STATEMENT OF THE PROBLEM Oral health
education during antenatal visits can improve knowledge and practices for oral
health and infant dental care significantly in all categories of the population
irrespective of educational level, occupation, and socioeconomic class. There
is a need to create awareness among new mothers about correct oral hygiene
methods and feeding practices for the children as early as possible so that the
dental health of children is not jeopardized .To the best of our knowledge,
there are no previous studies conducted to assess the effectiveness of educational intervention to
improve oral health knowledge and behaviours among pregnant women using Motivational Interviewing and cross
platform messaging application (WhatsApp messenger). NEED FOR THE STUDY The present study is designed to assess oral health status, oral hygiene
practices, and self‑perception about oral health among pregnant women and to
evaluate the effectiveness of Motivational interviewing and WhatsApp® ,an
ubiquitous instant messaging application for oral health education on the oral
health knowledge and behaviours of pregnant women attending ante natal
care. These approach to health behavior modification, already successfully
applied in other fields of medicine, might be a good alternative to
conventional oral health promotion. The results of the present study can
be used for oral health training during pregnancy in promoting the beliefs and
behaviours of pregnant women on oral health and to give more attention to oral
and dental education programs is recommended during pregnancy. AIM AND OBJECTIVES OF THE STUDY Aim: To assess effectiveness of Motivational Interviewing and cross
platform messaging application (WhatsApp messenger) for oral health education
on the oral health knowledge, attitude and behaviours among pregnant women
attending ante natal care, Mangaluru. Objectives: 1. To
assess the knowledge, attitude and behaviour of oral health care among pregnant
women attending ante natal care, Mangaluru. 2. To
assess and compare the effectiveness of Motivational Interviewing and cross
platform messaging application (WhatsApp messenger) for oral health education
on the oral health knowledge, attitude and behaviours among pregnant women
attending ante natal care, Mangaluru. STUDY DESIGN Randomized Controlled Trial MATERIALS AND METHODS Materials Disposable gloves, mouth mask, mouth mirror, explorer, periodontal
probe, tweezers, cotton rolls. Methodology The proposed study will be conducted among 84 pregnant women of age 18
years and more with gestational age of 8 weeks to 30 weeks who are visiting OPD
of Department of Obstetrics and Gynaecology, Yenepoya Medical College and
Hospital, Mangaluru. Baseline examination: Principal
investigator will interview participants to assess their knowledge, attitude,
and behaviour of oral health care among pregnant women. Questions for the
interview is adapted from the study conducted by Bansal K et al
(2019)5 Oral hygiene status will be assessed using OHI-S index by John C. Greene and Jack R. Vermillion, 1964.
Gingival inflammation will be assessed using The Loe and Silness Gingival Index,After interview
and oral examination and eligible participants will be randomly allocated to
one of the 2 group using lottery method.All participants in group I (n=42) will
receive WhatsApp messages on oral health care of pregnant women and children
after the interview. Participants in group-II (n=42)will receive a 20-
minute talk based on a Motivational Interviewing approach, delivered by dentist
trained in MI( Principal Investigator) Follow up visit (after one month of intervention) Principal investigator will interview the participants to assess their
knowledge, attitude, and behaviour of oral
health care using the same questions used for baseline examination. Questions for the interview is
adapted from the study conducted by Bansal K et al (2019)5.Oral hygiene status will be assessed using OHI-S index by John C. Greene and Jack R. Vermillion, 1964.Gingival inflammation will
be assessed using The Loe
and Silness Gingival Index,1963.Evaluation of effectiveness of MI and cross
platform messaging application (WhatsApp messenger) will be assessed. The proposed study will be a Randomised Controlled Trial with the
following procedural steps Obtaining approval for the study protocol from Scientific Review Board,
Yenepoya deemed to be University, Mangaluru. Registering
in Clinical Trial Registry of India. Obtaining approval for the study protocol from Yenepoya Ethics Committee
2, Yenepoya deemed to be University, Mangalore. Obtaining official permission to conduct the study from Department of
Obstetrics and Gynaecology, Yenepoya Medical College and Hospital, Mangaluru. Obtaining informed consent from the participants. Principal investigator will interview participants to assess their
knowledge, attitude, and behaviour of oral health care among pregnant women Questions for interview is adapted from the study conducted
by Bansal K et al (2019)5 II. Procedure
for intervention The oral examination
will be done by a single examiner with the help of an assistant The study sample will comprise of 84 pregnant women of age 18 years and
more with gestational age of 8 weeks to 30 weeks to 2 groups Group 1 (n=42): Cross platform messaging application (WhatsApp
messenger) Group 2 (n=42): Motivational Interviewing for oral health education by
principal investigator After baseline examination, eligible participants will be randomly
allocated to one of the 2 groups using lottery method. Oral hygiene status will be
assessed using OHI-S index by John C. Greene and Jack R. Vermillion,
1964 Scoring
criteria for Debris index
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Score 0
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No debris or stain
present
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Score 1
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Soft debris
covering not more than one third of the tooth surface, or presence of
extrinsic stains without other debris regardless of surface area covered
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Score 2
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Soft debris
covering more than one third, but not more than two thirds, of the exposed
tooth surface.
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Score 3
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Soft debris
covering more than two thirds of the exposed tooth surface
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Scoring
criteria for calculus index
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Score 0
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No calculus
present
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Score 1
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Supragingival
calculus covering not more than one third of the exposed tooth surface
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Score 2
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Supragingival
calculus covering more than one third but not more than two thirds of the
exposed tooth surface or the presence of individual flecks of subgingival
calculus around the cervical portion of the tooth or both.
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Score 3
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Supragingival
calculus covering more than two third of the exposed tooth surface or a
continuous heavy band of subgingival calculus around the cervical portion of
the tooth or both
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· Gingival
inflammation will be assessed using The Loe
and Silness Gingival Index.,1963 The Loe
and Silness gingival index (GI) is used to assess gingival inflammation. The
mesial, buccal, distal, and lingual/palatal sites of each tooth present were
scored for GI as follows:
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Score 0
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Normal gingiva
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Score 1
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Slight change in
color or slight inflammation without bleeding on probing indicating mild
inflammation
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Score 2
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Signs of redness
and edematous gingiva with bleeding on probing showing moderate inflammation
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Score 3
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Remarkable redness
and edema with susceptibility to spontaneous bleeding demonstrating severe
inflammation
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Face to face interview will be done to assess
the knowledge, attitude and behaviour of oral health care among the
participants. Questions for the interview is adapted from the study conducted by
Bansal K et al (2019)5 Questions will be translated to Kannada and Malayalam language. One group will receive health education through
motivational interviewing and second group will receive oral health education
through cross platform messaging application (WhatsApp messenger) Follow up will be done
after one month Group –I — All participants in group I
will receive WhatsApp messages on oral health care of pregnant women and
children. — These messages will include Importance of oral health
during pregnancy Hormonal changes during
pregnancy Oral health’s effect on
general health Importance of primary teeth
and its maintenance. Diet of the mother during
pregnancy Feeding practices Dietary advices for
pregnant women and children and Brushing techniques. Group-II Participants in group-II will receive a 20- minute talk based on a
Motivational Interviewing approach, delivered by dentist trained in MI(
Principal Investigator) The MI will include four aspects Partnership: working together with
equal input from patient and Principal investigator, respecting patient
autonomy. Acceptance: understanding the
patient’s perspective and not being judgmental; ensuring that we focus on their
positive health behaviors and support them with their self-efficacy to change
unhealthy behaviors. Compassion:
supporting patients who may be struggling with behavior change, showing real
compassion and empathy towards them. Evocation: is an
attempt to explore what is important to the patient and how they would like to
make a change. There will be two phases
for Motivational Interviewing First Phase- there is an
attempt to establish rapport and trust and to help identify the problem of
concern.MI provider will establish rapport by talking about their oral health
and child’s oral health and their goals for their own and their child’s oral
health using open-ended questions and affirming positive efforts.Questions will
be themed around the following topics: Eliciting commitment to change,
identifying potential problems, enhancing commitment to change, and recognizing
resistance to change. Second phase- It involves moving from
the contemplative to the action stage.The person is asked to weigh the pros and
cons of changing.There will be discussion of the potential obstacles to action
for each action option.Working with the person focuses mainly on identifying a
plan to act. Several skills and methods used to communicate effectively with patients To communicate with
participants OARS( Open-ended questions , Affirmations Reflective
listening, Summarizing) method will be used.14 Open-ended questions: Using open-ended questions which facilitate a dialogue between the
clinician and patient so that the patient is encouraged to speak and the
clinician listens. Affirmations: Acknowledge that behavior change is difficult and promote patient
self-efficacy by affirming their strengths. Reflective listening: -Listening and understanding what the patient has expressed. This can
enhance the relationship between the clinician and the patient, encouraging
them to continue exploring change in behaviors and supporting motivation. Summarizing: Demonstrates that the clinician has listened to the patient and
provides a concise overview of what has been discussed. This may also support
dealing with ambivalence. On
the follow up visit after one month of intervention, Principal
investigator will interview the participants again to assess their knowledge,
attitude, and behaviour of oral health care using the same questions used for
baseline examination. Oral hygiene status will be
assessed using OHI-S index by John C.
Greene and Jack R. Vermillion, 1964 Gingival inflammation will be assessed using The Loe
and Silness Gingival Index.,1963 Evaluation of effectiveness of MI and cross platform messaging
application (WhatsApp messenger) will be assessed. Source of
data/ sampling method: Study setting The study will be conducted
in Department of Obstetrics and Gynaecology, Yenepoya Medical College and
Hospital, Mangaluru. Sampling method: Simple
random sampling After oral examination eligible participants will be randomly allocated
to any of the two groups using lottery method. The study sample comprise of pregnant women of gestational
age of 8 weeks to 30 weeks The total sample comprises of 2 groups Group I: Cross platform
messaging application (WhatsApp messenger) Group
II: Motivational Interviewing for oral health education Sampling method: Simple random
sampling Sample size (including sample size calculation) Sample size is
calculated by using G* power software for independent sample t test. At 5% level of
significance and 80% power with effect size of 0.575 from pooled standard
deviation 5.2 from related article by Bahri N et al 2 the
total sample size in each group is 38 Total sample size n=76 At 10% non response error
rate, total sample size is 84, that is 42 samples in each group. Inclusion criteria: Those who consented to
participate in the study With confirmed pregnancy and aged 18 years and older( gestational age
between 8 and 30 weeks) Participant who possess a Smartphone at the time of allotment and
familiar with the usage of Whatsapp. Minimal education
qualification of schooling of 7th standard. Exclusion criteria History of smoking
and alcohol consumption Lack of access to
participate in the second stage (follow up) of the study Diseases that could
prevent dental examination( eg: COVID-19) Statistical analysis For continuous variable- will be
presented by Mean and Standard deviation. For categorical variable- will be presented by frequency and
percentage. Independent sample t -test will be used for
comparison of two groups. Data analysis will be done using SPSS
24.0 (Statistical Package for Social Sciences).
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