COMPARISON OF PEER-LED, DENTIST-LED AND TEACHER-LED SCHOOL-BASED ORAL HEALTH PROMOTION STRATEGIES AMONG ADOLESCENTS IN IBADAN, NIGERIA

Abstract

School-based Oral Health Promotion (SbOHPm) programmes largely depend on dentists as resource persons. However, dentists are relatively few in Nigeria, making coverage for SbOHPm difficult. This has contributed to high unmet dental needs among adolescents. A need, therefore arises to explore the feasibility and effectiveness of SbOHPm activities led by non-dentists. The effectiveness of SbOHPm activities conducted by three cadres of Resource Persons (RPs) [peer, dentist and teacher] among adolescents in Ibadan were compared. Exploratory sequential mixed-method study design was adopted. A convenience sample of 120 adolescents and 52 teachers participated in the qualitative phase that consisted of 12 Focus Group Discussions (FGDs) for students and five for teachers. Information obtained from the FGDs was utilised in designing the Oral Health Promotion Intervention (OHPI). The quantitative phase was a cluster randomised controlled trial of 1800 Senior Secondary School-I students selected by multi-stage sampling from 36 schools in four out of five Local Government Areas (LGAs) in Ibadan Metropolis. The LGAs were randomised into three Intervention Groups (IGs) varied according to RPs delivering SbOHPm activities (peer-led,dentist-led and teacher-led); and a control group. The RPs were trained and they conducted the OHPI bi-monthly for one school-year. A structured pretested validated questionnaire was used to evaluate Oral Health Knowledge (OHK), Attitude (OHA), Practices (OHP) and Oral Health-Related Quality of Life (OHRQoL) while Oral Health Status (OHS) was evaluated using standardised tools before and six months after OHPI. Qualitative data were analysed using thematic approach while quantitative data were analysed with Chi-square, Wilcoxon signed-rank test and generalised estimating equation at α0.05. At baseline, the adolescents displayed different points of view, unfavourable attitude and misconceptions about oral health. The percentage improvements, post-intervention in OHK were 69.3%, 87.1%, 56.0% and 6.9% for peer-led, dentist-led, teacher-led and control groups, respectively. For OHA, improvement according to groups, were 127.4%, 135.1%, 131.5% and 11.5%, respectively and for OHP; 27.3%, 36.2%, 22.4% and 7.3%, respectively. Measures of improvement in OHS according to groups were: gingival health; 62.1%, 68.2%, 46.9% and 10.0%, periodontal treatment needs; 44.7%, 87.2%, 82.9% and 3.7%, decayed teeth; 4.4%, 5.0%, 3.2% and 0.7% and oral hygiene; 34.7%, 83.9%, 42.4% and 2.8% in the peer-led, dentist-led, teacher-led and control groups, respectively. Students in peer-led, dentist-led and teacher-led groups, had better OHK (OR=1.60, 95%CI=1.50–1.70, OR=1.86, 95%CI=1.74–1.99, OR=1.57, 95%CI=1.47–1.68), better OHA (OR=1.86, 95%CI=1.69–2.05, OR=2.02, 95%CI=1.83–2.22, OR=2.03, 95%CI=1.85–2.23) and better OHP (OR=1.22, 95%CI=1.17–1.27, OR=1.31, 95%CI=1.26–1.37, OR=1.18, 95%CI=1.13–1.23) compared to the control group. The OHRQoL also improved in IGs compared to control group: peer-led (OR=1.80, 95%CI=1.13–2.84), dentist-led (OR=1.81, 95%CI=1.14–2.86), teacher-led (OR=1.57, 95%CI=0.98–2.51). Perspective of oral health by adolescents changed positively following the intervention. The dentist-led oral health promotion strategy was the most effective at improving oral health knowledge, attitude, practices, oral health status and oral health-related quality of life of in-school adolescents. Peer-led and teacher-led interventions were comparable and could effectively support or replace dentist-led method in school-based oral health promotion to reduce burden of unmet dental needs.