The effect of two types of intervention (based on the principles of social marketing and traditional education) on increase in self-reported frequency and duration of tooth brushing of elementary school students: A controlled quasi-experimental study

The aim of this study was to evaluate the effect of social marketing approach versus the traditional method on promotion of tooth brushing habits in primary school students of Kahak and Jafariyeh, Qom

This quasi-experimental controlled trial had a parallel design. The study was conducted in the cities of Kahak and Jafariyeh, Qom, Iran. Considering the relatively small number of students in the two cities, sampling was not done and the whole target population entered the census. 1318 students participated in the study and enrolled in February 2017 and followed one and half months.

Intervention Group (Kahak) In this city, intervention was done according to the social marketing approach. The SMART model was used to organize different phases of social marketing in the following order [6, 13]: Phase 1: Preliminary planning The main problem, to overcome which this study was designed, was lack of interest in tooth brushing with the proper length and frequency. Therefore, the main objective of the study was to improve tooth-brushing habits as at least two times a day for at least two minutes each time. The main method that was used for project assessment was a self-report checklist before and after the intervention and comparison of the checklists. Phase 2: Audience analysis Only the primary school students of the two cities were identified as the target population. To analyze the target population’s beliefs and prioritization of the reasons for irregular or no tooth brushing from the perspective of themselves or their parents, a checklist was provided to all students and its results (Table 1) were used in designing the intervention tools. Phase 3: Channel analysis Since most of the students’ time was spent at home or school, communication channels that were appropriate for these environments like face-to-face training sessions, printed material for use in the school, training through parents, and the effect of parents on their children were considered. Phase 4: Market analysis In this study, one of the supporting factors was the performance of some teachers that considered a day of the week as the “tooth brush day”. On this day, the teachers asked the students to bring their toothbrushes and brush their teeth under the teacher’s supervision. One of the identified competitors was the parents’ low level of oral health knowledge in Iran [14]. Another competitor was the common belief among the students that brushing the teeth once a day is enough [15]. The second part of market analysis was implementation of market mix principles or 4P as the following: 1. Product: The main product was prevention of tooth decay and the real product was tooth brushing two times a day for two minutes each time. 2. Price: The time spent in the class (about 30 minutes), time spent on brushing the teeth and commitment to completing the tooth brushing calendar were among the expenses that the participants met. 3. Place: The place that was considered for the intervention was the students’ schools and houses because they were easily accessible. 4. Promotion: All the tools that were designed to persuade students to brush their teeth are placed in this group. These tools were planned based on the results of the first checklist. Phase 5: Development In this study, a sample of the tools was provided to school managers and health authorities to collect their comments. The intervention tools were approved in all schools and no comments were received. Phase 6: Implementation In this phase, the project was implemented as designed in the previous phases, and interventions were applied in the schools. At the beginning of this phase, a checklist containing questions on tooth-brushing habits was completed by the students to record their status before the intervention. This checklist was completed by the parents of students in grades 1 to 3 and by the students in grades 4-6. After the checklists were collected, the intervention was continued for one and a half months. Phase 7: Evaluation In this study, considering the students’ presence at school, it was possible to convey messages to the target population. On the other hand, due to the availability of teachers, they were requested to cooperate in the assessment of the project and review the main concepts of the project with the students and check the tooth-brushing calendar at least once a week. At the end of this phase, the students completed the tooth-brushing habits checklist for the second time to evaluate the changes following the intervention. Control Group (Jafariyeh) The students in Jafariyeh completed the tooth-brushing habits checklist before the intervention (similar to students in Kahak). After collecting the checklists, since this city was considered as the control group, a traditional intervention, i.e. pamphlet that was exactly similar to the pamphlet distributed in Kahak, was applied. Then, the changes were assessed through completing the checklist for a second time.

Entry requirements: All primary school students (grade 1 to 6) of Kahak and Jafariyeh in the 2016-2017 academic year Non-entry requirements: Non-cooperation of the students and their parents’ unwillingness

Intervention group: All primary school students of Kahak city in the 2016-2017 academic year Control group: All primary school students of Jafariyeh city in the 2016-2017 academic year

Duration of tooth brushing Frequency of tooth brushing

Funding of Tehran University of Medical Sciences for thesis and research projects

The total potential data can be shared after unidentifying people

The start of access to data is 3 months after publishing the results

Study data will be available to all individuals, including academic and industry researchers

Access to data will be available for oral health promotion programs and any statistical analysis will be allowed.

1. Dr Mahdia Gholami, Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Call Phone: +982188015960 Email: m_gholami@sina.tums.ac.ir 2. Dr. Ahmadreza Shamshiri- Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran Call Phone: +982188015960 Email: ar_shamshiri@yahoo.com

The requester must send the application to the persons mentioned in previous section to receive the study data. It is expected to receive information within a week.