School-Based oral health promotion and prevention program

Planning Project

Running head: SCHOOL-BASED ORAL HEALTH PROMOTION AND

PREVENTION PROGRAM.

Jordan University of Science and Technology

Faculty of Nursing

NUR 732: Planning and Evaluation of Health Programs

Submitted by :

Ashraf Smadi. RN, NSA student

[email protected]

Student # 20063040026

Submitted to :

Dr. Nahla Al-ali RN PhD

May .2008

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Planning Project

Introduction and significance

Jordan is a small developing country with expected inhabitants of around 5.8 million

citizens. Like other developing countries, Jordan has experienced a significant increase of its

population, with children and adolescents forming a big portion of its total population.

Schools provide an ideal environment for promoting oral health, internationally around 80%

of children go to primary schools and 60% complete at least four years of education, and the

school years cover a period that runs from childhood to adolescence (WHO, 2003). These are

significant periods in individuals lives when enduring sustainable oral health related

behaviors, as well as beliefs and attitudes are being developed (WHO, 2003).

School student’s health is one of the most considerable fields in community health,

oral health enables a person to eat, speak and socialize without pain or active disease.

Furthermore, oral health is fundamental to well being, considerably impacting on quality of

life, and it can affect general health conditions. Oral health means more than healthy teeth, its

also mean the health of the gums; oral soft tissues; chewing muscles; the palate; tongue; lips,

and salivary glands (US Department of Health and Human Services, 2000).

Oral health among school students is very important because students who have poor

oral health can have an unfavorable effect on their performance in school and their success in

the future. Children who experience poor oral health are 12 times more likely to have more

restricted-activity days including missing school than those who do not (US General

Accounting Offices; Oral health, 2000). In addition, good oral health of school student's will

be better for being still healthy in the future. Locally, Many Jordanian schools students

experience needless pain and suffering, complications that can impact overall health

(Taani.Q, 2004).

Consequently, leaving oral care and untreated oral diseases become more

problematical over time and may impact aspects of physical and mental health. School health

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Planning Project

deals with a wide range of health problems, such as: accidents, injuries, communicable

diseases, substance abuse, smoking, dental problems, violence, and psychological problems.

Dental caries (tooth decay) is the most common childhood chronic disease and dental

care is a common unmet need among Jordanian schools students. It affects over 50% of

school-aged children and adolescents (MOH, 2002). The school oral health services

department of the Jordanian Ministry of Health is responsible of the organization of oral

health programs for children. Therefore, all Jordanian school children should have their teeth

examined regularly (MOH, 2002). The target population for the application of the school-

based oral health promotion and prevention program is 12-16 year old age students of the Ibn

Al-waleed School in Irbid city; School's population consists of (1142) male students.

In order to conduct this program, the following organizations are involved:

1. School's administrators, teacher's, and staffs.

2. Health and education officials, students, parents and community leaders in

efforts to promote oral healthcare.

3. General directorate of health in Irbid.

4. Learning resources of health in Irbid.

5. Learning resources center.

6. School health department.

7. Jordanian Association of Dentists.

Problem Assessment

Oral health among school students and adolescents was considered broadly in western

literature; but there are few studies that discussed or described oral health in Jordan. One

study specifically discussed oral health in Jordan, has carried out by Quteish Taani, which

titled “Oral health in Jordan” This study described oral care in Jordan with references such as

the prevalence and severity of dental caries, oral lesions, periodontal diseases and oral

hygiene status. The findings of this study revealed about 21% of males and 51% of females

brush their teeth regularly, while more than 50% of males and only 11% of females did not

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Planning Project

brush their teeth at all. In addition, 57% of private school children and 35% of public school

children claimed to brush their teeth on a regular basis.

In an integrated literature review regarding oral health in Jordan, plaque and gingival

scores were founded to be higher among public school children than private and it’s higher in

males than females (Taani.Q, 2002; Taani.Q & Al-Wahadni AM, 2003). And other related

studies carried out in Jordan between 1993-1997 showed that dentals caries experienced

varies between genders but slightly higher among boys, and children attending in public

schools had similar scores to those attending private schools (Witt MCR,1992; Bastawi, et

al,1989). In general, boys had higher plaque and gingival scores than girls and the

occurrences of shallow and deep pockets in these children were low (0.3–5.3%).

Al-Omiri et al. (2006) examined oral health attitudes, knowledge, and behaviors

among Jordanian children, for purpose which titled “Oral Health Attitudes, Knowledge, and

Behavior Among School Children in North Jordan”. The purpose of this study was to

investigate the dental health attitudes, knowledge, and behaviors of school children in north

Jordan; A 570 students were participated randomly from 10 public schools in irbid governate;

from 570 questionnaires were distributed to the total participants a 557 questionnaires were

returned; response rate was 97.7%.

The study sample was included 262 males (47%) and 295 females (53%); and the

participants age ranged from 10-16 years; the mean age was 13.45 years. The comprehensive

questionnaire was used as a instrument to collect data from the participants and this

instrument was adopt from Peterson et al; this instrument included 33-items designed to

evaluate the knowledge, attitudes, and behaviors of children regarding their oral health and

dental treatment. (Kappa test coefficient for all items was 0.93).

The findings of this study revealed that the 69% of students brushed their teeth at

least twice daily; 17% students reported irregular tooth brushing; 83% reported using

toothbrush and tooth past to clean their teeth; only 2% reported using dental floss; 6% using

mouth wash, and 7% using tooth picks as an extra aids for oral hygiene. In addition, 71% of

students reported they consume 2 minutes to brush; while 15% consume < 1 minute.

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Planning Project

Regarding to the parent roles in the oral healthcare; the result was showed that 59%

of their roles focused to giving advice on the importance of teeth brushing; only 26% of the

students reported being advised and watched by parents during brushing technique; 15% of

students reported that their parents never watched their brushing technique and don't gave

them any advise on brushing; and around 40% reported that brushing and flossing assists to

prevent gingivitis; and when the students were asked about the relation between dental plaque

& gingivitis on one hand, and caries & tooth discoloration on other hand; only 13% of

students answered it might cause caries, and 25% answered it might cause tooth

discolorations and about 28% were failed to report relation between plaque and any of these

conditions.

Consequently, related to carious teeth a 75% of students were reported have it and

77% were aware that it and dental caries affect dental aesthetics. On other hand, the students

awareness related to the significant of tooth brushing for caries prevention was 81% and only

32% were aware of the relation between dental plaque and caries; related to the numbers of

deciduous and permanent teeth only 2.7% of students knew the correct number of deciduous

teeth and 54% were knew correct number of permanent teeth and 91% reported having two or

fewer filled teeth.

Additionally, 68% of students reported that they did not know what the treatment for

toothache; although 60% acknowledged the significant of such knowledge; 87% of student

aware about the sweet and 77% aware that soft drink have a negative effect on dental health

and 77% aware that a fluoride has positive effects on the dentition. Consequently, 47% of

students that they visited dentist only when they become on pain; 33% were regular dental

attendees and 82% were aware of the importance of regular dental visit, and about 20% of

students were never visited the dentist. Only 14% of parents encouraging their children to

visit the dentist and the most common causes of not doing students to visiting the dentist were

49% for fear; 21% for lack of toothache; and 12% for high cost.

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Planning Project

Finally, the researcher recommended to urgently needed to implemented school-

based oral education programs among Jordanian schools, and indicated on the importance of

involving students parents in these programs.

Other study intended to oral health knowledge, attitudes was conducted by Petersen

P.E (2003) which titled "oral health knowledge, attitudes and behavior of children and

adolescent in china" the purposes of this study were to describe the pattern of oral health

behavior, illness behavior, oral health knowledge and attitudes among 12-18 year old

Chinese.

The result of this study showed 44.4% of the Chinese children brushed their teeth at

least twice a day but only 17% used fluoridated tooth paste. And they visited the dentist

during the previous 12 months or two years were 31.3% and 35.3% for 12 year olds and

22.5% for 18 year olds, respectively. 29% of 12 years olds and 40.5% of 18 year olds would

visit a dentist in case of signs of caries but only when in pain and 47.2% had never received

any oral health care instruction and the risk of dental caries was high in the case of frequent

consumption of sweets and dental caries was low for children with use of fluoridated

toothpaste (Petersen. P.E, 2003).

Although an improvement in oral hygiene, gingival conditions and dental caries has

been reported recently in children, the prevalence of these conditions is still high compared to

that found in the developed countries. Dental caries in US, it is five times more frequently

than childhood asthma, and named it the most chronic disease among children and seven

times more common than fever (US Department of Health and Human Services, 2000;

2002).The prevalence of gum diseases in school students is very high, for example, 90% of 12

years old in Portugal have signs of gum disease that required treatment (Mexica de Almeida,

C., 2003).

Other studies revealed that a considerable number of children have limited knowledge

of the causes prevention of the most common oral disease (Petersen. P.E, 2003).Furthermore,

School-based oral health promotion program in Australia shows that the use of a setting

approach in promoting oral health can lead to oral health benefits (US Department of Health

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and Human Services, 2000). In Jordan, Ministry of Health reports revealed that the

prevalence rate of oral disease is more than 70% among schools' students.

Cultural beliefs and values plays a significant role in the perception of the causes of

oral health problems such as dental decay and gum diseases, also many children were not

familiar with the threats and susceptibility of oral health diseases. Furthermore, some students

were not familiar with the relationship between diet and oral health diseases and a high

proportion of students consume sugary snacks and drink Cola daily.

Thus, oral health promotion and prevention program become an important program

for promoting oral health among school's students, and it can be easily improving by adopted

and incorporated into daily routines, such as: daily tooth brushing, good dietary pattern and

enhance cultural awareness, knowledge and attitudes of Jordanian children and parents

regarding oral health care.

Before performing a complete assessment for the educational need for Ibn Al-Waleed

School students, it’s essential to gain permission and support of the health education program

for oral health and prevention program. An official approval of Irbid Education Directorate

for the program will be gained. Formal and informal communication with the stakeholders in

different directorate and association which will participate in conducting the program will be

done, and a planning committee of experts and decision makers will be established. A

comprehensive approach to improve oral health and prevent oral diseases assures integration

of multidisciplinary team to guarantee the program sustainability and effectiveness. The

committee will include representatives from the following agencies:

Irbid General Public Health Department – MOH.

Ministry of Education – Irbid Directorate of Education.

Community and Voluntary Health Agencies.

Health Care Providers (physician, nurses' health educators, nutritionist).

Students’ families and Teachers.

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The purposes of this paper are:

1. Understand the nature of the oral health problems among Jordanian schools students.

2. Incorporate school-based oral health promotion and prevention program in Ibn-

Alwaleed school as an integral part of school activities or curriculum.

3. Design, plan, implement and evaluate oral health promotions interventions as a part

of developing school-based oral health promotion and prevention program among

Jordanian schools students.

Planning Model

To address the oral health problems and diseases issue among school students into

practice field, the assessment phase of PRECEDE-PROCEED model will be used.

PRECEDE-PROCEED is a planning framework designed by Lawrence Green and

Marshall Kreuter for health education and health promotion programs. Its overriding principle

is that most enduring health behavior change is voluntary in nature. This principle is reflected

in a systematic planning process which seeks to empower individuals with understanding,

motivation, and skills and active engagement in community affairs to improve their quality of

life.

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PRECEDE-PROCEED model has 9 phases:

PRECEDE have first 5 phases are assessment phases:

1. Social assessment phase: is performed in an effort to help target population (school

students) identify their needs, wants, resources, and desired quality of life. Students who

have similar needs assessment in social assessment phase, should feel empowered to

improve their current level of oral health and all individuals who have abilities to exert

influence and control over students must ask them about what they need to be successful

in promote their oral health.

In this phase the program planners discussed with Ibn-Alwaleed school

administrators, teachers, staffs and parents; the purposes, objectives, times, strategies and

valuable information of this program and assessed with them; the school students

behaviors, knowledge about the causes and prevention of the oral diseases and their

eating attitudes; and their perception about the significant of oral health condition and

dental treatment and their oral hygiene habits such as tooth brushing; and their parents’

role in the oral hygiene habits; lifestyle skills that their taken to promote oral health of

their children;. From these social assessments the planners revealed that the most of the

Ibn-Alwaleed school students have poor oral health status and need to increase their

knowledge about oral health, because they are unfamiliar with the healthy oral behaviors

and most of their foods consist of high sugar such as chocolate, chips, and Cola; and their

parents role in the oral healthcare found limited.

2. Epidemiological assessment phase: Taani (2002a) showed that 25% of Jordanian

populations suffered bleeding gums on brushing; and the incidence of both dental caries

and gingivitis in Jordan school children was found to be higher than that of school

children in developing countries (Taani., 2002b). In addition, another study was

conducted in Jordan revealed that the 80% of north Jordan school children visited the

dentist only for emergencies (Taani, 2002c).

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Planning Project

3. Behavioral and environmental assessment phase: This phase focuses on the systematic

identification of oral health practice and other related factors which appear to be linked to

identify oral health problems among school students by identifying the behavioral and

environmental correlates to student’s oral health and diseases. Behavioral correlates; during

this phase the program planners assessed the school students oral health behaviors included

brushing activity such as the frequency; duration; time; and brushing aids that contribute to

oral health and diseases; and the planners revealed that most of the school students have

unhealthy behaviors related to teeth brushing because they reported that they do irregular

tooth brushing daily and they did not brush their teeth at similar time during the day; and most

of their school food consumption contain excess sugars such as gums, cola, and chocolates.

Environmental correlates: are social and physical factors that support student’s oral

health and prevent oral diseases which include: advertising for certain types of foods, media

influences, peer influences, parent influences, and attitudes; during this phase the program

planners assessed the parents role in students oral hygiene; dental education; and dental visit

such as regularity of visit the dentist; reasons behind the dentist visit; effect of toothache on

dental attendance; and the planners revealed that a very small percentage of students reported

that their parents giving them advice related to the importance of dental visit and using florid

toothpaste; and educate them about the ideal brushing technique to promote their oral health

status; on other hand, the majority of the school students did not receive any advice from their

parents related to oral health; and most of the students reported visited the dentist only when

they become on teeth pain, and the toothache was the driving factor for their visits.

In addition, some students said that they fear from the dentist treatment and they can't

visit dentist regularly because it's very costly. On other hand, related to the healthy food types

in the school canteen, they said that most of the canteen food contains high sugar; and its have

a very negative impacts on oral health condition; and most of students said that their peers

consume the same types of this food (such as cola, and chocolate.)

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4. Educational and ecological assessment phase: the purpose of this phase is to identify

predisposing, reinforcing, and enabling factors that increase the probability that the

behavioral and environmental change will occur.

a) Predisposing factors: Individual's factors that influence the Student's behavior such as:

knowledge to guide food choices, attitudes about oral health, believes, personal

preferences, and existing skills related to oral health. During the analysis of the students

predisposing factors; the planners revealed that the majority of the school students

knowledge and awareness have that the teeth brushing and flossing help to protect and

prevent their teeth plaque and gingivitis; and they did not know the proper treatment of

toothache, but they knew that the sweet foods and soft drinks have a negative impacts on

their oral health condition; in addition, the majority of students believes that the dentist

provides suitable care and explained dental procedures and prevention instructions when

they visit him; and around half of them knew the correct numbers of teeth during

childhood and adulthood periods; and they have bad skills such as insert solid tool to their

teeth and opening the cola bottle covered by their teeth.

b) Reinforcing factors: include factors that reward or reinforce, motivate and incentives or

ability/skills for continued healthy behavior such as social support, praise, direct benefits

and the reinforcing behaviors can be delivered by the family, peers, friends, teachers, self,

and other who control rewards.

The assessment includes: peer norms, approval of eating habits and setting (social

reward), lack of role models, parental attitudes (food rewards), cultural factors (Foods

preparation). During this phase the planners reported that the majority of the students did not

received any rewards or incentives from their parents, teachers or friends for maintaining their

oral healthy behaviors.

c) Enabling factors: are emotional/psychological or physical factors that facilitate

motivation to change student’s behavior; during this phase the planners will assess which

rewards or motivations that could be support school students for attend and be able to gain

cost-effective outcomes from this program. Also assess any factors that support change in the

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school behaviors and environmental reaction to empower psychological supporters. By the

end, the providers will assess barriers as student's perception toward socioeconomic status;

and quality of oral care.

5. Administrative and policy assessment phase: This phase focuses on the administrative and

school concerns which must be addressed prior to oral health promotion and prevention

program implementation. During this phase the planners assessed the school capabilities,

policies, and circumstances; and existing school situation that could hinder or facilitate the

development of the oral health program; and they assessed the available resources in the

school that may assists in the implementation of the program like the educational curriculum,

data show and computers room were available in this school; equipments training availability;

and responsible people for implemented the program lectures. And should identify the school

stakeholders regarding the attainable benefits back from this program.

PROCEED Phases:

6. Implementation phase: For this phase, the program planners will select the most

appropriate methods and strategies of the program interventions according to the appropriate

resources in their hand; and the school-based oral health promotion and prevention program

will be schedule for three month's period, in order to allow all school students to participate

effectively in the all program interventions.

7. Process evaluation: Process evaluation involving any combination of measurement

procedures obtained during the implementation of the school-based oral health and prevention

activities to control, assure, or improve the quality of the program performance.

This program depends on the actual educate and training of school children to increase

their knowledge, behaviors, attitudes, and skills about the good oral healthcare. During this

phase each step in this program will be review such as program goals, objectives and

strategies; determine whether the necessary resources are available to conduct the evaluation;

budget for additional cost; hire an evaluator, if needed, and review data collection and data

analysis procedures to insure maximum performance of the program at each level.

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8. Impact evaluation: This phase focuses on evaluate immediate observable effects of

school-based oral health promotion and prevention program on school students leading to the

intended outcomes of a program. In this program, if students are increased their knowledge,

awareness, attitudes, skills and behaviors of good oral health, they must be able to show the

positive effect regarding good oral health.

9. Outcome evaluation: If the school-based oral health promotion and prevention program will

be institutionalized in this community, more and more school students will be included, and then the

program planners will be able to evaluate the outcomes by following up the monthly oral health

report in Jordan to observe the possible decline oral health problems among Jordanian school

students.

The proposed period for planning is one month. Planning includes gaining the permission and

support from the health and education directorates, preparing materials, instruments, place, and

arrangements with school and parents.

Planning the interventions:

Oral health program can be an effective program for construct a school’s capacity to plan and

implement many of strategies and interventions in health promotion. The critical steps to consider in

planning school based oral health promotion and prevention program are:

1. Including a School Health Team and a Community Advisory Committee.

2. Performing a situational assessment.

3. Obtaining political, parental and community commitment.

4. Establishing supportive school health policies.

5. Setting goals and objectives.

A school health team should be consists of individuals who are committed to work

collaboratively to encourage and promote the oral health of all students who are studying and

learning at school such as students, parents, teachers and school staff, school governors, PTA

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representatives, administrators, food service providers and healthcare providers. The school health

team should be given authority, power, time, resources and support to guide and manage oral health

promotion activities in the school.

In addition to the community advisory committee should be consists of leaders who are

interested in oral health and health promotion, knowledgeable and influential to the community, and

have capability to direct, advice and provide support to the target population (Students). They

recognize the key oral health related issues affecting the school and community, have access to

resources that can contribute to oral health promotion and have a significant influence on creating a

helpful atmosphere for oral health. Committee members play a critical role in encouraging the

relationships between the school and the community at large and they have a good authority to

control and increasing the impacts of oral health promotion interventions.

Situational assessment :

The significant of the situational assessment is to support the development of oral health

promotion effort, conducting by policies, community commitment, teachers and school staff,

decision makers and interested groups. The situational assessment involves the gathering and

analysis data related to oral health from different sources, the school health team and community

advisory committee can establish the local planning process by conducting the situational

assessment. The purpose of the situational assessment is to assess the resources, needs and

circumstances that are relevant to the planning and development of school–based oral health

promotion and prevention program.

A good situation assessment is critical as it provides:

Information on recent oral health status, barriers, risk factors, availability of

resources including existing services and activities.

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Planning Project

The policy, decision makers with verification to support their strategies about oral

health promotion and prevention interventions, particularly in relation to

resources location.

Precise up-to-date data that can be used for planning, rationalization, discussion,

and setting or ranking priorities for actions.

Baseline data for examining and evaluation of oral health promotion

interventions.

Before planning and implementation of oral health promotion and prevention interventions, it is

important to assess and analysis the present oral health conditions and key oral health problems of

school students, compared with those of regions and country; the information should include the

prevalence and severity of the problems.

Purposely, the information needed includes:

Present health and oral health condition of school children and adolescents.

Oral health knowledge, attitudes, beliefs and behaviors.

Behaviors and other key factors related oral health and problems.

Other socio-environmental factors that impact on oral health.

Available resources in school and the community.

Existing activities and programs in school and the local community, as well as

those delivered by the health service providers.

School physical and organizational structure, curriculum, psychosocial

environment, health-related policies and practice, and school-home-community

interaction.

Physical, cultural, political, social and economic factors that support or hinder the

development of good oral health practices.

Policies and guidelines from the health, education, agricultural of government sectors are

essential to the implementation of the school-based oral health program such as: safe water and

sanitation policy, oral hygiene policy, infection control policy, oral health education within the

school curriculum policy, smoking and tobacco use policy, and alcohol policy. Furthermore, the

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development and influences of the oral health interventions depend on the level of support from the

local community; Community contribution is mainly essential to ensure that the issue is addressed

sufficiently, effectively and creating a sense of community ownership.

Community commitment can be confirmed by enthusiastically contributing in community oral

health programs, managing oral health interventions with other actions in the community, public

acknowledgement of the significance of the oral health by community leaders and other related

associations, directing local resources for oral health promotion interventions and use of media.

Establishing school health polices can be conducting by cooperation and harmonization

between health, education, food and agricultural sectors of the government and between the school

and the community are essential in planning policy. For example, school teachers, parents, and

students are involved in the planning, development and feedback process, the school health team

and community advisory committee meet periodically to evaluate the development and maintain

coordination between the school and community; the school courses includes oral health in the

school health education programmed; school staff get systematic and continuing training in oral

health and prevention of oral diseases. The school canteen, cafeterias serve nutritious foods and

drinks that are contributing to good oral health, School canteen staff and food providers are

educated about diet and oral health.

The involvement and commitment of parents in oral health interventions are very essential

because they plays as role models and they have directly influence on their children’s by providing

a home environment that is contributing to oral health, Their participation in monitoring children’s

oral hygiene practices and dietary behaviors at home. Parents and other significant family members

should be educated about the importance of oral health, consequences of oral diseases and

preventive oral health practices.

Vision of the program: Achieving optimal oral health for all Jordanian school students, thus

improving overall health.

Mission of the program: Improve the oral health of Jordanian school students through

education and prevention.

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Planning Project

Goal: increase perception of the significance of oral healthcare as a component of overall

health for the eighth grade students.

Objectives:

1) To collect data about the students' knowledge, awareness, behaviors, skills, and beliefs

regarding their oral healthcare condition.

2.a ) To inform the students about oral health problems and its indications.

2.b ) To elucidate the healthcare behaviors regarding good oral health status.

3.a ) To identify the prevalence of oral health problems and dental decay among the school

students.

3.b ) To detect the students' oral diseases and make referral if necessary.

Theoretical foundation

The Health Belief Model (HBM) developed in the early 1950s by a team of social psychologists

at the U.S; provides a framework for illustrating the causes that some individuals who are not risky

take action to avoid illness, while others fail to take such protective actions. Another purpose of the

HBM was to expect what are the circumstances under which individuals would engage in simple

preventive behaviors, such as oral healthcare practices (pender, 1996).

The HBM suggests that individuals must make a decision that the behavior creates a serious

health problem, before an individual takes an action, and that he/she is personally susceptible to this

behavior harm and the moderating or changing the beneficial, the perceived barriers to assume a

behavior are considered most significant to health promotive effort (Roden, 2004).

Perceived susceptibility and perceived severity to behavior harm are based to a large extent on

the individual's knowledge, awareness, and attitudes toward health problems, and its potential

outcomes (Nexoe et al., 2002). The model deal with "the cues of action" that promote the decision

making process about performing the target behavior. Consequently, perceived susceptibility to and

severity of harm give the force for action, and the perception of high benefits and low barriers give

a course of action which is the cause of the action that start the process of change.

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HBM is congruent with the school-based oral health promotion and prevention program

purpose and interventions. The identification of school students’ knowledge, awareness, behaviors,

and attitudes can be used to identify their readiness to carry out healthy behaviors and lifestyles

regarding good oral healthcare.

To join in the preventive actions, the individual should recognize and believe that:

1. He or she is susceptible to oral and dental health diseases.

2. Contracting the disease would have at least moderately to sever impact on

his/her life.

3. Individual benefits from performing healthy behaviors through prevention

would occur after selecting or taking a firm action.

4. There is a barrier, from taking actions for oral healthcare practices such as

costs and access (Pender, 1996).

Implementation Phase

School-based oral health promotion and prevention program was implemented as required for

Planning and Evaluation of Health Programs (NUR 732) course. The goal of this program is to

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"increase perception of the significance of oral health as a component of overall health for the

eighth grade students."

A complete set of interventions associated with increasing student's knowledge, awareness,

attitudes, and beliefs were used. These interventions educate the school students about the

susceptibility, threats, cost, and the benefits of good oral healthcare. These valuable information are

supposed to begin the school students "cues of action" to apply recommended oral healthy practices

regarding good oral healthcare. The primary assessment represents the foundation for developing

the implementation plan which leads the program planning, implementation, and evaluation. The

following general plan is the structure for program activities.

Target group: School students of eighth grade; Ibn AL-waleed School.

Goal: Increase perception of the significance of oral health as a component of overall

health for the eighth grade students.

Objective (1):

1. To collect data about the students' knowledge, awareness, behaviors, skills, and

beliefs regarding their oral healthcare condition.

Strategies:

1.a ) Distribute questionnaire to assess the students' knowledge, awareness, behaviors, skills,

and beliefs.

1.b ) Evaluate the students' questionnaire responses.

1.c ) Design health education program to meet the students' needs.

Resources needed:

Healthcare providers such as dentist and nurses, questionnaire papers, pencils, data

show, instructors, computer for analyzing data.

Responsible and Time frame:

Program providers, school administrators, teachers, and students.

Time frame is Oct. 2008

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Indicator of Success:

School students' participation by filling the oral healthcare questionnaire.

Data analysis of the questionnaire was completed.

Strengths and weaknesses points regarding student's knowledge, attitudes, skills and

beliefs were determined.

Objective (2):

2.a ) To inform the students about oral health problems and its indications.

2.b ) To elucidate the healthy behaviors regarding good oral healthcare status.

Strategies:

2.a ) Provide health care education instructors (clinical instructors) .

2.b ) Video Tapes shows about behaviors of good oral healthcare were done.

2.c ) Distribute leaflets and brochures regarding recommended oral health behaviors.

2.d ) Explain the correct tooth brushing technique for students.

2.e ) Develop a community education program (Open Day).

Resources needed:

DVD, Papers, Tooth brushes, Tooth pastes, Clinical preceptors.

Responsible and Time frame:

Dentist, nurses, teachers, and students.

Time frame is Nov. 2008 To Dec. 2008

Open day at 12 Dec. 2008.

Indicator of Success:

Successful students' participation in the oral health discussion.

Improve student's oral health perception (post test results).

Effective school administrators and staff participation.

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Open day completed.

Objective (3):

3.a ) To identify the prevalence of oral health problems and dental caries among the school

students.

3.b ) To detect the students' oral diseases and make referral if necessary.

Strategies:

3.a ) Examine students oral health condition by health care providers (dentists).

3.b ) Document the results of oral examination procedures in students' health files.

3.c ) Determine the prevalence of certain oral health problems among students.

3d.) Referral students who have acute oral health problems to the dentist.

Resources needed:

Dentist, nurses, oral examination tools, oral diagnostic procedures such as dental

screening.

Responsible and Time frame:

Health care providers (dentist, nurses), school administrators, and parents.

Time frame is 07 Dec. 2008

Indicator of Success:

Examination of the student's oral health conditions was done.

Early detection of student's oral health problems and diseases were achieved.

Referral of some students to the dentist.

Action Plan

1. Recognize the student's knowledge, attitudes, behaviors, skills and believes regarding oral

healthcare. The recognized information will assist in determining the student’s characteristics

regarding perceived risks of the oral health diseases, perceived susceptibility of having oral health

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Planning Project

problems such as dental decay and gingivitis, perceived advantages of performing recommended

healthy behaviors regarding good oral healthcare, also it will provides guidance for the lectures

actions associated with beginning the students' cues of action.

2. Looking for community stakeholders to support the program.

a) Contribution of Irbid general health directorate, school health directorate, the health

care center, religious affairs in the school-based oral health promotion and prevention

program interventions.

b) Gaining the support of Jordanian Dentists Association, and Education Resources

Center. They will provide pamphlets, leaflets, brochures, and video tapes regarding

oral healthcare.

3) Educational sessions and discussions regarding oral healthcare. It involved: prepare

educational oral healthcare materials; prepare leaflets and brochures regarding good oral

health care behaviors and practice; Lectures regarding signs and symptoms of oral health

problems; the role of bad nutrition such as sweet food in oral health problems and diseases;

and the correct tooth brushing technique; Video tapes show to emphasize certain

recommended healthy behaviors regarding good oral healthcare and communicate knowledge

and individual attitudes towards oral healthcare.

Budget of the Program

The school-based oral health promotion and prevention program is a non-profit program,

and mainly will be financially supported by the some sponsors concerned oral healthcare. The

following table represents the proposed planned budget for this program.

Income AmountContribution from sponsors :

Irbid General Public Health Department – MOH.

1000 JD

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Planning Project

Ministry of Education – Irbid Directorate of Education.

1500 JD

Community and Voluntary Health Agencies.

1000 JD

The Irbid Department of Developmental Services.

1200JD

Community Clinics. 1400JD

Gifts: Private Clinics.

950JD

Famous sponsors Person. 900JD

Commercial Institutions 550JD

Total 8500JD

Expenses AmountEquipment 900JDCurriculum materials 2500JDPersonnel:

1. For Planning.2. Program Facilitators.3. Clerical.4. Evaluators.

800JD400JD400JD650JD

Marketing expenses: Print advertising materials Mass Media

500JD1500JD

Supplies 300JDTransportation cost 250JDIncentives school students 300JD

Total 8500JD

(JD: Jordanian Dinnar); Balance = (0.00 JD)

The Program Marketing

Marketing of the school-based oral health promotion and prevention program require

providing good products to the target audience (school students) for involving them in the

program activities; this program promotes oral health activities designed to reinforce oral

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Planning Project

health practices and to help prevent oral health problems such as dental decays, and gum

disease among Jordanian school students. These activities focus on provide education and

prevention strategies to all Jordanian school students to promote their oral health and risk

reduction oral activities to reduce the occurrence of oral health problems among them. The

school-based oral health promotion and prevention program identifies oral health resources

available for local health departments and collaborates with the oral health community, public

& private schools, local health departments, families and others concerned with oral health

promotion activities.

The program planners can market their program among school students through many

ways such as offer free open day dental screening for all students; dental screening may help

to build a positive attitude among Jordanian students on the part of oral health. And it may

encourage student's parents to schedule dental examinations for their children; and the

valuable information from the dental screening may suggest topics of the health education

program that could be enhanced. In addition, effective and efficient of the oral health

program marketing can also be enhanced by collaborating with the internal agencies such as

the quality improvement and continues education departments through design oral health

training programs and marketing materials for medical professionals and their staff; school

administrators and teachers; parents and caregivers, students, advocates, and other

stakeholders to learn oral health assessment tools and oral diagnostics procedures to improve

involving target audience in this oral health program.

On other hand, the planners can improve audience involving through using mass

media channels by advertising the significance of oral health as a part of overall health

through radio, TV (ex. compose songs appropriate for school students), newspapers, medical

journals, magazines; oral health posters, stickers, and oral health messages will disseminated

in all community places. Finally, the planners can market their program through disseminate

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Planning Project

report about the goals, strategies, and outcomes of the program to the sponsors and target

school to be reserved in their archives.

Evaluation of the Program

Two types of program evaluation process formal and informal were conducted to

establish the efficient and effective of the school-based oral health promotion and prevention

program, and to change the program goals, and objectives according to the desired outcomes.

The indicators of the program success should considered students participation rate in all

steps of the program; school involvement, increasing the students knowledge, awareness,

behaviors, attitudes, skills, and believes regarding to their oral healthcare, and increase the

positive attitude of students as a result of following program information. Process evaluation

assessed through the different steps of the program, it indicated by the related parties

approved to participate in the program. The response rate of school students on the pre-test

questionnaire, effective participation of students in program sessions, a qualified personnel

participate in conducting the program sessions, distribution of educational material to all

students, Identifying the strengths, weaknesses, opportunities and threats of student’s

lifestyle behaviors which exposed through the assessment phase.

On other hand, the impact evaluation was assessed by make a comparison between

the pre-test and post-test findings of the oral healthcare questionnaire. The school students

reported a high level of knowledge and awareness about the risks, symptoms and significance

of oral healthcare, in addition to a positive change in their attitude and skills toward changing

their everyday life behaviors. Moreover, it assessed through the message of the significance

of the program, which was accepted and communicated by the school students and other

community agencies.

In addition to advocacy efforts which were started to be directed toward more

improvement in the students everyday life behaviors, from the school administration, through

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Planning Project

providing healthy food in school canteen and cafeteria. Finally, outcome evaluation will be

assess after sixth months from the school administration to discover if the school students

continue perform the recommended healthy behavior which they acquired from their

involvement in the oral health program interventions. Finally, the informal evaluation

assessed through observation assessment for the participants support through debating in the

program lectures, and their concentration or attention toward the lectures presenters, which

mean that the oral health program lectures were effective and efficient.

Summary & Conclusion

Oral health issue is considered as a globally health problem, locally in Jordan like

globally , Ministry of Health reports revealed that the prevalence rate of oral health diseases is

more than 70% among schools' students. Consequently, Oral health among school students is

very important because students who have poor oral health can have an unfavorable effect on

their performance in school and their success in the future.

Related to the studies about this issue among school students, there are few studies

that discussed this issue in Jordan. This program focused on the knowledge, behaviors,

attitudes, skills and lifestyles of students for the contributing factors of the oral health

problems and diseases. Moreover, the roles of the students parent, teachers and their peers in

increasing this issue. Finally, the program committee planning suggested that the oral health

problems should be controlled in primary prevention of healthcare by performing a national

study to expose the spreading of such issue. This work need to the support and collaborative

of different community sectors to achieve a national oral healthcare strategy.

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Planning Project

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