Primary School-Based Intervention for Preventing Caries

Running head: PRIMARY SCHOOL-BASED INTERVENTION FOR CARIES
Primary school-based intervention for preventing caries
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PRIMARY SCHOOL-BASED INTERVENTION FOR PREVENTING CARIES
Table of Contents
Section A:...................................................................................................................................2
Overview of health improvement approaches........................................................................2
Existing reviews.....................................................................................................................3
Theoretical approach..............................................................................................................5
Section B....................................................................................................................................7
Challenges in implementation of the interventions:...............................................................7
Evaluation of the intervention:...............................................................................................8
Section C:.................................................................................................................................10
Clear description or examples of the initiative:...................................................................10
Reach, uptake, channels and sources:..................................................................................11
Theoretical approaches and socio-ecological influences:....................................................12
References:...............................................................................................................................14
Appendix:.................................................................................................................................18

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PRIMARY SCHOOL-BASED INTERVENTION FOR PREVENTING CARIES
Section A:
Overview of health improvement approaches
Rochdale is a town located in Greater Manchester, England and has a borough that
works in partnership with the schools, health professionals and providers for improving the
oral health status of the residents. The Borough Council focuses on the importance of a
healthy mouth and promotes the maintenance of good oral hygiene for preventing the onset of
dental problems. The Oral Health Improvement for the Elderly Programme has been enforced
and implemented by the Rochdale Borough Council, Rochdale Clinical Commissioning
Group, and NHS Heywood, with the aim of enhancing the oral health of the elderly.
Furthermore, the area is one of its kind in greater Manchester that has invested adequate
funds for creating training provisions for care homes, community services, hospital staff and
home care, in order to check and clean the mouths of the older and vulnerable population
(National Institute for Health and Care Excellence 2014). The community also takes efforts to
lower the likelihood of the vulnerable population to contract hospital acquired pneumonia
(Hmr.nhs.uk 2018).
Regardless of the fact that dental caries are a preventable health condition, upon
assessment by the local authority, an estimated 47% five year old individuals were found to
suffer from dental caries, in Rochdale. This proportion was found to be twice the national
average. This justifies the role of the Borough Council in implementing oral health programs.
Of all Oral Health Need Assessments (OHNA) that were completed, 35% were done during
2016-2017, and an estimated 50% were completed during 2014-2015 (Public Health England
2018).
The Annual Health Report also suggests that the Borough Council has taken into
account the introduction of sweetened beverage duty at a rate of 20paise, for addressing the

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PRIMARY SCHOOL-BASED INTERVENTION FOR PREVENTING CARIES
problems associated with poor dental health that are prevalent in the target population (Public
Health England 2018). Some of the common oral health improvement programs that have
been enforced and implemented by the UK local authorities encompass oral health training,
healthy drink and food policies, targeted provision for toothpaste and toothbrush, monitored
tooth brushing in school settings, community water fluoridation programs, and help from peer
support workers. The aforementioned data suggest that much efforts have been adopted by
the government for improving oral health. However, oral health issues such as, dental caries
amid primary school students remains relatively unaddressed.
Existing reviews
Marinho et al. (2013) affirmed the use of topically administered fluoride varnishes for
the prevention of dental caries in adolescents and children. Upon conducting a meta-
regression, the researchers failed to establish a noteworthy association between the
application of fluoride varnish and severity of dental caries among children. Owing to the fact
that there was less information on the effect exerted by fluoride varnishes on the proportion
of kids who develop dental caries, no definite conclusion regarding effectiveness of
preventive intervention could be reached. However, Cooper et al. (2013) was effective in
determining a potential setting that can be implemented across all primary schools for the
implementation of behavioural interventions for supporting children adopt a healthy
behaviour.
There is mounting evidence for the fact that child developmental theories typically
place a focus on the ways by which children alter and grow over the entire course of their
childhood, and also focus on different domains of child development namely, emotional,
cognitive and social growth (Dweck 2013). Although Cooper et al. (2013) elaborated on the
implementation of different behavioural interventions, none of them were allied with the
developmental theories, thereby establishing a gap in the evidence.

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PRIMARY SCHOOL-BASED INTERVENTION FOR PREVENTING CARIES
Reasoned action theory has been recognised as one of the most extensively used
theories in health intervention and behavior research (Montano and Kasprzyk 2015). The
theoretical perspective of the theory on beliefs, underpinning behavior proposition a notional
understanding of impact that health messages bring about in behavior change. In the words of
Conner et al. (2017) this theory also can be implemented in the form of a practical tool for
classifying principles that appear favourable for addressing health messages. However, the
primary school based oral health intervention techniques have rarely focused on this theory.
A detailed analysis of health behaviour modification interventions for dental caries
prevention further suggested that behavioural alteration techniques were restricted to
information on significances, information-behaviour associations, and education and
demonstration of actions. However, none of the implemented interventions were grounded on
behaviour change theory (Adair, Burnside and Pine 2013).
Another recent review by Albino and Tiwari (2016) on behavioural techniques to
avert childhood caries elaborated on the complex interplay of microbial, genetic,
biochemical, physical, environmental, behavioural and social factors, in relation to dental
caries etiology. Motivational interviewing was considered as an effective strategy for
modifying the decision related to individual oral health. This form of intervention can be
allied with the behavioural child development theories that elaborated on the description of
human behaviour in terms of a range of environmental influences. The intervention can be
further associated with classical conditioning owing to the fact that behaviour are often learnt
in childhood by means of repetitive connotation between a stimulus and response. Batliner et
al. (2018) also conducted a randomised clinical trial with the aim of determining the
effectiveness of motivational interviewing for early caries prevention. They suggested that
while this behavioural intervention was responsible for greatly enhancing maternal
knowledge on oral health and hygiene, it had little or no effect on the oral health behaviour

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PRIMARY SCHOOL-BASED INTERVENTION FOR PREVENTING CARIES
manifested by the children, who formed the target population. This also led to the
establishment of the role of social factors in determining the oral health among children.
Upon evaluating the relationship between parental attitude on dental care of their
children with socioeconomic status and parental education, it was found that parents with
greater educational attainment obtained satisfactory income cared on instructions related to
oral hygiene and preventive dental check-ups (36.7% and 40.8% ; P < 0.01 and P < 0.001).
Hence, the behavioural intervention should take into account the educational attainment of
parents, their knowledge, and socioeconomic status, prior to its implementation (Saldūnaitė
et al. 2014). This can be directly correlated with Bandura’s social learning theory that is
based on the fact that behaviours are usually learned by children through reflection and
modelling. Witnessing the activities of others, counting on peers and parents, help children
advance new abilities and attain novel information.
This was in accordance with the fact that a plethora of life course factors such as,
biological, sociodemographic, oral and psychological health behaviour, in addition to dental
status of the mothers were found associated with the onset and development of dental caries
among kids (Abreu et al. 2015). Hence, increasing the knowledge on oral health among
parents will prove more effective in making children adhere to activities that prevents dental
caries. Blake et al. (2015) suggested the effectiveness of classroom-based interactive
educational sessions, delivered by dental professionals in improving the oral health among
primary school children. The findings indicated the short-term improvements that the
program brought about in children’s oral health knowledge, thus confirming its
implementation in primary school settings.