Video: Improving oral health in Australia

(PDF) Effectiveness of an educational video in improving oral health knowledge in a hospital setting

Video: Improving oral health in Australia

Shah, et al.: Effect of an educational video on oral health‑related knowledge

Indian Journal of Dentistry | June 2016 | Vol 7 | Issue 2 73

difference was found in the pre‑ and post‑intervention

knowledge scores, signifying the fact that there

is a need for oral health education program in the

general population. Various other studies have also

documented effective improvement in attitude of

subjects, using video instruction.[16,17]

Health messages through educational materials such

as leaflets can change individuals’ behaviors.[15]

However, it has been recommended that pamphlet is

more effective if used with some other intervention

method.[18] Although web‑based audiovisual programs

are found effective and can be updated periodically,

they may not be feasible in all settings, due to various

reasons such as computer literacy, affordability, and

access. With the increase in application of computer

technology in India, a DVD‑based video film can

be an effective mode of oral health education in an

oral health‑care setting such as dental hospitals,

schools, nursing homes, or private clinics. Eaton

et al., 2008, concluded that even a slight gain in

skill or improvement in knowledge is an indicator

of success.[19] any other health education,

oral/dental health education is plagued with the

problem of retention of knowledge and transferring

the information to practice. Thus, reinforcement is the

key for retention of new knowledge or acquiring a skill.

In the present study, the major difference in knowledge

among 14 items was associated with the following


• Is there a necessity to treat tooth decay in milk

teeth as they fall out after sometime and new

teeth will erupt?

It has been known that people do not attach

much importance to care of primary teeth

with the belief that these will eventually fall

out. In the present study, also it was found

that only 31 of 109 subjects were aware

of importance of milk teeth preintervention.

After the intervention, almost 2‑fold increase

was observed in the subject’s knowledge.

Awareness needs to be brought to the

general population regarding the importance

of milk teeth and their care and importance

of their retention. Tooth decay can reduce

the masticatory efficiency and esthetics;

the developing tooth bud may develop

hypoplasia, besides causing malocclusion in

permanent dentition. The knowledge score

has shown improvement since this aspect has

been highlighted properly in the video.

• When should a mother start brushing a child’s


Lack of knowledge regarding the brushing

skill exists since ages. It was observed in this

study that merely ten subjects had knowledge

regarding the accurate age to start brushing

preintervention, whereas postintervention, a

signicant change was observed. As per the

American Dental Association guidelines, the

mother should start brushing a child’s teeth,

as soon as the rst tooth erupts in the oral

cavity, to prevent the accumulation of plaque

on the erupting tooth.

What should be done in case a tooth falls out

due to injury?

Injury to primary and permanent teeth and their

supporting structures is one of the common

dental problems seen in children. Dental

injuries can result in functional and esthetic

impairment and lead to great concerns, both

for the parents and for the child. Informing

about possibility of an avulsed (tooth fallen

its socket) can be reimplanted and how

to store the tooth, importance of immediate

replantation without time loss, etc., can save

many avulsed teeth and prevent psychological

trauma, physical morbidity, and cost of

prosthetic rehabilitation. Self‑management

of avulsed tooth was shown very effectively

in the video; thereby it could bring about a

signicant change in knowledge.

• Signs of oral cancer

Although one‑to‑one counseling for quitting

tobacco is considered to be the most effective

method for producing behavior change,

AV film depicting early and late stages

of oral cancer resulting after tobacco use

can also have a powerful impact. Gordon

et al., 2004, conducted a study to compare

the effect of tobacco education program

by dentist, telephonic conversation, and

utilizing 5 As (ask, advice, assess, assist,

and arrange) and concluded that interactive

educational program is engaging, easy to

use, and increases the knowledge in tobacco

cessation.[20] Thus, it can be ascertained

that knowledge about the harmful effects

of tobacco, self‑examination of oral cavity

leading to early detection, can bring a major

difference in the incidence of oral cancer.

In the present study, the difference in

mean knowledge was found to be more in

males compared to females though it was

statistically not signicant. This could be

attributed to the unequal distribution of sample

according to gender in the study. Yazdani

et al. conducted a cluster randomized trial in

a school health education program, in which

health education was given either by a leaet

or by videotape.[15] At an interval of 12 weeks,

[Downloaded free from on Friday, June 24, 2016, IP:]


Simple Ways to Improve Oral Health | Colgate® Oral Care

Video: Improving oral health in Australia

You probably don't think that being in better health than an Olympic athlete is something you can easily achieve, but by adopting some simple ways to improve oral health, you'll be the one wearing the gold medal.

A recent study by the London Eastman Dental Institute in the British Journal of Sports Medicine examined the oral health of London 2012 Olympic athletes and revealed that 55 percent had cavities, 76 percent had gingivitis (inflammation or infection of the gums) and 15 percent had periodontitis (inflammation or infection of the gums spreading to the ligaments and bone that support the teeth). Nearly half of these athletes had not received a dental examination or dental hygiene care in the previous year.

It was concluded that the oral health of these athletes was poor. Many of them felt it had a negative impact on their athletic performance and well-being.

The Right Tools for the Right Regimen

Practicing proper oral hygiene regimens and using the right tools are really important ways to improve oral health.

The American Dental Association's (ADA) Mouth Healthy site recommends brushing twice a day with a soft-bristled brush and toothpaste to help remove food and plaque (a sticky film of bacteria that forms at the gum line and on the teeth).

Correct brushing technique is to place the toothbrush at a 45-degree angle toward your gum line and gently move the bristles back and forth in short strokes. Make sure to brush the outer, inner and biting surfaces of all your teeth. Brush your tongue as well, or use a tongue cleaner.

Use a toothbrush that fits comfortably in your mouth and a toothpaste containing active ingredients that can help protect you from specific problems, such as cavities, gum disease, bad breath, tartar buildup, stains or sensitivity; Colgate® Sensitive Pro-Relief in particular addresses sensitivity. The ADA also recommends including an interdental cleaner such as floss once a day as part of a daily routine for a healthy mouth.

Other Ways to Improve Oral Health

Eat a balanced diet and limit sugary snacks and beverages.

Consuming whole grains, low-sugar breads and cereals, fresh fruits and vegetables and high-quality protein such as that contained in lean meats, eggs, fish, cheese and dry beans are the best food choices for a healthy mouth.

According to the ADA, fruits and vegetables should take up half of your plate, with the other half divided between whole grains, low-fat dairy products and lean protein foods.

Fruits and vegetables are especially beneficial because chewing firm, coarse, watery and fibrous foods, such as broccoli, cauliflower, spinach, apples and lettuce, stimulates the flow of saliva, which facilitates the digestion of foods and reduces food retention in your mouth. Calcium-fortified tofu can be substituted for animal protein sources.

Regularly visit your dental office for oral exams and professional cleanings. You should go to your dental maintenance visits twice per year, but only your dental health professional can tell you how often you should have your checkup and professional cleaning your needs.

If you're unsure how to clean your mouth properly, ask your dental health professional to show you the correct technique.

If you are experiencing symptoms of disease such as bleeding gums or discomfort, do not wait for your regular checkup because it may be a sign of a problem that requires immediate attention.

Wear a mouth guard if you play a sport. Mouth guards help prevent injuries by cushioning blows to your lips, teeth and jaw when playing sports.

Not every Olympic athlete takes the precaution, but a mouth guard is the best protection against getting your teeth broken or knocked out.

There are many types of mouth guards, so you will need to ask your dentist to help you decide which type is right for you.

Olympic athletes are viewed as healthy. But what does it really mean to be healthy? Oral health is an important part of your well-being. When you take care of your body, your mouth should be included — and it's simple to do.

About the Dianne L. Sefo is a dental hygienist and dental hygiene educator. She has been involved in multiple publications, has worked in private practices in New York and Southern California, and has been a faculty member at Monroe Community College, Concorde Careers College — San Diego, and New York University.


Oral health

Video: Improving oral health in Australia

The majority of oral health conditions are: dental caries (tooth decay), periodontal diseases, oral cancers, oral manifestations of HIV, oro-dental trauma, cleft lip and palate, and noma (severe gangrenous disease starting in the mouth mostly affecting children). Most oral health conditions are largely preventable and can be treated in their early stages.

The Global Burden of Disease Study 2017 estimated that oral diseases affect close to 3.5 billion people worldwide, with caries of permanent teeth being the most common condition. Globally, it is estimated that 2.3 billion people suffer from caries of permanent teeth and more than 530 million children suffer from caries of primary teeth.2  

In most low- and middle-income countries, with increasing urbanization and changes in living conditions, the prevalence of oral diseases continues to increase.

This is primarily due to inadequate exposure to fluoride (in the water supply and oral hygiene products such as toothpaste) and poor access to oral health care services in the community.

Marketing of food and beverages high in sugar, as well as tobacco and alcohol, has led to a growing consumption of products that contribute to oral health conditions and other noncommunicable diseases.

Dental caries (tooth decay)

Dental caries result when plaque forms on the surface of a tooth and converts the free sugars (all sugars added to foods by the manufacturer, cook, or consumer, plus sugars naturally present in honey, syrups, and fruit juices) contained in foods and drinks into acids that destroy the tooth over time. A continued high intake of free sugars, inadequate exposure to fluoride and a lack of removal of plaque by toothbrushing can lead to caries, pain and sometimes tooth loss and infection.

Periodontal (gum) disease

Periodontal disease affects the tissues that both surround and support the tooth. The disease is characterized by bleeding or swollen gums (gingivitis), pain and sometimes bad breath.

In its more severe form, the gum can come away from the tooth and supporting bone, causing teeth to become loose and sometimes fall out. Severe periodontal diseases are estimated to affect nearly 10% of the global population.

The main causes of periodontal disease are poor oral hygiene and tobacco use.

Oral cancer

Oral cancer includes cancers of the lip, other parts of the mouth and the oropharynx. The global incidence of cancers of the lip and oral cavity) is estimated at 4 cases per 100 000 people.

However, there is wide variation across the globe: from no recorded cases to around 20 cases per 100 000 people.

3 Oral cancer is more common in men and in older people, and varies strongly by socio-economic condition.

In some Asian-Pacific countries, the incidence of oral cancer ranks among the three top cancers.3 Tobacco, alcohol and areca nut (betel quid) use are among the leading causes of oral cancer.4 In North America and Europe, human papillomavirus infections are responsible for a growing percentage of oral cancers among young people.5

Oral manifestations of HIV infection

Oral manifestations occur in 30-80% of people with HIV,6 with considerable variations depending on the affordability of standard antiretroviral therapy (ART).

Oral manifestations include fungal, bacterial or viral infections of which oral candidiasis is the most common and often the first symptom. Oral HIV lesions cause pain, discomfort, dry mouth, and difficulties swallowing.

Early detection of HIV-related oral lesions can be used to diagnose HIV infection and monitor the disease’s progression. Early detection is also important for timely treatment.

Oro-dental trauma

Oro-dental trauma results from injury to the teeth, mouth and oral cavity. Around 20% of people suffer from trauma to teeth at some point in their life.

7 Oro-dental trauma can be caused by oral factors such as lack of alignment of teeth and environmental factors (such as unsafe playgrounds, risk-taking behaviour and violence).

Treatment is costly and lengthy and sometimes can even lead to tooth loss, resulting in complications for facial and psychological development and quality of life.


Noma is a severe gangrenous disease of the mouth and the face. It mostly affects children between the ages of 2 and 6 years suffering from malnutrition, affected by infectious disease, living in extreme poverty with poor oral hygiene and/or with weakened immune systems.

Noma is mostly found in sub-Saharan Africa, although cases have also been reported in Latin America and Asia. Noma starts as a soft tissue lesion (a sore) of the gums, inside the mouth. The initial gum lesion then develops into an acute necrotizing gingivitis that progresses rapidly, destroying the soft tissues and further progressing to involve the hard tissues and skin of the face.

In 1998, WHO estimated that there were 140 000 new cases of noma annually. Without treatment, noma is fatal in 90% of cases.

Survivors suffer from severe facial disfigurement, have difficulty speaking and eating, face social stigma, and require complex surgery and rehabilitation.

Where noma is detected at an early stage, its progression can be rapidly halted, through basic hygiene, antibiotics and improved nutrition.

Cleft lip and palate

Clefts of the lip or palate affect more than 1 in 1000 newborns worldwide. Genetic predisposition is a major cause.

However, poor maternal nutrition, tobacco consumption, alcohol and obesity during pregnancy also play a role.8 In low-income settings, there is a high mortality rate in the neonatal period.

If lip and palate clefts are properly treated by surgery, complete rehabilitation is possible.

Noncommunicable diseases and common risk factors

Most oral diseases and conditions share modifiable risk factors (such as tobacco use, alcohol consumption and an unhealthy diet high in free sugars) common to the four leading noncommunicable diseases (cardiovascular disease, cancer, chronic respiratory disease and diabetes).

In addition, it is reported that diabetes is linked in a reciprocal way with the development and progression of periodontal disease. Moreover, there is a causal link between the high consumption of sugar and diabetes, obesity and dental caries. 

Oral health inequalities

Oral diseases disproportionally affect the poor and socially-disadvantaged members of society.

There is a very strong and consistent association between socioeconomic status (income, occupation and educational level) and the prevalence and severity of oral diseases.

9 This association exists from early childhood to older age, and across populations in high-, middle- and low-income countries.


The burden of oral diseases and other noncommunicable diseases can be reduced through public health interventions by addressing common risk factors.

These include:

  • promoting a well-balanced diet low in free sugars and high in fruit and vegetables, and favouring water as the main drink;
  • stopping use of all forms of tobacco, including chewing of areca nuts;
  • reducing alcohol consumption; and
  • encouraging use of protective equipment when doing sports and travelling on bicycles and motorcycles (to reduce the risk of facial injuries).

Adequate exposure to fluoride is an essential factor in the prevention of dental caries.

An optimal level of fluoride can be obtained from different sources such as fluoridated drinking water, salt, milk and toothpaste. Twice-daily tooth brushing with fluoride-containing toothpaste (1000 to 1500 ppm) should be encouraged.

Access to oral health services

Unequal distribution of oral health professionals and a lack of appropriate health facilities in most countries means that access to primary oral health services is often low.

Overall, according to a survey of adults expressing a need for oral health services, access ranges from 35% in low-income countries to 60% in lower-middle-income countries, 75% in upper-middle income countries and 82% in high-income countries.

10 Moreover, even in high income settings, dental treatment is costly, averaging 5% of total health expenditure and 20% of out-of-pocket health expenditure.

11 Efforts in support of UHC  can  help  frame policy dialogue to address weak  primary oral   health   services,   and   address   substantial  out-of-pocket expenses associated with oral health care in many countries.

WHO response

Eight years after the United Nations High-Level Meeting on Noncommunicable Diseases recognized that oral diseases pose a major health burden for many countries, 2019 saw the inclusion of oral health in the Political Declaration on Universal Health Coverage. During the same period, Members States, with the support of the WHO, developed and endorsed strong regional strategies and calls for action in favour of oral health in the African, East Mediterranean, South-East Asia and Western Pacific regions.

In such a context, WHO is committed to ensuring promotion of oral health and quality, essential treatment for oral health conditions for all people in all countries without individual financial hardship.

Reducing oral health conditions calls for a reform of oral health systems to shift the focus from invasive dental treatment to prevention and more minor treatment.

WHO has identified key strategies for improving oral health, with a focus on low-income and marginalized populations where access to oral health care is most limited. These include strengthening both cost-effective population-wide prevention and patient-centred primary health care.

This work is being implemented through a three-year roadmap (2019-2021) that comprises a mix of normative work and practical support to countries. A top priority is the development of a global oral health report, which will provide information about the status of oral health globally. The report will serve as the evidence base for the development of a global oral health action plan.

WHO also supports countries in this area by:

  • supporting interventions to accelerate the phase-down of dental amalgam in the context of the Minamata Convention on Mercury;
  • building capacity and providing technical assistance to countries to support a life-course approach and population-based strategies to reduce sugar consumption, control tobacco use, and promote fluoride-containing toothpaste and other vehicles of fluoride;
  • providing assistance to strengthen oral health systems such that they are an integral part of primary health care and do not cause financial hardship; and
  • reinforcing oral health information systems and integrated surveillance with other noncommunicable diseases to demonstrate the scale and impact of the problem and to monitor progress achieved in countries.


1. United Nations General Assembly. Political Declaration of the High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases. Resolution A/66/L1. 2011

2. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1789–8583

3. Ferlay J EM, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Published 2018. Accessed 14 September, 2018.

4. Mehrtash H, Duncan K, Parascandola M, et al. Defining a global research and policy agenda for betel quid and areca nut. Lancet Oncol. 2017;18(12):e767-e775.

5. Mehanna H, Beech T, Nicholson T, et al. Prevalence of human papillomavirus in oropharyngeal and nonoropharyngeal head and neck cancer–systematic review and meta-analysis of trends by time and region. Head Neck. 2013;35(5):747-755.

6. Reznik DA. Oral manifestations of HIV disease. Top HIV Med. 2005;13(5):143-148.

7. Petti S, Glendor U, Andersson L. World traumatic dental injury prevalence and incidence, a meta-analysis – One billion living people have had traumatic dental injuries. Dent Traumatol. 2018.

8. Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate. Lancet. 2009;374(9703):1773-1785.

9. Marco A Peres and Al. Oral diseases: a global public health challenge. Lancet. 2019

10. Hosseinpoor AR, Itani L, Petersen PE. Socio-economic inequality in oral healthcare coverage: results from the World Health Survey. J Dent Res. 2012;91(3):275-281.

11. OECD. Health at a Glance 2017: OECD indicators. Published 2017. Accessed 15 February 2018.


Effectiveness of an educational video in improving oral health knowledge in a hospital setting

Video: Improving oral health in Australia

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Effectiveness of a Web-Based Health Education Program to Promote Oral Hygiene Care Among Stroke Survivors: Randomized Controlled Trial

Video: Improving oral health in Australia

Provision of oral hygiene care is often underemphasized and underpracticed in the acute hospital setting []. This is despite growing acceptance of the importance of oral hygiene to general health, because of its potential link with bacteremia and aspiration pneumonia [,].

For stroke patients in the acute hospital setting, it is recognized that oral hygiene care is of key importance to prevent complications that may compromise rehabilitation or potentially give rise to a recurrent stroke [].

There is a growing interest in how to effectively increase the practice of providing oral hygiene care in the hospital setting through clinical interventions [,] and through education and training of caregivers [,].

Unfortunately, however, all this has met with limited success and a persistence of poor knowledge and attitudes toward providing oral hygiene care in the acute hospital setting typically prevails [].

Despite the acknowledged importance of dental education and oral health promotion activities, the effectiveness to change practices with respect to oral hygiene care has met with limited success among carers and patients [,].

To this end, the need to plan and implement oral health promotion programs psychological models has advocated the need to “translate theory into practice” [].

One of the most widely used theories (model) is the theory of planned behavior (TPB), which emphasizes the importance of changing the “general intention”’ (GI) to perform a health behavior and its relationship to attitude (positive or negative views of a behavior), subjective norm (SN, perceived of social pressure to perform a behavior) and perceived behavior control (PBC, one’s control to perform a behavior) [,].

Providing dental health education and oral health promotion through continuing professional development (CPD) programs is an important and practical way to promote oral hygiene care practices in hospital settings [].

The use of Web-based and computer-aided learning (CAL) has been widely used in CPD programs for health carers, owing to its ability to implement programs across wide geographical areas at relatively low costs and because of the reported effectiveness of such programs in changing health care practices [-] and health behavior []. Increasingly, Web-based and CAL programs are being used to enhance oral hygiene care in hospital and other institutionalized setting, and there are several reports of their ability to positively bring about change in knowledge [], attitudes [], and oral health behavior [].

We aimed to evaluate the effectiveness of a Web-based (CPD) program to change the GI of health carers to perform daily mouth cleaning for stroke patients using TPB in a large randomized controlled trial across Malaysia. In addition, the study aimed to identify key factors associated with changes in GI among health care workers to provide oral hygiene care to stroke patients.

Study Design and Sample

This study was a double-blind, cluster-randomized, controlled trial with 1 month and 6 months follow-ups. The study involved 10 public hospitals in Malaysia, which have participated in a survey of oral hygiene practice for stroke patients.

These hospitals were selected because they provide rehabilitation services that are led by rehabilitation medicine specialists. Hospitals were first stratified by size into either large, medium, or small in terms of number of health care providers.

From each stratified group, hospitals were block-randomized in groups of 4 (“ABBA”) by a computer-generated randomization method. In total, 5 hospitals were assigned to the test group (277 registered nurses) and 5 hospitals were assigned to the control group (270 registered nurses).

The allocation sequence was concealed from the investigator coordinating the trial (who had contact with the centers). Through concealment, the assessor was “blind” as to what group participants had been assigned and participants were also blind as to what groups they were assigned to, as both received a form of Web-based CPD.

The study population was registered nurses caring for stroke patients at the hospitals, mainly from the rehabilitation and general medical wards. All the registered nurses from these identified wards were invited to take part in this trial.

Information sheet related to the study and written informed consent were given to all the nurses before commencing the study. The forms were distributed to the nurses by the ward managers or chief nurses. Nurses who provided their written consent were those who participated in the trial from the study population.

Participation was voluntary and no contact was made with the nurses to ensure confidentiality and reduce the potential for “social bias.”

Ethics Approval

This clinical trial was registered with the National Institutes of Health, Ministry of Health, Malaysia; NMRR-13-1540-18833(IIR).

Before the commencement of the study, ethical approval was obtained from the Institute for Health Behavioral Research and Medical Research and Ethics Committee of the National Institutes of Health, Ministry of Malaysia. Permissions to conduct the study were also obtained from the directors of the respective hospitals.

Recruitment and baseline assessments were from September 2014 to November 2014 at 10 hospitals across the country (both the Peninsular Malaysia and island of Borneo Malaysia). This study followed CONSORT guidelines.

Data Collection

The nurses self-completed a questionnaire on the practice of providing oral hygiene care to stroke patients, which contained 12 items specific to attitudes, SN, PBC, and GI to providing oral hygiene care related to TPB.

These items were derived from the manual of “Constructing Questionnaires the Theory of Planned Behavior” developed by the Centre of Health Services Research, University of New Castle, UK (2004) []. Items related to direct measure of the domains were chosen and modified to the oral health context.

For example, in the GI domain, “I expect to measure the blood pressure of my patients with diabetes in each consultation” was modified to “I expect to perform oral care (including denture) for patients in every session.

” Each domain had 3 items that were rated on a 5-point rt scale (strongly disagree, disagree, not disagree or agree, agree, and strongly agree).

Domain scores can range from 3 to 15, with higher scores reflecting more positive attitude, stronger subjective norms, greater perceived behavior control, and greater general intention to provide oral hygiene care. Sociodemographic and environmental characteristic (eg, attended oral care training, availability of oral health guidelines and oral hygiene kits, and having dental professional support in the ward) information were also obtained from the participants.

In addition, knowledge of oral health care was assessed using 5 items related to dental plaque, gum bleeding, consequences of dental plaque, how to prevent gingivitis, and how oral health affects general health []. Knowledge scores can range from 0 to 5, with higher scores indicative of greater oral health knowledge. Assessments were carried out preintervention and at 1 month and 6 months postintervention.


A Web-based CPD program was developed for the test and control groups. The test group program was specific to provision of oral hygiene care to stroke patients and covered details of oral health knowledge, attitudes, subjective norms, means of behavioral control, and intention (ie, TPB).

The test group contents include, for example, information on good oral condition and the importance of having good oral health, the consequences of poor oral hygiene, and the importance of nurse’s roles and care of stroke patients.

The development of the contents was guided by the definition of the TPB domains and scope of the study. The control group received an analogous Web-based CPD program related to “bundles of care” for stroke patients that included some details on oral hygiene care but not specific to TPB [].

The CPD programs were developed by stroke physicians (rehabilitation medicine) and dentists and followed good practices of CAL for oral health []. Following the assignment to the groups, the participants were provided with details of the Web-based programs through a secure internet portal.

Participants were reminded and encouraged to complete the Web-based CPD program every 6 weeks.

Sample Size

With the assumption that this practice is at 50% and that it will not change without education intervention, whereas there will be a 25% improvement in practices following CAL intervention (ie, 63% of nurses will practice oral care in rehabilitation). Then a proposed sample size of 247 in each group is required with sample power at 80%. Allowing for nonparticipation and a dropout rate of ~20%, thus it was prudent to attempt to recruit over 600 nurses (300 per group) in total to test the hypothesis.

Data Analysis

The changes in knowledge, attitudes, SN, PBC, and GI were determined overtime and compared between the test and control groups using Friedman two-way analysis of variance (ANOVA) and Mann-Whitney U test analysis, respectively. Multiple linear regression analyses were performed to determine key factors associated with changes in GI to provide oral hygiene care at 1 month and 6 months.


The response rate of the trial was 68.2% (373/547); mostly loss to follow-up was because nurses were transferred to other wards or hospitals (). The response rate among the test group was 70.4% (195/277) and among the control group was 65.

0% (178/270); there was no significant difference between the response rate among those in the test and control groups (P>.05). The majority of nurses were female (95.7%, 357/373), had a certificate or diploma in nursing (81.5%, 304/373), worked in general medical wards (78.

6%, 293/373), and reported to have worked for less than 5 years (59.0%, 220/373; ).

Characteristics n (%)
Provider characteristics
Male 16 (4.3)
Female 357 (95.7)
Years worked
Less than 5 years 220 (59.0)
More than 5 years 153 (41.0)
Certificate or diploma 304 (81.5)
Post basic or degree 69 (18.5)
Working wards
Rehabilitation ward 80 (21.4)
Medical ward 293 (78.6)
Oral care training
Yes 108 (29.0)
No 265 (71.0)
Oral health care guidelines
Yes 296 (79.4)
No 77 (20.6)
Oral hygiene kit
Yes 253 (67.8)
No 120 (32.2)
Dental professional support
Yes 52 (13.9)
No 321 (86.1)

‎Table 1. Health care provider and environmental characteristics (n=373)View this table

Among all participants, there was a significant difference in knowledge scores over time (P.05).

Time General intention
Mean (SD)
Mean (SD)
Subjective norm
Mean (SD)
Perceived behavior control
Mean (SD)
Mean (SD)
Baseline 10.8 (2.1) 13.1 (1.7) 9.7 (1.7) 10.5 (1.7) 3.0 (1.0)
1 month 11.0 (1.9) 12.9 (1.6) 9.9 (1.7) 10.3 (1.9) 3.2 (1.1)
6 months 10.7 (2.2) 13.0 (1.6) 9.7 (1.8) 10.3 (1.9) 3.2 (1.1)
P value .36 .11 .05 .28 .005a