Evaluation of a Long Standing School-based Oral Health Program: A Sequential-explanatory Mixed-method Approach

  • Author / Creator
    Alsumait, Aishah
  • Background: In 1983, the Kuwait Ministry of Health established the School-based Oral Health Program (SOHP) in the Capital region and, in 1995, extended it to all Kuwaiti regions. The program provides education activities, prevention procedures, and treatment care. The service is delivered through a system of center- and school-based clinics and preventive mobile teams that deliver preventive services to children in schools without permanent dental clinics. Objectives: The overall goals of this evaluation study are to evaluate the impact of the prevention program through measuring children’s oral health and Oral Health-Related Quality of Life (OHRQoL) as well as mothers’ oral health awareness and OHRQoL (Phase 1), and to explore the impact of the contextual factors on program performance and maintenance (Phase 2). Method: A mixed-method was employed based on sequential explanatory design to evaluate the prevention component of SOHP in the Kuwait Capital region. A framework developed based on the Ecological Health Model and RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) guided this evaluation research. Five sources of data were collected via questionnaires and oral examinations, interviews, archival records, and field notes. The study consisted of two phases. In Phase 1, we conducted a cross-sectional quantitative project to explore children’s oral health status and OHRQoL, as well as mothers’ oral health Knowledge, Attitude, and Practice (KAP) and OHRQoL. In Phase 2, we conducted a qualitative project using a focused ethnography approach. An interview guide inspired by the RE-AIM model directed the interviews and focus groups. The quantitative and qualitative data were then compared and contrasted to enhance the validity of our results. Results: The quantitative results revealed that of 440 children-mother pairs in the 11-to-12 year age group participating in the current study (of which 49.3% were male), there was an almost equal distribution of participants classified into two groups: SOHP and non-SOHP. The results showed that mean decay level (SD) DT/dt was 1.41 (1.66) and 2.61 (2.63) for SOHP-enrolled and non-SOHP, respectively (p<0.05). SOHP children also had a higher number of sealed and restored teeth. No significant differences were found in Child Perception Questionnaire (11-14) scores or subscale scores between the two groups. SOHP mothers had significantly better OHRQoL compared to non-SOHP mothers (p<0.05), with significant differences in their OH knowledge but not in attitude and practices (p=0.019, 0.077, 0.12, respectively). The qualitative data included 30 service providers, key informants, and decision-makers in four focus groups and four in-depth interviews. The interview data analysis showed two and three main categories of influencers affecting implementation and maintenance, respectively. For implementation dimension, from the participants’ viewpoints, the two categories that hindered the successful implementation of the program in school settings were: 1) elements related to program structure and strategies, and 2) factors related to school settings and oral health behaviors of schoolchildren and stakeholders. It was discovered that the program went through major modifications in order to be maintained over the last three decades. Multiple factors were related to three chronological phases, including leadership, evidence-based dentistry and decision-making, development change, and proactive sustainability plan. Meanwhile, vision and sustainable funding were found to be the key elements for long-standing maintenance. Conclusion: For Kuwaiti schoolchildren, preventive treatment had a positive impact on their emotional well-being, restorative treatments improved their oral function, and an increase in the number of carious teeth was associated with a limitation in oral functions. Mothers’ oral hygiene practices were associated with their children’s dental disease level and oral hygiene as well as their children’s OHRQoL. Schoolchildren who were enrolled in the SOHP had lower dental caries and a higher number of sealed teeth, but no correlation was found between enrollment in SOHP and OHRQoL. Additionally, implementation barriers relating to organization capacity and unsupportive settings because of poor intersectoral relationships affected the fidelity of service delivery and the sustainability of some program components, but not the maintenance of the program. Therefore, revisiting the program’s statement of mission, assessing program theory, and embracing community-based participatory principles may enhance the program’s outcomes. The outcomes of this study provide insights for decision- and policy-makers to consider in action towards improved capacity for school-based oral health interventions.

  • Subjects / Keywords
  • Graduation date
    Fall 2016
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
  • Institution
    University of Alberta
  • Degree level
  • Department
  • Supervisor / co-supervisor and their department(s)
  • Examining committee members and their departments
    • Dr. Maryam Amin (Dental medicine, University of Alberta)
    • Dr. Paul E Petersen (School of dentistry, Malmö University)
    • Dr. Louanne Keenan ( Family Medicine Medicine & Dentistry, University of Alberta)
    • Dr. Ken Cor (Pharmacy and Pharmaceutical Sciences, University of Alberta)
    • Dr. Kim Raine (School of Public Health, University of Alberta)
    • Dr. Rebecca Gokiert (Faculty of Extenstion, University of Alberta)