|Year : 2017 | Volume
| Issue : 3 | Page : 110-115
|Comparison of the effectiveness of a mobile phone-based education program in educating mothers as oral health providers in two regions of Saudi Arabia
Saleh Ali AlKlayb1, Mansour K Assery2, AlJohara AlQahtani2, Madawy AlAnazi2, Sharat Chandra Pani1
1 Department of Preventive Dentistry, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia
2 Deanship of Postgraduate Studies and Research, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia
|Date of Submission||12-Mar-2017|
|Date of Acceptance||25-Apr-2017|
|Date of Web Publication||22-May-2017|
Sharat Chandra Pani
Department of Preventive Dentistry, Riyadh Colleges of Dentistry and Pharmacy, P. O. Box: 84891, Riyadh 11681
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aims and Objectives: The penetration of mobile phone devices is widespread across the Kingdom of Saudi Arabia. Recently, there has been evidence of the success of phone-based applications in the provision of preventive oral health care to children and their parents. The aim of this study was to compare the effectiveness of a mobile phone-based application in educating mothers of children aged below 6 years of age in preventive dental care.
Materials and Methods: A mobile phone-based application (iTeethey™) was developed for iPhone and Android and made freely available on Google Play and App Store. The application was then distributed to 3879 mothers of children below 6 years of age (1989 in Riyadh Region and 1890 in Najran region). The mothers were subjected to a standardized knowledge attitude and practice of oral hygiene questionnaire before being asked to download the application. A total of 1055 mothers who downloaded the application completed 3-month recall process.
Results: Significant improvement in the knowledge of the mothers was reported after the use of the application from both regions. The mothers from Najran showed significantly greater improvement in knowledge when compared to the mothers from Riyadh region. The application was also more effective in mothers with more than one child when compared to first-time mothers.
Conclusion: Within the limitations of this study, we can state that the mobile phone application used in this study significantly improves the knowledge of mothers toward their child's oral health.
Keywords: Mobile phone apps, oral health promotion, teledentistry
|How to cite this article:|
AlKlayb SA, Assery MK, AlQahtani A, AlAnazi M, Pani SC. Comparison of the effectiveness of a mobile phone-based education program in educating mothers as oral health providers in two regions of Saudi Arabia. J Int Soc Prevent Communit Dent 2017;7:110-5
|How to cite this URL:|
AlKlayb SA, Assery MK, AlQahtani A, AlAnazi M, Pani SC. Comparison of the effectiveness of a mobile phone-based education program in educating mothers as oral health providers in two regions of Saudi Arabia. J Int Soc Prevent Communit Dent [serial online] 2017 [cited 2019 Jul 20];7:110-5. Available from: http://www.jispcd.org/text.asp?2017/7/3/110/206675
| Introduction|| |
The concept of teledentistry or the provision of care to patients using telephone-based care is not new, and recently, there has been evidence of the success of this form of dentistry in the provision of preventive oral health care to children and their parents.,,,, The advent of the digital age has also seen the creation of web-based programs and interventions to promote oral health care. The Kingdom of Saudi Arabia is the largest country in terms of area in the Arab world. Geographic as well as cultural factors make the effective dispersion of auxiliaries for oral health education in remote areas of the Kingdom difficult., Saudi Arabia has one of the fastest growing internet consumption rates in the world, which has led some authors to suggest that electronic dental health is not only applicable but also inevitable in Saudi Arabia.
The role of the mother in the overall health of the child is well recognized, and over the past two decades, there have been several studies examining the extension of this concept to children's oral health.,, Research in the field of pediatrics has led to the creation of the concept of “medical home” and later the concept of “dental home” which stress on parental education and early diagnosis and early intervention to provide comprehensive oral health care to children., The conventional “dental home” concept relied on areas such as schools and community centers where children and their parents could interact first hand with either dentists or trained dental auxiliaries.,
Early childhood caries (ECC) is defined by the American Academic Pediatric Dentistry (AAPD) as the presence of one or more decayed, missing, and filled teeth before 71 months of age (AAPD). The prevalence of ECC in Saudi Arabia is >90% and has remained so for over 20 years,, making early diagnosis and prevention of ECC an important public health need. There have been several papers in the past decade that have shown that the lack of maternal education has been one of the key reasons for the spread of ECC.,,, This risk when combined with geographic and socioeconomic barriers to health-care results in clearly observable deterioration of oral health and increased rates of ECC.,,,,
Recently, Assery (2015), in a study conducted in Riyadh City demonstrated that the mothers were able to detect dental caries and if given the right education, could serve as effective screeners of oral health-care needs in Saudi Arabia. There is, however, not much research on the effectiveness of mobile phone-based preventive strategies in training mothers in recognizing dental caries early and seeking timely dental intervention. The aim of this study was to compare the effectiveness of a mobile phone-based application in educating mothers of children aged below 6 years of age in preventive dental care.
| Materials and Methods|| |
The study was carried out between June 2015 and December 2016. This study was registered, and ethical approval was obtained from the research center of Riyadh Colleges of Dentistry and Pharmacy. The study was assigned the registration number FPGRP//43435005/126. Informed consent was obtained electronically from all users of the application who participated in the study.
Sample size and selection
The sample comprised mothers of children aged below 71 months of age reporting to a pediatric primary care center. The sample power required for an alpha of 0.05 with 95% confidence interval was 500 participants. However, no limit was set on the maximum number of responses. To achieve a good response rate, applications were distributed throughout the Department of Pediatrics and Neonatal Care at primary health centers of the Ministry of Health at Riyadh and Najran.
Development of the application
An account was made on an online web-development platform, and an application was developed which provides information about the oral health care for children from infancy to 6 years of age. The application also provided information for expecting mothers. The application (iTeethey™) was developed using information on early childhood oral health care and based on the guidelines and recommendations of the AAPD (2013).
The application had home pages in English and Arabic and was hosted on both the App Store (https://itunes.apple.com/us/app/iteethey/id1051796708?mt=8) for users of iPhones (Apple Inc. Cupertino CA, USA) and the Google Play Store (https://play.google.com/store/apps/details?id=com.app.p6386GB) for users of phones running the Andriod™ platform (Google Corp., San Jose, CA, USA) [Figure 1].
All participants were sent a reminder 3 months after the initial test to reevaluate the knowledge scores to monitor the retention of the knowledge among mothers.
Location of sample
The sample comprised two groups: Group A comprised mothers in Riyadh city, ArRiyadh Region, whereas Group B comprised mothers in Najran city, Najran Region. Although the minimum sample size was 500, there was no limit set on the number of participants. The apps were distributed to a total of 3879 mothers who presented at eight different primary health-care centers (three in Riyadh and five in Najran). Responses of those participants who are unable or unwilling to complete the tool were recorded to assess the applicability of the tool in the Saudi Population. All mothers having at least one child >6 years of age who agreed to participate in the study were included in the study. Consent of the parent was established electronically through an online user agreement. Mothers who had a medically compromised child were excluded from the study.
To rule out any potential bias arising from the inability to use electronic devices, the mothers were asked to complete a previously validated Arabic tool designed to test their knowledge of their child's oral health (Farsi et al., 2013). The mothers were followed up for usage statistics using the online data usage statistics (http://applicius.com/) and reminders were sent after 3 months only to those mothers whose data usage statistics were positive (had used the application at least once in the past 3 months). The mothers who responded were then asked to complete the same validated Arabic language tool.
The SPSS (IBM Corp, Armonk NY, USA) version 21 data processing software was used for all analyses, and the level of significance for all tests was set at P < 0.05.
| Results|| |
A total of 3879 mothers were given the link to the mobile phone application of whom 1055 mothers downloaded the application. Of these, a total of 616 mothers in Riyadh and 439 mothers in Riyadh completed the follow-up. Although there were more mothers who completed the follow-up in Riyadh when compared to Najran, Chi-square test showed that the differences were not statistically significant (P = 0.091). This final set comprised 71 first-time mothers and 545 mothers with more children in the Riyadh region and 96 first-time mothers and 343 mothers with more than one child in Najran region.
The average age of the mothers ranged from 18 to 42 years with a mean age of 28.09 years. The mean monthly income of the sample studied was 13,521 Saudi Riyals (SR) per month and ranged between 3494 SR and 23,000 SR [Table 1]. The sample comprised both working mothers and mothers who stayed at home. When the overall impact of the mobile application was evaluated using the paired sample t-test, it was observed that there was a significant improvement in the maternal knowledge 3 months after using the application [Table 2]. Then, the effect of the region was evaluated; it was observed that significant improvements in the knowledge were observed in both Riyadh and Najran regions [Table 3]. It was observed that the mothers in Riyadh had a greater improvement in their knowledge when compared to mothers in Najran. The t-test showed that these differences were significant at P < 0.05 [Table 4].
|Table 2: Mean knowledge score of the mother before and after using the application|
Click here to view
|Table 3: Improvement in the knowledge of the mothers before and after the application in Riyadh and Najran regions|
Click here to view
|Table 4: Comparison of the improvement of knowledge between the mothers in Riyadh region and those in Najran region|
Click here to view
When the impact of the different factors influencing the change in the knowledge score of the mothers was evaluated using a linear regression model, it was observed that only the region and the number of children in the family had a significant impact on the score. The occupation of the mother, age of the mother, or the income of the family did not significantly influence the change in oral knowledge of the mothers [Table 5].
|Table 5: Linear regression model of factors that can influence the improvement of maternal knowledge after use of the application|
Click here to view
| Discussion|| |
The internet and mobile phone technology have changed the way we live life in the 21st century. While the use of the internet in bringing in new ideas is well recognized, it must be remembered that the internet can also serve as a mean to improve the life of individuals within an existing social structure. The difficulty women face in being able to come to the dentist was the reason to develop an application that would allow mothers to interact virtually with their dentist. Saudi Arabia is a technologically advanced society with recent literature documenting an active use of the internet, mobile phones, and social media. There is also evidence to suggest that online medical advice and “e-health” are feasible in the social and cultural framework of Saudi society.,,
Saudi Arabia is the largest country by land area in the Gulf region, and the difficulties in providing health care to such a vast population have been previously documented. It has been suggested that the development of an electronic health-care system may help overcome the challenges posed by the vast geographic expanse of the Kingdom. One of the objectives of developing a phone-based application was to explore the possibility of using this technology to overcome physical and logistical barriers toward providing preventive dental care. The fact that the application was able to bring about an increase in the knowledge of both first-time mothers and the mothers with more than one child was a positive factor. These results are in keeping with other studies that have documented the success of mobile phone-based applications in the promotion of breastfeeding and maternal health., Based on these results, the application was distributed in the rural and semi-urban parts of Najran region.
Although the response rates in Riyadh were higher than those seen in Najran, it was interesting to note that no statistically significant difference existed between the two regions. The fact that less than one-third of the mothers who were given the application downloaded it and completed the study period is one of the limitations of the use of such mobile phone technology. However, this acceptance rate is similar to those observed for other new technologies used in health promotion , and can be considered to be promising.
The baseline oral health knowledge of mothers in Riyadh was significantly higher than the knowledge of those in Najran. This finding is in keeping with studies from across the world that have shown that mothers in cosmopolitan areas with easy access to dental care have significantly better knowledge of their child's oral health problems., Interestingly, the use of the application resulted in significant improvements in maternal knowledge of oral health conditions in both regions. The significant improvement in the oral health knowledge in Najran seems to suggest that the use of technology can greatly improve the effective communication of oral health education in areas where there is a documented shortage of trained public health professionals.
The decision to base the study in the pediatrics clinics was inspired by several findings in Western countries that have shown the pediatrician to be an effective communicator of oral health goals., There are significantly greater number of pediatricians and infant health care centers in Saudi Arabia in comparison to dental centers, thus making the provision of preventive dental care through such centers an attractive proposition. However, the traditional method of oral health education lectures is time consuming and requires a full-time oral health professional to be stationed in the center. This study shows that it is possible to overcome those challenges through the use of technology.
Apart from the region, it was observed that the other significant predictors of the success of the application were the number of children in the family. We found a significant positive association between the number of children in the family and the change in the knowledge score. This suggests that mothers with more than one child in the family are more receptive to the application. These findings are in keeping with studies that have shown that awareness of oral health problems increases in mothers with more than one child., Furthermore, we found no significant association between the age of the mother and the improvement of the dental knowledge of the mother. This finding is in keeping with a recent study done in Saudi Arabia that has shown that mothers of all ages can be effective screeners for their children's oral health. This seems to suggest that the technology is not age bound. Both these factors are in keeping with evidence from psychological literature that shows that the presence of a “felt need” is the most important factor for influencing a change in a health-related behavior.
The internet revolution has been particularly strong in Saudi Arabia, with data showing that Saudis use one of the highest per capita internet bandwidth in the world. The popularity of social media and the vast reach of “smartphones” could explain the effectiveness of the application in promoting oral health. This study goes beyond existing studies on web-based tools , and shows that unlike web-based tools, mobile phone applications are not restricted by the constant availability of internet or the need for a computer.
The sample size achieved in this study though not representative of the entire Kingdom can be thought to adequately represent two distinct cultural domains. The fact that this application had the same acceptability in a cosmopolitan center such as Riyadh as in a semi-urban, largely Saudi region such as Najran emphasizes the potential for mobile phone applications to cross cultural barriers.
| Conclusion|| |
Within the limitations of this study, we can state that the mobile phone application used in this study significantly improves the knowledge of mothers toward their child's oral health.
Financial Support and Sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Estai M, Kanagasingam Y, Tennant M, Bunt S. A systematic review of the research evidence for the benefits of teledentistry. J Telemed Telecare 2017:1357633X16689433.
Haron N, Zain RB, Nabillah WM, Saleh A, Kallarakkal TG, Ramanathan A, et al.
Mobile phone imaging in low resource settings for early detection of oral cancer and concordance with clinical oral examination. Telemed J E Health 2017;23:192-9.
Irving M, Stewart R, Spallek H, Blinkhorn A. Using teledentistry in clinical practice, an enabler to improve access to oral health care: A qualitative systematic review. J Telemed Telecare 2017:1357633X16686776.
McFarland KK, Nayar P, Chandak A, Gupta N. Formative evaluation of a teledentistry training programme for oral health professionals. Eur J Dent Educ 2017; Mar 15. doi: 10.1111/eje.12265. [Epub ahead of print].
Queyroux A, Saricassapian B, Herzog D, Müller K, Herafa I, Ducoux D, et al.
Accuracy of teledentistry for diagnosing dental pathology using direct examination as a gold standard: Results of the Tel-e-dent study of older adults living in nursing homes. J Am Med Dir Assoc 2017. pii: S1525-861030005-1.
Albert D, Barracks SZ, Bruzelius E, Ward A. Impact of a web-based intervention on maternal caries transmission and prevention knowledge, and oral health attitudes. Matern Child Health J 2014;18:1765-71.
Almalki M, Fitzgerald G, Clark M. Health care system in Saudi Arabia: An overview. East Mediterr Health J 2011;17:784-93.
Ministry of Health KoSA. Need for dental personnel in the 13 regions of Saudi Arabia in Riyadh. Ministry of Health KoSA (Riyadh) Saudi Arabia: Ministry of Health KoSA; 2012.
Sait SM, Al-Tawil KM. Impact of internet usage in Saudi Arabia: A social perspective. Int J Inf Technol Web Eng 2007;2:81-115.
Altuwaijri MM. Electronic-health in Saudi Arabia. Just around the corner? Saudi Med J 2008;29:171-8.
Mothers linked to teens' caries status, report shows. J Am Dent Assoc 2012;143:1082.
Amin M, Perez A. Is the wait-for-patient-to-come approach suitable for African newcomers to Alberta, Canada? Community Dent Oral Epidemiol 2012;40:523-31.
Begzati A, Bytyci A, Meqa K, Latifi-Xhemajli B, Berisha M. Mothers' behaviours and knowledge related to caries experience of their children. Oral Health Prev Dent 2014;12:133-40.
Hale KJ; American Academy of Pediatrics Section on Pediatric Dentistry. Oral health risk assessment timing and establishment of the dental home. Pediatrics 2003;111(5 Pt 1):1113-6.
Kamp AA. Well-baby dental examinations: A survey of preschool children's oral health. Pediatr Dent 1991;13:86-90.
Houpt MI. A dental home by age one. Pediatr Dent 2003;25:323.
Nowak AJ, Casamassimo PS. The dental home: A primary care oral health concept. J Am Dent Assoc 2002;133:93-8.
al-Shammery AR. Caries experience of urban and rural children in Saudi Arabia. J Public Health Dent 1999;59:60-4.
Khan SQ, Khan NB, Arrejaie AS. Dental caries. A meta analysis on a Saudi population. Saudi Med J 2013;34:744-9.
Simratvir M, Moghe GA, Thomas AM, Singh N, Chopra S. Evaluation of caries experience in 3-6-year-old children, and dental attitudes amongst the caregivers in the Ludhiana city. J Indian Soc Pedod Prev Dent 2009;27:164-9.
] [Full text]
Kakudate N, Morita M, Sugai M, Nagayama M, Kawanami M, Sakano Y, et al.
Development of the self-efficacy scale for maternal oral care. Pediatr Dent 2010;32:310-5.
Wigen TI, Wang NJ. Maternal health and lifestyle, and caries experience in preschool children. A longitudinal study from pregnancy to age 5 yr. Eur J Oral Sci 2011;119:463-8.
Choi HS, Ahn HY. Effects of mothers involved in dental health program for their children. J Korean Acad Nurs 2012;42:1050-61.
Kim YO, Telleen S. Predictors of the utilization of oral health services by children of low-income families in the United States: Beliefs, cost, or provider? Taehan Kanho Hakhoe Chi 2004;34:1460-7.
Barker JC, Horton SB. An ethnographic study of Latino preschool children's oral health in rural California: Intersections among family, community, provider and regulatory sectors. BMC Oral Health 2008;8:8.
Telleen S, Rhee Kim YO, Chavez N, Barrett RE, Hall W, Gajendra S. Access to oral health services for urban low-income Latino children: Social ecological influences. J Public Health Dent 2012;72:8-18.
Nanayakkara V, Renzaho A, Oldenburg B, Ekanayake L. Ethnic and socio-economic disparities in oral health outcomes and quality of life among Sri Lankan preschoolers: A cross-sectional study. Int J Equity Health 2013;12:89.
Narang R, Saha S, Jagganath GV, Kumari M, Mohd S, Saha S. The maternal socioeconomic status and the caries experience among 2-6 years old preschool children of Lucknow city, India. J Clin Diagn Res 2013;7:1511-3.
Asiodu IV, Waters CM, Dailey DE, Lee KA, Lyndon A. Breastfeeding and use of social media among first-time African American mothers. J Obstet Gynecol Neonatal Nurs 2015;44:268-78.
Qureshi R, Selim HA, Long KM, Vignoles VL. Exploring identity motives in twitter usage in Saudi Arabia and the UK. J Med Internet Res 2014;199:128-32.
Jamal A, Khan SA, AlHumud A, Al-Duhyyim A, Alrashed M, Bin Shabr F, et al.
Association of online health information-seeking behavior and self-care activities among type 2 diabetic patients in Saudi Arabia. J Med Internet Res 2015;17:e196.
Wiljer D, Raman J. Mobile technology in nursing education: Where do we go from here? A review of the literature. JMIR Mhealth Uhealth 2015;35:663-72.
Ashkanani F, Al-Sane M. Knowledge, attitudes and practices of caregivers in relation to oral health of preschool children. Med Princ Pract 2013;22:167-72.
Harrison RL, Veronneau J, Leroux B. Effectiveness of maternal counseling in reducing caries in Cree children. J Dent Res 2012;91:1032-7.
Damle SG, Patil A, Jain S, Damle D, Chopal N. Effectiveness of supervised toothbrushing and oral health education in improving oral hygiene status and practices of urban and rural school children: A comparative study. J Int Soc Prev Community Dent 2014;4:175-81.
Dimitrova MM. A study of pregnant women's knowledge of children's feeding practice as a risk factor for early childhood caries. Folia Med (Plovdiv) 2009;51:40-5.
Assery MK. Effectiveness of providing dental health education to mothers in controlling dental diseases in children. J Int Oral Health 2015;7:1.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
| Article Access Statistics|
| Viewed||1150 |
| Printed||21 |
| Emailed||0 |
| PDF Downloaded||168 |
| Comments ||[Add] |