 100.0

83

It represents that 78.3% of the respondents had the inadequate knowledge;

18.3% of the respondents had moderate knowledge and 3.4% had adequate

knowledge regarding dental caries. With respect to attitude towards dental caries

73.3% of the respondents possessed Negative attitude, 11.7% of the respondents’

possessed neutral attitude and 15 % possessed positive attitude regarding dental

caries.

Table 5.17

Correlation between pre test and post test scores

This shows that mean of the pre test score is 23.5 and post test mean is

12.6.The standard deviation of pre test score is 13.6 and standard deviation of post test

score is 11.8. The correlation between pre test score and post test score is + 0.894274.

This proved the pre test score and post test scores are highly correlated with each

other.

ITEMS MEAN STANDARD

DEVIATION

CORRELATION

Pre test 23.51 13.56

Post test 12.63 11.83

0.894274

84

85

DISCUSSION

A report of findings is never sufficient to convey their significance. The

meaning that researchers give to the results plays a rightful and important role in the

report. The discussion section is devoted to a thoughtful and insightful analysis of the

finding, leading to a discussion of their home and theoretical utility. The findings of

the study have been discussed with reference to the objectives and hypothesis stated.54

The aim of the present study was to assess the knowledge and attitude of the

primary school children mothers regarding dental caries those who are in

st.philomena’s high school, Bengaluru. A total of 60 primary school children mothers

from st.philomena’s high school children were selected for the study by using non

probability purposive sampling method. Structured questionnaire for knowledge and

rating scales for attitude was given to all the subjects.

The findings are discussed under the demographic characteristics and objectives.

Description of demographic characteristics of the sample

Findings of the revealed that majority of the subjects were (25%) in the age

group of 21- 25years, majority of the subjects (38%) had upto SSLC education and

majority of the respondents (25%) were coolie worker. 37% of the family income falls

between Rs. 3001 -4000. Majority of respondents were have 2 children (18%).26%of

the samples have mouth ulcer, 36% samples were from nuclear family. Majority of

them got information from health personnels about dental caries.

86

A study conducted by kosika K, chowska A and przybos A (2005) on attitude

of primary school children mothers towards dental caries related to the study of forms

and preparation and preference. Samples were the 275 primary school children

mothers in Puck high school in Warsaw was assessed in the period of July 2003 to

February 2004.This revealed that the dental caries was very popular among better

educated women from big cities, while those with lower education from small cities

and villages.44

A study by Schröcksna H, Kunziky V, Brezinka C and Oberaigner W(2004)

cited in Australia. Samples were 265 primary school children mothers.So dental caries

is considered to be a safe method for a healthy teeth. This study proved that attitude of

the women was depending upon the educational level. 45

Similarly in present study demographic data included were Age,

Occupation,no.of children, Income, type of family and Source of information.

The first objective of the study was to assess the knowledge of primary school

children mothers regarding dental caries.

In this study the results revealed that out of 60 primary school children

mothers 73.3 (73.3%) had inadequate knowledge, 11.7(11.7%) women had

moderately knowledge and 15 of the primary school children mothers had adequate

knowledge regarding dental caries. These findings are supported by the following

study.

87

A study was conducted by Made RM, Fourur MJ(2005) bon women's

experience of giving adequate care for their family. This study aimed to give

importance to women's experiences and knowledge of dental caries. The sample was

five women from a large urban region in New Zealand, who give adequate care for

their family, at home and in hospital. The knowledge increases their confidence to for

giving care for their family. Women's knowledge contributes an important part in this

study.46

The second objective of this study was to determine the attitude of the primary

school children mothers regarding dental caries.

In present study results revealed that out of 60 primary school children

mothers, 78.3 (78.3%) women had negative attitude, 18.3(17%) and 3.4 (3.4%) had

positive attitude, towards dental caries.

A study was conducted by Halsm and Holloway IM(1995) to examine primary

school children mothers experiences in dental caries. This was an exploratory study

and setting of the study was a peadiatric unit of a local general hospital set in a semi-

rural location in England. Nine women were participated in this study. This study

concluded that all women participated in the study had a positive attitude towards

dental caries.47

The Third of objective of the study was to find out the correlation between the

pre test post test knowledge & attitude of primary school children mothers

regarding dental caries.

88

The correlation between pre test post test knowledge score and attitude score

regarding dental caries is 0.883574.So this is highly correlated with each other.

A study by Richard H conducted in London (2004) to assess the awareness of

primary school children mothers regarding dental caries. This study showed the

knowledge and attitude of primary school children mothers regarding dental caries. A

sample of 189 mothers who were experienced dental care taken for this survey. Most

women desired dental hygiene and dental caries as they have inadequate knowledge

and attitude.48

The fourth objective of the study was to find out the association between the pre

test post test knowledge and attitude scores with selected demographic variables.

1. Knowledge scores

The significance associations of knowledge with the selected demographic

variables in this study are age,education, occupation,no.of children,history of

dental disorders,type of family, and source of information.

Age - The value of X2 found significant at the level of 5% (X2 = 9.248 at P>0.05

level).

Occupation – The value of X2 found non significant at the level of 5%(X2 = 0.793 at

P<0.05 level).

Education- The value of X2 found to be statistically non significant at the level of 5%

(X2 = 1.078 at P<0.05 level).

Number of children- The value of X2 found to be statistically significant at the level

of 5% (X2 = at 5.568 P>0.05 level).

89

Religion- The value of X2 found to be statistically significant at the level of 5% (X2 =

7.968 at P>0.05 level).

Source of information-The value of X2 found to be statistically significant at the level

of 5%(X2 = 7.0808 at P>0.05 level).

A study conducted by Julett, Burns(2008)for assessessing the knowledge and

attitude of women related to their information about dental caries. This study cited at

High field, United Kingdom and samples were 3146 primary school children

mothers.The fact is that adequate dental care is carried out according to their sources

of information.49

2. Attitude Scores

The significance association of attitude with the selected demographic

variables in this study are Age, Education,Occupation,number of children,history of

dental disorders and source of information.

Age- The value of X2 found to be statistically significant at the level of 5%. (X2

=18.72 at P>0.05 level).

Education- The value of X2 found to be statistically non significant at the level of 5%.

(X2 = 0.205 at P<0.05 level).

Occupation- The value of X2 found to be statistically non significant at the level of

5%. (X2 =2.33 at P<0.05 level).

Number of children- The value of X2 found to be statistically non significant at the

level of 5%. (X2 =5.75 at P<0.05 level).

History of dental disorders- The value of X2 found to be statistically significant at the

level of 5%. (X2 = 10.51 at P>0.05 level).

90

Source of information -The value of X2 found to be statistically significant at the level

of 5%. (X2 = 23.73 at P>0.05 level).

A study was conducted by R Dällenbch , .Martens (2003) to identify Pros and

cons and the attitude of primary school children mothers towards dental caries. This

was conducted in Basel, Switzerland. This study showed that the primary school

children mothers needed all the information to develop good attitude from the

professionals. so the information have a significant role in developing good attitude

towards dental caries. 50

91

92

CONCLUSION

On the basis of findings of the study the below set conclusions were drown. It

also brings about the limitations of study in to practice. The implications are given on

the various aspects like nursing education, nursing practice, nursing administrations

and it also gives insight in to the future studies.

Many studies show that there is a lack of knowledge and negative attitude

regarding dental caries among primary school children mothers. Planned teaching

programme is the one of the best method to improve knowledge and attitude

regarding dental caries among primary school children mothers.

The knowledge and attitude of primary school children mothers regarding

dental caries was inadequate and negative when assessed. So planned teaching

programme was given to maintain the adequate knowledge and positive attitude.

The study was based on the Pender’s health belief model (1996). It is one of

the most widely used models to explain why people do or do not take preventive

health actions.

Implications of the Study

The findings of the study have implications in the field of nursing practice,

nursing education, nursing administration and nursing research.

93

1. Nursing Practice

• Nursing professionals working in the community as well as in the hospital

should educate regarding dental caries for reducing the dental problems.

• Nursing professionals play a key role in enhancement of knowledge of dental

caries, which could change the attitude and practice towards the dental

hygiene and dental caries

2. Nursing Education

• Nursing education is to bring changes in the behaviour of people so as to

prepare them to play their roles effectively as an individual and as a good

responsible citizen.

• As a nurse educator, there are abundant opportunities for nursing professionals

to educate the primary school children mother as well as to the married

women regarding dental hygiene and dental caries

• The study emphasizes significance of short term in service education

programmes for nurses and peripheral health workers to educate for adopting

dental caries

3. Nursing Administration

• Nursing administration is to organise and direct human and material resources

to achieve desired nursing outcomes.

• The nursing administrator can take part in developing protocols, regarding the

health education programmes and strategies for primary school children

mothers regarding dental caries

94

• The nursing administrator can mobilize the available resource personnel

towards the health education of primary school children mothers regarding

dental caries

• The nurse administrators should explore their potentials and encourage

innovative ideas in the preparation of appropriate teaching material. She

should organize sufficient manpower; money and material for disseminating

health information.

4. Nursing Research

• Nursing research is to explore new solutions and remedies for overcome the

health related problems of dental caries

• This study helps nurse researchers to educate the primary school mothers to

participate in adopting this alternative method according to their demographic,

socio-economic, cultural and political characteristics.

• Nurses should come forward to carryout studies on dental caries and publish

them for the benefit of public and nursing fraternity. The public and private

agencies should also encourage research in this field through materials and

funds.

Limitations of the Study

• The study is limited only primary school children mothers in selected high

school.

• The sample size was limited to 60 primary school children mothers.

• The study period is 4-6 weeks only.

95

Recommendations

On the basis of the findings of the study following recommendations have been

made:

• A similar study can be replicated on a large sample to generalize the findings.

• A quasi-experimental study can be undertaken with a control group for

effective comparison of the result.

• A study can be conducted by including additional demographic variables.

• Manuals, self-instruction module may be developed in areas of dental caries

among primary school children mothers.

• A study can be carried out to evaluate the efficiency of various teaching

strategies like SIM, pamphlets, leaflets and computer-assisted instruction on

dental caries.

96

97

SUMMARY

This chapter presents the summary of the study, its discussion, conclusion, its

nursing implications and recommendations.

• This is a descriptive study on assessing the knowledge and attitude of primary

school children mothers regarding dental caries. A sample of 60 primary

school children mothers was selected by using non probability purposive

sampling. It was concluded that primary school children mothers have

inadequate knowledge and negative attitude regarding dental caries.

OBJECTIVES OF THE STUDY:-

The objectives of the study to:

1. To assess the pre and post test level of knowledge on prevention of dental caries.



caries.



5. To find out the difference between the pre test and post test attitude on prevention

of dental caries.

6. To find out the association between the pre tests knowledge on prevention of

dental caries among mothers of primary school children with their demographic

variables.

98

HYPOTHESIS:-



H 2 - There will be a significant association between the pre test knowledge on

prevention of dental caries among mothers of primary school children with their

secured demographic variables.




CONCEPTUAL FRAME WORK:-

The investigator selected conceptual framework was based on the Pender’s

health belief model (1996). It is one of the most widely used models to explain why

people do or do not take preventive health actions.

STUDY SETTINGS:-

The study was conducted at Anekal st.philomena’s high school on the month

of November 2012.The study was a descriptive survey type. The data was collected

from 60 samples through Non probability Purposive sampling technique. It was

conducted during the period of 15-10-2012 to 20-10-2012.

The sample of this study comprised of 60 primary school children mothers at

Anekal st.philomena’s high school. Non Purposive sampling technique was used to

draw the sample for the study.

99

The tool developed and used for the data collection. 7 experts validated the

content validity of the tool and the tool was found to be reliable and feasible. The

reliability of the knowledge tool was established by Karl Pearson coefficient of

correlation and that was .85 and attitude tool reliability was .64.

Pilot study was conducted as a part of the major study, tool proved to be

comprehensive, feasible and acceptable. After obtaining written permission from

concerned authorities, the main study data was collected by using structured

knowledge questionnaire and 3 point likert’s attitude scale from 25th November to 30th

November 2011.

The tool used for assessment consists of

SECTION-A

Demographic variables which include Age,number of children, Education, Occupation,

Income,history of dental problems, Type of family, Sources of information.

SECTION-B

Knowledge questionnaire regarding dental caries which consist of 24items ,

SECTION-C

3 point likert’s Attitude scale regarding dental caries consist of 16 items. It includes 8

positive and 8 negative attitude statements.

The data gathered were analyzed and interpreted according to objectives.

Descriptive statistics like mean, and standard deviation. And inferential statistics like

χ2-test were included to test the hypothesis at different levels of significance and the

data obtained are presented in the graphical form.

100

Major findings of the study

The following conclusions were drawn on the basis of the findings of the study:

Finding related to demographics characteristics

• Majority of the subjects were (25.0%) in the age group of 21-25years followed by

13.0% in above 30 years and 12.0% in below 20 age group.

• Majority of the subjects (38.0%) had SSLC education followed by 14% had PUC

education as educational status.

• Majority of the respondents (25.0%) were Coolie workers.

• Most of the respondents (37.0%) had family income between ’3001 - 4000.

• Majority of respondents were have 2 children (18.0%).

• Majority of respondents were have mouth ulcer (26.0%).

• Majority of respondents were from nuclear family (36.0%)

• Majority of respondents got information from(17%) health personnels.

Finding related to knowledge and attitude of primary school children

mothers

• In this study out of 60 primary school children mothers, 73.3(73.3%) had

inadequate knowledge, 11.7(11.7%) women had moderately knowledge and

15(15%) of the primary school children mothers had adequate knowledge

regarding dental caries. The respondent’s mean knowledge score is 97.96%.

• In this study out of 60 primary school children mothers, 78.3 (78.3%) women had

negative attitude,18.3(18.3%) women had neutral attitude and 3.4 (3.4%) had

101

positive attitude towards dental caries. The respondent’s mean attitude level

showed is 78.96% .

Finding related to association of pre test post test knowledge and attitude

scores of primary school children mothers with selected demographics

variables

• There is a significant association between Age and knowledge at the level of 5%

(X2 =9.25 at P>0.05 level).

• There is no significant association between Occupation and knowledge at the level

of 5% (X2 = 0.793 at P<0.05 level).

• There is no significant association between Education and knowledge at the level

of 5% (X2 = 1.078 at P<0.05 level).

• There is a significant association between number of children and knowledge at

the level of 5% (X2 = 5.568 at P>0.05 level).

• There is a significant association between Type of family and knowledge at the

level of 5% (X2 = 5.993 at P>0.05 level).

• There is a significant association between history of dental problems and

knowledge at the level of 5% (X2 = 7.862 at P>0.05 level).

• There is no significant association between Source of information and knowledge

at the level of 5%(X2 = 7.08at P<0.05 level).

Finding related to correlation between pre test post test knowledge and

attitude scores of primary school children mothers regarding dental caries

102

There is a positive significant relationship between knowledge and attitude of

respondents on dental caries (r = +.0.883574).So this is highly correlated with each

other.

103

LIST OF REFERENCES

104

1. Filstrup SL, Briskie D, da Fonseca M, Lawrence L,Wandera A, Inglehart MR.

Early childhood caries and quality of life: child and parent perspectives.

PediatrDent 2003;25:431-440.

2. Low W, Tan S, Schwartz S. The effect of severe caries on the quality of life in

young children.PediatrDent 1999;21:325-326

3. Acs G, Lodolini G, Kaminsky S, Cisneros GJ. Effectof nursing caries on body

weight in a pediatric population.Pediatr Dent 1992;14:302-305.

4. Milnes AR. Description and epidemiology of nursing caries. J Public Health Dent

1996;56:38-50.

5. Downer MC. The 1993 national survey of children’s dental health. Br Dent J

1995;178:407-412.

6. Hallett KB, O’Rourke PK. Social and behavioural determinants of early childhood

caries. Aust Dent J 2003;48:27-33.

7. Jose B, King NM. Early childhood caries lesions in preschool children in Kerala,

India.Pediatr Dent 2003;25:594-600.

8. Li Y, Wang W. Predicting caries in permanent teeth from caries in primary teeth:

an eight-year cohort study. J Dent Res 2002;81:561-566.

9. Kaste LM, Marianos D, Chang R, Phipps KR. The assessment of nursing caries

and its relationship to high caries in the permanent dentition. J Public Health Dent

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10. Johnsen DC, Gerstenmaier JH, DiSantis TA, Berkowitz RJ. Susceptibility of

nursing-caries children to future approximal molar decay.Pediatr Dent 1986;8:

168-170.

11. al Shalan TA, Erickson PR, Hardie NA.Primary incisor decay before age 4 as a

risk factor for future dental caries.Pediatr Dent 1997;19:37-41.

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12. Peretz B, Ram D, AzoE, Efrat Y. Preschool caries as an indicator of future caries:

a longitudinal study. PediatrDent 2003;25:114-118.

13. Holbrook WP, de Soet JJ, de Graaff J. Prediction of dental caries in pre-school

children. Caries Res 1993;27:424-430.

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bottle caries. J Pedod1988;13:1-10.

15. Holm AK. Caries in pre-school children: international trends. J Dent 1990;291-5.

16. Hinds K, Gregory JR. National diet and nutrition survey: Children aged 11/2 to 4

½ years. Report of dental survey.Vol. 2. London: HMSO; 1995.

17. 17.Friedman LA, Mackler IG, Hoggard GJ, French CI. A comparison of perceived

and actual dental needs of a selected group of children in Texas. Community Dent

Oral Epidemiol1976;4:89-93.

18. Finlayson TL, Siefert K, Ismail AI, Sohn W. Maternal self-efficacy and 1-5 year

old children's brushing habits. Community Dent Oral Epidemiol 2007;35:272-81.

19. National Oral Health Policy: JIDA 1986;58:397-401.

20. Chawla H.S: Dental health promotion, reaching the needy: JIDA 1985;57:387-

95.

21. Oral health, ICMR Bulletin, 1994;24:4.

22. National Oral Health Survey. Dental Council of India, New Delhi: 2002 -03.

23. Holm AK. Caries in pre-school children: international trends. J Dent 1990;291-5.

24. Berkowitz RJ. Mutans streptococci acquisition and transmission.Peadiatr Dent

2006;28:106-9.

25. Dental caries and periodontal conditions among primary school children in

Morogoro municipality, Tanzania. Kikwilu EN, Mandari GJ 2002

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26. Institute of Dental Research, First Faculty of Medicine, Charles University,

General Teaching Hospital, Prague, Czech Republic. [email protected]

27. Department of Health Behavior and Health Education, University of Michigan,

Ann Arbor 48109-2029.

28. Department of Social and Preventive Dentistry, School of Dentistry, Federal

University of Rio Grande do Sul, Porto Alegre, RS, Brazil.

29. Department of Community Dentistry, Institute of Dentistry, University of Oulu,

Oulu, Finland. [email protected]

30. Tewari A, Chawla HS. A study of prevalence of dental caries in an urban area of

India, Chandigarh. J Indian Dent Assoc 1977;49:231-7

31. Department of Community Dentistry, Dr, Ishrat Ul Ebad Khan Institute of Oral

Health Sciences, DUHS, Rafiqui Shaheed Road, Karachi, Pakistan.

[email protected]

32. Alvarez, J. O., Eguren, J. C, Caceda, J. & Navia, J. M. (1990). The effect of

nutritional status on the age distribution of dental caries in the primary teeth.

Journal of Dental Research, 69, 1564-1566. doi:10.1177/00220345900690090501

33. CDC Data & Statistics | Feature: Untreated Dental Caries (Cavities) in Children

Ages 2-19, United States [Internet]. [cited 2012 Feb 25].

34. Available from: http://www.cdc.gov/Features/dsUntreatedCavitiesKids/

35. US Department of Health and Human Services. Agency for Health Care Policy

and Research. Acute Pain Management: operative or medical procedures and

trauma. Rockville (MD): The Agency; 1993. Clinical Practice Guideline No.1.

AHCPR Publication No. 92-0023. p.107.

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36. Pitts NB, Nugent ZJ, Davies JA. The Scottish Health Boards’ Dental

Epidemiological Programme Report of the 1997/98 survey of 5 year old children.

Dundee: University of Dundee, 1998.

37. Pitts NB, Nugent ZJ, Smith PA. The Scottish Health Boards’ Dental

Epidemiological Programme Report of the 1998/99 survey of 14 year old children.

Dundee: University of Dundee, 1999.

38. Pitts NB, Binnie V, Gerrish AC, Mackenzie NM, Watkins TR. Dental Caries in

Children. Scottish Needs Assessment Programme Report. 1994, Scottish Forum

for Public Health, Glasgow.

39. Pitts NB, Binnie V, Gerrish AC, Stevenson J. Dental Caries in Children (Update).

Scottish Needs Assessment Programme Report. 1998, Scottish Forum for Public

Health, Glasgow.

40. Field MJ, Lohr KN (editors) Clinical practice guidelines: directions for a new

program. Washington (DC): National Academy Press; 1990. Committee to Advise

the Public Health Service on Clinical Practice Guidelines, Institute of Medicine

41. Scottish Intercollegiate Guidelines Network. SIGN guidelines: an introduction to

SIGN methodology for the development of evidence-based clinical guidelines.

Edinburgh: SIGN; 1999 (SIGN publication no. 39).

42. Disney JA, Graves RC, Stamm JW, Bohannan HM, Abernathy JR, Zack DD. The

University of North Carolina Caries Risk Assessment Study: further developments

in caries risk prediction. Community Dent Oral Epidemiol 1992; 20: 64-75.

43. Faculty of General Dental Practitioners (UK) Working Party. Selection Criteria

for Dental Radiography. London: Faculty of General Dental Practitioners (UK)

The Royal College of Surgeons of England, 1998.

108

44. Seppa L, Hausen H, Pollanen L, Helasharju K, Karkkainen S. Past caries

recordings made in Public Dental Clinics as predictors of caries prevalence in

early adolescence. Community Dent Oral Epidemiol 1989; 17: 277-81.

45. Stecksen-Blicks C, Gustafsson L. Impact of oral hygiene and use of fluorides on

caries increment in children during one year. Community Dent Oral Epidemiol

1986; 14: 185-9.

46. Hackett AF, Rugg-Gunn AJ, Appleton DR. Sugar consumption of Northumbrian

children aged 11-14 years. Nutr Health 1987; 5: 19-23.

47. Serra Majem L, Garcia Closas R, Ramon JM, Manau C, Cuenca E, Krasse B.

Dietary habits and dental caries in a population of Spanish schoolchildren with

low levels of caries experience. Caries Res 1993; 27: 488-94.

48. Gustaffson BE, Quensel CE, Lanke LS, Lundquist C, Grahnen H, Bonow BE,

Krasse B. The Vipeholm dental caries study. The effect of different levels of

carbohydrate intake on caries activity in 436 individuals observed for five years.

Acta Odont Scand 1954; 11: 232-364.

49. Newbrun E. Frequent sugar intake - then and now: interpretation of the main

results. Scand J Dent Res 1989; 97: 103-9.

109

110

LIST OF ANNEXURES

Sl.No

Annexure Page. No

1 Letter seeking permission for conducting the study 110

2 Certificate of content validity 111

3 Letter seeking experts opinion for the content validity of the tool

used for the study 112-113

4 Scoring key 114-115

5 Tool for data collection 116-173

6 Blue print of the tool 174

7 Letter requesting permission to conduct the piolot study 175

8 Letter granting permission to conduct piolot study 176

9 Letter requesting permission to conduct the main study 177

10 Letter granting permission to conduct main study 178

11 Letter seeking consent of the subjects for participation in the study 179

12 List of experts who validated the tool 180

13 Certificate of editing 181

111

ANNEXURE-I

LETTER SEEKING PERMISSION FOR CONDUCTING THE STUDY

Ref. No: - Date:-

To,

The principal,

St.philomena’s high school,

Anekal,

Bangalore-562106

Respected Sir\Madam,

Sub: - Letter seeking permission for conducting the study.

Ms Anju Appukuttan is a student of Msc Nursing in our college. She is

conducting a study on “A study to evaluate the effectiveness of planned teaching

programme regarding knowledge and attitude on prevention of dental caries among

mothers of primary school children at AnekalDistrict Bangalore.’’

This is for her research project to submit to Rajiv Gandhi University of Health

Sciences in partial fulfillment of University requirement for the award of Master of

Nursing degree. We request you to kindly accord permission to conduct the study at

selected setting.

Thanking you,

Yours Faithfully

(PRINCIPAL)

Date :-

Place :-

112

ANNEXURE- II

CERTIFICATE OF CONTENT VALIDITY

This is to certify that the tool developed by Ms Anju Appukuttan, second year

Msc nursing student of Spurthy college of Nursing, Marasur gate, Anekal Taluk,

Bangalore for my study “A study to evaluate the effectiveness of planned teaching

programme regarding knowledge and attitude on prevention of dental caries among

mothers of primary school children at AnekalDistrict Bangalore.” is validated by the

undersigned and can proceed with this tool to conduct main study.

Place

Date Signature of the expert.

113

ANNEXURE- III

LETTER SEEKING EXPERTS OPINION FOR THE CONTENT VALIDITY

OF THE TOOL USED FOR THE STUDY

From

Ms. Anju Appukuttan

II Year M.Sc.Nursing

Spurthy College of Nursing,

Bangalore – 562106

To

_______________________________

_______________________________

_______________________________

Forwarded Through

Principal


Bangalore – 562106

Respected Sir/Madam,

Sub: - Expert opinion for content validation of Research tool.

I am Anju Appukuttan postgraduate student in child health Nursing studying

at Spurthy College of Nursing, Bengaluru. For the partial fulfillment of the course I

have undertaken a research project. I have selected the below mentioned topic for the

research project to be submitted to Rajiv Gandhi University of Health Sciences,

Bengaluru.



primary school children at AnekalDistrict Bangalore.’’

I hereby have enclosed the following documents for your kind reference.

1. Structured interview schedule to assess the knowledge

2. 3-Point attitude scale to assess the attitude

3. Lesson plan

4. Answer keys

5. Criteria checklist for content validation

6. Certificate of content validity

114

115

ANNEXURE 1V

SCORING KEY

Respected Madam/ Sir,

Kindly go through the items in the enclosed tool and place a tick mark (√)

against each item in the column provided indicating your opinion best. There are 5

columns, namely Strongly Agree (SA), Agree (A), Neutral (N), Disagree (DA) and

Strongly Disagree (SDA). If there are any suggestions, please mention them in the

remarks column.

Q.NO SA A N DA

SDA REMARKS

TOOL –I: PART –I :DEMOGRAPHIC PROFORMA 1.

2.

3.

4.

5.

6.

7.

8.

PART -II : KNOWLEGDE STRUCTURED QUESTIONNAIRE FOR ASSESSING THE KNOWLEGDE OF PRIMARY SCHOOL CHILDREN MOTHERS REGARDING DENTAL HYGIENE AND DENTAL CARIES. 1.

2.

3.

4.

5.

6.

116

Q.NO SA A N DA

SDA REMARKS

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

21.

22.

23.

24.

117

ANNEXURE – V

TOOLS FOR DATA COLLECTION

STRUCTURED KNOWLEDGE QUESTIONNAIRE

Questionnaire includes multiple choice questions.

Part-I

Consists of ten items related to demographic variable of primary school children

mothers attending planned teaching programme at Anekal st.philomena’s high school.

Part -II

Consists of twenty four items on knowledge of primary school children mothers attending planned teaching programme at Anekal st.philomena’s high school regarding dental hygiene and dental care.

PART –I Dear participant,

This questionnaire is related to the demographic variables. I am here with requesting you to answer all the questions. This information will be treated as confidential. Kindly put tick marks in the appropriate information or encircle the most appropriate answer.

Sample code no:

DEMOGRAPHIC PROFILE

1. Age a. Below 20 yrs ( ) b. 21 yrs -25 yrs ( ) c. 26 yrs -30 yrs ( ) d. Above 30 yrs ( )

2. Educational status of the mother a. Illiterate ( ) b. Up to SSLC ( ) c. PUC ( )

118

d. Graduate ( ) e. Postgraduate ( )

3. Type of family

a. Nuclear family ( ) b. Joint family ( ) c. Extended family ( )

4. Family income per month

a. Rs 1001- 2000 ( ) b. Rs 2001-3000 ( ) c. Rs 3001- 4000 ( ) d. Rs > 4000 ( )

5. Occupation of the mother

a. Home maker ( ) b. Cooli worker ( ) c. Government employee ( ) d. Private employee ( )

6. Number of children

a. 2 ( ) b. 1 ( ) c. 3 ( ) d. twins ( )

7. Sources of information a. Mass media ( ) b. Friends ( ) c. Relative ( ) d. Parents ( ) e. Health personal ( )

8. History of oral disorders

a. Mouth ulcer ( ) b. Dental caries ( ) c. Oral sores ( )

119

PART- 11

STRUCTURED INTERVIEW SHEDULE ON DENTAL HYGIENE AND

DENTAL CARIES

Kindly read the following questions, Select the correct answer

according to you and put tick marks or encircle them. Please note that it is important

to respond to all questions. This questionnaire is to assess the knowledge regarding

dental hygiene and dental caries.

1. DENTAL CARIES otherwise called

a. Glossitis ( )

b. Gingivitis ( )

c. Tooth decay ( )

d. Tooth extraction ( )

2. THE STUDYOF DENTAL CARIES IS

a. Cariology ( )

b. Cardiology ( )

c. Radiology ( )

d. Ophthalmology ( )

3. DENTAL CARIES is caused by

a. Streptococcus pneumonia ( )

b. Streptococcus aureus ( )

c. Streptococcus mutans ( )

d. Staphylococcus ( )

120

4. Inner layer of tooth is

a. Dentist ( )

b. Dentine ( )

c. Dental caries ( )

d. Periosteum ( )

5. Root canal therapy means

a. Removal of tooth ( )

b. Opening of tooth ( )

c. Repair the tooth ( )

d. Cutting of tooth ( )

6. Pathological changes in dental caries

a. De-mineralization ( )

b. Enlargement of tooth ( )

c. Bleeding from gums ( )

d. Pus collection to the teeth ( )

7. Sign’s & symptoms of dental caries is

a. Xerostomia ( )

b. Xereothalmia ( )

c. Sneezing ( )

d. Hair fall & joint pain ( )

121

8. Primary sign of dental caries

a. Black spot on the teeth ( )

b. White spot on the teeth ( )

c. Toothache ( )

d. Bad colour ( )

9. The diagnostic evaluation for DENTAL CARIES includes

a. Chest x-ray ( )

b. Intra oral radiographs ( )

c. Ophthalmoscopy ( )

d. All the above ( )

10. Use of Electronic caries detector

a. Measure demenerslisation ( )

b. Measurement of symptoms ( )

c. Detect tooth colour ( )

d. Check glossitis ( )

11. Complication of DENTAL CARIES is

a. Tycodeties ( )

b. Congestive heart failure ( )

c. Caveenous sinus thrombosis ( )

d. Tonsilities ( )

122

12. Measures to prevent dental caries

a. Advice for hand washing ( )

b. Wearing mask ( )

c. Oral hygine ( )

d. Playing out side ( )

13. Flossing means

a. Removal of teeth ( )

b. Cleaning between teeth ( )

c. Removal of enamel ( )

d. Removal of membrane ( )

14. Plague can be prevented by

a. Good oral hygine ( )

b. Advise for mouth wash ( )

c. Advise for hand wash ( )

d. Fissure sealant ( )

15. Fluoride protects against

a. Infection ( )

b. Inflammation ( )

c. Dental caries ( )

d. Gingiivities ( )

123

16. For dietary modification

a. Sugar intake is increased ( )

b. Sugar intake is decreased ( )

c. Fiber rich diet ( )

d. Green leafy vegetables ( )

17. Use of Topical fluoride

a. Protect the surface layer of teeth ( )

b. Protect the inner layer of the teeth ( )

c. Treat stomatitis ( )

d. Remove bacteria ( )

18. To prevent decay by

a. Increase flow of saliva ( )

b. Use antibiotics ( )

c. Use tooth paste ( )

d. Use mouthwash ( )

19. Rich source of fluoride is

a. Water ( )

b. Tooth paste ( )

c. Food ( )

d. Vegetables ( )

124

20. Filling is the measure to

a. Repair damage caused by caries ( )

b. Remove caries ( )

c. Increase circulation ( )

d. Decrease bleeding ( )

21. Drug of choice for dental caries

a. Bronchodialator ( )

b. Antepyratics ( )

c. Bronchoconstrutor ( )

d. Antibiotics ( )

22. treatment provided for cavity in the pulp is called

a. Filling ( )

b. Root canal ( )

c. Drug ( )

d. Extraction ( )

23. Which one of the following should avoided in the home

a. Cold drinks ( )

b. Exercise ( )

c. Tobacco smoke ( )

d. Daily brush ( )

125

24. Re mineralization factors are

a. Fats ( )

b. Calcium ( )

c. Protein ( )

d. Vitamins ( )

126

PART–III

ATTITUDE SCALE Instructions:

Kindly read the following questions. Select the correct answer according to

you and put tick marks. Please note that is important to respond to all questions. This

questionnaire is to assess the attitude regarding dental hygiene.

Sl No Attitude Statement

Agree

Disagree

1. dental caries is a bacterial infection

2. Outer layer of tooth contain calcium

3. Enamel protect the inner layer of the teeth

4. Sugar and carbohydrates will cause dental caries

5. Bad breath is the symptom of dental caries

6. Flurides will protect the tooth against dental caries

7. Root canal treatment is the one of the dental caries treatment

8. Cold drinks will cause dental caries

9. Chewy sticky food is the best food which are eaten during

dental caries

10. Brushing is important for oral health

11. Tooth abcess means collection of pus

12. Antibiotics drugs using for dental caries

13. Intra oral radiographs is the one of the diagnostic evaluation

for dental caries

14. Leedwing’s angina is the one of the complication for dental

caries

15. Flossing means cleaning between teeth

16. Reduce intake of cariogenic food will give good oral health

127

SCORING KEYS

Question No. Answer

1 c

2 a

3 c

4 b

5 c

6 a

7 a

8 b

9 b

10 c

11 d

12 b

13 b

14 c

15 a

16 b

17 c

18 d

19 b

20 b

Question No. Answer

21 a

22 c

23 a 24 b

128

ATTITUDE SCORES

Statement No. A D 1 1 0 2 0 1 3 1 0 4 0 1 5 1 0 6 0 1 7 1 0 8 0 1 9 1 0 10 0 1 11 1 0 12 0 1 13 1 0 14 0 1 15 1 0 16 0 1

129

SUBMITTED TO SUBMITTED BY MRS.PUSHPAKUMARI K MS.ANJU APPUKUTTAN ASSOCIATE PROFESSOR 2ND YEAR MSc NURSING CHN DEPARTMENT S.C.O.N S.C.O.N

130

LESSON PLAN Topic:Dental caries

Group: primary school children mothers

Place:st.philomena’s high school

Duration: 45 Minutes

Method of teaching: planned teaching programme

Audio -visual aids: LCD Projector

No of participants: 60

General objectives:

The primary school children mothers should acquire knowledge and understand the dental caries and the

importance of oral hygiene and to develop desirable skills in applying this knowledge in home.

131

Specific objectives:

Primary school children mothers will be able to

• Define dental caries

• Stages of dental caries

• Causes of dental caries

• Pathological mechanism

• Diagnostic evaluation

• complication

• preventive measures of dental caries

Introduction :

Good morning to all, I am final year MSc (N) student of spurthy college of nursing Bangalore .I am going to teach

regarding dental caries and dental hygiene, it’s a care have to teach to the family members.

132

TIME SPECIFIC OBJECTIVE

CONTENT TEACHER’S ACTIVITY

LEARNER;S ACTIVITY

AV AIDS

EVALUATION

3 min

Explain the introduction of dental caries

Introduction: Dental caries also known as tooth decay or a cavity is an infection, bacterial in origin, that causes demineralization and destruction of the bald tissue (enamel, dentin and cemetum)usually by production of acid by bacterial fermentation of the food debris accumulated on the surface. If demonetization exceeds saliva and other remineralization factors such as from calcium and fluoridated tooth pastes, these hard tissues progressively break down producing dental cares .today caries remain one of the most common diseases throughout the world .cardiology is the study of dental caries.

Teacher introduces the topic of dental

caries

Listening What is meant by dental caries

133

3 Min

ANATOMY & PHYSIOLOGY The outer hard layer of the tooth contains large amounts of calcium and is very hard. In fact of it is the hardest structure that can be formed by the body. The tooth enamel has no blood supply and can therefore also not heal itself once it has been damaged it is literally a dead layer of cells.

Teacher explain the

listening

Chart

What are the different parts of teeth

134

The enamel protects the inner somewhat softer, more porous inner layer of the tooth, called dentine. The detain is the living part of the tooth and is directly linked to the nerve inside the tooth. The nerve runs in a canal, called the root canal deep within the tooth. The root canal is literally a cavity in the root of every tooth.it contains not only the nerve but also the blood vessels which provide the dentine with nutrients and oxygen & keep it alive

135

2 Min 3 Min

Define dental caries

DEFINITION Dental caries is an irreversible microbial disease of the calcified tissues of the teeth, characterized by de‐mineralization of inorganic portion & destruction of organic substance of the tooth, which often leads to cavitation CAUSES BACTERIA Streptococcus mutans‐83% children’s are affected Lactobacilli Actinomycesviscosus SUGAR Sugar can be found in all carbohydrates foods, such as bread, potatoes, banana’s and breakfast and cereals. Plague + sugar + acid The bacteria in the plague use the sugar as a source of energy food. The bacteria digest the sugar and by products are exerted. these by products are very sticky and acidic and cause a fall in the mouth’s PH Time if the plague is not allowed to lie on the tooth surface for any length of time, no decay will result

Teacher defines Dental caries

Understanding causes of Dental

caries

Listening

Listening

Flash card

chart

What is the meaning of dental caries

What are the causes of dental caries

136

4 Min

List down the stages

Thus cleaning your teeth soon after eating will decrease the amount of time these factors have to cause dental caries. STAGES:

Teacher listening out the dental caries

Listening

Pamphlet

What are the stages of dental caries

137

138

3 Min

Identify pathologic mechanism

PHATHALOGIC MECHANISM Fermentation of dietary sugars by oral microorganism De‐mineralization Re‐ mineralization Further demineralization & cavitations initiation/formation of caries.

Listening out pathologic mechanism

Listening

Explain the pathologic mechanism

3 Min

Enumerate the signs and symptoms

SIGN & SYMPTOMS White spot on the skin Toothache Visible pits or holes in the teeth discoloration of teeth Bad breath Foul tastes Xerostomia Brown spot is spear

Teacher discuss about the signs and symptoms of dental caries

Listening

What are the signs and

symptoms of dental caries.

139

4 Min

Explain the diagnostic evaluation of dental caries

DIAGNOSIS: History taking Physical examination Visual examination Intra oral radiographs Electronic causes detectors

Teacher explains in details about diagnosis

Listening

Chart

What are

the diagnosis of dental caries

2 Min 2 min

List out the complaints of dental caries

List out the prevention of dental caries

COMPLICATIONS: Cavernous sinus thrombosis Leedwig’s angina PREVENTION: ORAL HYGIENE It is important that the plague should be effectively removed even brushing two or three times pee day is not good enough if you

Teacher list out the complaints

Teacher discuss about the

prevention of dental caries

Listening

listening

Flash card

What are the

complaints of dental caries

What are the

prevention of dental caries

140

4 Min

Use the correct technique Flossing is also essential in the removal of plague it is the only effective way cleaning between teeth. Fissure sealants: The sealing of the grooves on top of the premolars and molars as soon as their crown except fully through the gun, prevents them from becoming clogged with food particles sealants are then plastic like coating applied to the chewing surfaces of the molars. thus coating prevents the accumulation of the plague on the unalienable surfaces Older people may also benefit from the use of fissure sealants.

141

1 Min 2 Min 2 min

FLUROIDS: To protect teeth against dental caries TOPICAL FLUROIDS: Helps to protect the surface layer of the teeth. It is mainly found in tooth pastes & mouth wash DIET: Chewy, sticky foods are best as a past of a meal rather than snacks Encourage to take sucrose intake

Selective counseling Reduce intake of cariogenic food Reduce long time use of baby bottles

142

4 Min

TREATMENT Fluoride treatment Treated with high concentrations of fluorides resulting in the arrest of caries & remineralisation of the tooth enamel Filling It is used to repair the damage caused by carries Root canal treatment If the infection has reached the pulp, then root canal treatment is sued Some of the restrictive materials include porcelain, composite resin gold and dental amalgam Tooth extraction can also be the treatment of extreme decay In some cases, endodontic therapy can be necessary to presence the tooth Decayed methanol from an affected tooth can be removed with the help of a dental hand piece like a drill

143

Early treatment is generally less painful. If a cavity is so extensive that there is no space to place the restrictive material, then a crown is needed, crown are made of porcelain or gold & fused to a metal In severe cases, anesthesia such as laughing gas (eg: nitrous oxide)or other medicine are given before the treatment

2 Min

Home treatment for toothache If you have sensitivity to cold drinks, try using tooth paste made for sensitive teeth Avoid alcoholic beverages such as wine The other condition you can attempt to treat at home is dull ache and pressure in your upper teeth & jaw

144

2 Min

SUMMARY: In today’s class I disused about definition of dental causes stages, causes, pathology, signs & symptoms, diagnostic evaluation, complication, prevention & management of dental causes like oral hygiene, dietary modification, avoid cold drinks etc. It is very important to protect them by giving good personal hygiene, food, & cross infection CONCLUSION: This is knowledge about dental caries will help to mothers to know about home care & to improve the dental hygiene of primary school children. This knowledge also helps to education others to build up healthy children & healthy nation

145

BIBLIOGRAPHY

146

KANNADA TOOL VERSION

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ANNEXURE – VI

BLUE PRINT OF THE TOOL - II

Sl. No Items/Content

Question Numbers

Total Questions

Percentage(%)

1 Information regarding dental caries

1-24 24 100%

Total

24

24

100%

Blue Print for Attitude Statement

SL. NO Attitude Statements Item number Total

number Percentage

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1. Positive statements

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16 16 100

177

ANNEXURE – VII

LETTER SEEKING PERMISSION FOR CONDUCTING PILOT STUDY

From

Ms.Anju Appukuttan,

II year M.Sc. Nursing,


Bangalore-562106.

To

The pricipal,

Spurthy Pre University college,

Marasur

Bangalore -562106.

Respected Sir\Madam,

Sub: Seeking permission to conduct a pilot study.

With reference to the above subject, I am Anju Appukuttan II year M.Sc.

Nursing student of Spurthy College of Nursing with a specialization in child health

nursing. I have to conduct a research study for the partial fulfillment of the course on

a topic “A study to evaluate the effectiveness of planned teaching programme

regarding knowledge and attitude on prevention of dental caries among

mothers of primary school children at AnekalDistrict Bangalore”.

I request you to kindly give the necessary permission for conducting study at

selected setting.

Thanking You,

Yours faithfully,

Date:

Place: (MS ANJU APPUKUTTAN )

178

179

ANNEXURE – 1X LETTER SEEKING PERMISSION FOR CONDUCTING MAIN STUDY

From

Ms.Anju appukuttan

II year M.Sc. Nursing,


Bangalore-562106.

To

The Pricipal,

Spurthy college of nursing,

Marasur

Bangalore -562106.

Respected Sir,

Sub: Seeking permission to conducting study.

With reference to the above subject, I am Anju appukuttan, II year M.Sc.

Nursing student of Spurthy College of Nursing with a specialization in child health

nursing would like to bring to your kind notice that I have to conduct a research study

for the partial fulfillment of the course on a topic “A study to evaluate the

effectiveness of planned teaching programme regarding knowledge and attitude

on prevention of dental caries among mothers of primary school children at

AnekalDistrict Bangalore.”

In this regard, I need permission from the principals of Spurthy College of

Nursing and stphilomena’s high school. Hence I request you to communicate with the

principal for getting permission for conducting this at selected setting.

Thanking You,

Yours faithfully,

Date:

Place: (MS.ANJU APPUKUTTAN)

180

181

ANNEXURE – XI

LETTER SEEKING CONSENT OF THE SUBJECTS FOR PARTICIPATION

IN STUDY

Dear participant,

I am a final year MSc.(N) student of Spurthy College of Nursing, Marasur

Gate, Bangalore. As a partial fulfillment of the course, I have selected the below

mentioned topic for research work.




I request you to respond to the given questionnaire with the most appropriate

responses. Kindly do not leave any question unattended. The information given by

you will be kept confidential and used only for the study purpose.

Thanking you, yours faithfully

(ANJU APPUKUTTAN)

182

ANNEXURE X11

LIST OF EXPERTS

1. Dr.Ramareddy

Peadiatrician

Maruthi hospital

Banglore

2. Mrs.Nirmala Florence

H.o.d

M sc peadiatrics

K.T.G College of Nursing

3. Mrs. D.Kalaichelvi

Principal and h o d

Department of paediatrics

National college of nursing

Banglore

4. Mrs.Jayavanitha

Msc paediatrics

Professor

Nightingale college of nursing

5. Mrs.Sathyavathi

Associate professor peadiatric nursing

National college of nursing

Banglore

6. Mr.Bhaskar Raj

Statistician

183

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