Benefit of counselling and whatsApp messaging for the improvement in oral hygiene of pregnant women
- Conditions
- pregnant women of age 18 years and more with gestational age of 8 weeks to 30 weeks
- Registration Number
- CTRI/2021/09/036407
- Lead Sponsor
- Amitha Basheer N
- Brief Summary
**STATEMENT OF THE PROBLEM**
Oral healtheducation during antenatal visits can improve knowledge and practices for oralhealth and infant dental care significantly in all categories of the populationirrespective of educational level, occupation, and socioeconomic class. Thereis a need to create awareness among new mothers about correct oral hygienemethods and feeding practices for the children as early as possible so that thedental 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 toimprove oral health knowledge and behaviours among pregnant women using Motivational Interviewing and crossplatform messaging application (WhatsApp messenger).
**NEED FOR THE STUDY**
The present study is designed to assess oral health status, oral hygienepractices, and self‑perception about oral health among pregnant women and toevaluate the effectiveness of Motivational interviewing and WhatsApp® ,anubiquitous instant messaging application for oral health education on the oralhealth knowledge and behaviours of pregnant women attending ante natalcare. These approach to health behavior modification, already successfullyapplied in other fields of medicine, might be a good alternative toconventional oral health promotion. The results of the present study canbe used for oral health training during pregnancy in promoting the beliefs andbehaviours of pregnant women on oral health and to give more attention to oraland dental education programs is recommended during pregnancy.
**AIM AND OBJECTIVES OF THE STUDY**
**Aim:**
To assess effectiveness of Motivational Interviewing and crossplatform messaging application (WhatsApp messenger) for oral health educationon the oral health knowledge, attitude and behaviours among pregnant womenattending ante natal care, Mangaluru.
**Objectives:**
1. Toassess the knowledge, attitude and behaviour of oral health care among pregnantwomen attending ante natal care, Mangaluru.
2. Toassess and compare the effectiveness of Motivational Interviewing and crossplatform messaging application (WhatsApp messenger) for oral health educationon the oral health knowledge, attitude and behaviours among pregnant womenattending ante natal care, Mangaluru.
**STUDY DESIGN**
Randomized Controlled Trial
**MATERIALS AND METHODS**
**Materials**
Disposable gloves, mouth mask, mouth mirror, explorer, periodontalprobe, tweezers, cotton rolls.
**Methodology**
The proposed study will be conducted among 84 pregnant women of age 18years and more with gestational age of 8 weeks to 30 weeks who are visiting OPDof Department of Obstetrics and Gynaecology, Yenepoya Medical College andHospital, Mangaluru.
**Baseline examination:**Principalinvestigator will interview participants to assess their knowledge, attitude,and behaviour of oral health care among pregnant women. Questions for theinterview 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 interviewand oral examination and eligible participants will be randomly allocated toone of the 2 group using lottery method.All participants in group I (n=42) willreceive WhatsApp messages on oral health care of pregnant women and childrenafter the interview. Participants in group-II (n=42)will receive a 20-minute talk based on a Motivational Interviewing approach, delivered by dentisttrained in MI( Principal Investigator)
**Follow up visit** (after one month of intervention)
Principal investigator will interview the participants to assess theirknowledge, attitude, and behaviour of oralhealth care using the same questions used for baseline examination. Questions for the interview isadapted 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 willbe assessed using The Loeand Silness Gingival Index,1963.Evaluation of effectiveness of MI and crossplatform messaging application (WhatsApp messenger) will be assessed.
**The proposed study will be a Randomised Controlled Trial with thefollowing procedural steps**
Obtaining approval for the study protocol from Scientific Review Board,Yenepoya deemed to be University, Mangaluru.
Registeringin Clinical Trial Registry of India.
Obtaining approval for the study protocol from Yenepoya Ethics Committee2, Yenepoya deemed to be University, Mangalore.
Obtaining official permission to conduct the study from Department ofObstetrics and Gynaecology, Yenepoya Medical College and Hospital, Mangaluru.
Obtaining informed consent from the participants.
Principal investigator will interview participants to assess theirknowledge, attitude, and behaviour of oral health care among pregnant women
Questions for interview is adapted from the study conductedby Bansal K et al (2019)5
**II. Procedurefor intervention**
The oral examinationwill 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 andmore with gestational age of 8 weeks to 30 weeks to 2 groups
Group 1 (n=42): Cross platform messaging application (WhatsAppmessenger)
Group 2 (n=42): Motivational Interviewing for oral health education byprincipal investigator
After baseline examination, eligible participants will be randomlyallocated to one of the 2 groups using lottery method.
Oral hygiene status will beassessed using OHI-S index by John C. Greene and Jack R. Vermillion,1964
**Scoringcriteria for Debris index**
| | |
| --- | --- |
|Score 0
No debris or stain present
|Score 1
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
|Score 2
Soft debris covering more than one third, but not more than two thirds, of the exposed tooth surface.
|Score 3
Soft debris covering more than two thirds of the exposed tooth surface
**Scoringcriteria for calculus index**
| | |
| --- | --- |
|Score 0
No calculus present
|Score 1
Supragingival calculus covering not more than one third of the exposed tooth surface
|Score 2
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.
|Score 3
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
· Gingivalinflammation will be assessed using The Loeand Silness Gingival Index.,1963
The Loeand Silness gingival index (GI) is used to assess gingival inflammation. Themesial, buccal, distal, and lingual/palatal sites of each tooth present werescored for GI as follows:
| | |
| --- | --- |
|Score 0
Normal gingiva
|Score 1
Slight change in color or slight inflammation without bleeding on probing indicating mild inflammation
|Score 2
Signs of redness and edematous gingiva with bleeding on probing showing moderate inflammation
|Score 3
Remarkable redness and edema with susceptibility to spontaneous bleeding demonstrating severe inflammation
Face to face interview will be done to assessthe knowledge, attitude and behaviour of oral health care among theparticipants.
Questions for the interview is adapted from the study conducted byBansal K et al (2019)5
Questions will be translated to Kannada and Malayalam language.
One group will receive health education throughmotivational interviewing and second group will receive oral health educationthrough cross platform messaging application (WhatsApp messenger)
Follow up will be doneafter one month
**Group –I**
— All participants in group Iwill receive WhatsApp messages on oral health care of pregnant women andchildren.
— These messages will include
Importance of oral healthduring pregnancy
Hormonal changes duringpregnancy
Oral health’s effect ongeneral health
Importance of primary teethand its maintenance.
Diet of the mother duringpregnancy
Feeding practices
Dietary advices forpregnant women and children and
Brushing techniques.
**Group-II**
Participants in group-II will receive a 20- minute talk based on aMotivational Interviewing approach, delivered by dentist trained in MI(Principal Investigator)
The MI will include four aspects
**Partnership**: working together withequal input from patient and Principal investigator, respecting patientautonomy.
**Acceptance**: understanding thepatient’s perspective and not being judgmental; ensuring that we focus on theirpositive health behaviors and support them with their self-efficacy to changeunhealthy behaviors.
**Compassion**:supporting patients who may be struggling with behavior change, showing realcompassion and empathy towards them.
**Evocation**: is anattempt to explore what is important to the patient and how they would like tomake a change.
There will be two phasesfor Motivational Interviewing
**First Phase**- there is anattempt to establish rapport and trust and to help identify the problem ofconcern.MI provider will establish rapport by talking about their oral healthand child’s oral health and their goals for their own and their child’s oralhealth using open-ended questions and affirming positive efforts.Questions willbe themed around the following topics: Eliciting commitment to change,identifying potential problems, enhancing commitment to change, and recognizingresistance to change.
**Second phase**- It involves moving fromthe contemplative to the action stage.The person is asked to weigh the pros andcons of changing.There will be discussion of the potential obstacles to actionfor each action option.Working with the person focuses mainly on identifying aplan to act. Several skills and methods used to communicate effectively with patients
To communicate withparticipants OARS( Open-ended questions , Affirmations Reflectivelistening, Summarizing) method will be used.14
**Open-ended questions:** Using open-ended questions which facilitate a dialogue between theclinician and patient so that the patient is encouraged to speak and theclinician listens.
**Affirmations:** Acknowledge that behavior change is difficult and promote patientself-efficacy by affirming their strengths.
**Reflective listening**: -Listening and understanding what the patient has expressed. This canenhance the relationship between the clinician and the patient, encouragingthem to continue exploring change in behaviors and supporting motivation.
**Summarizing:** Demonstrates that the clinician has listened to the patient andprovides a concise overview of what has been discussed. This may also supportdealing with ambivalence.
Onthe follow up visit after one month of intervention, Principalinvestigator will interview the participants again to assess their knowledge,attitude, and behaviour of oral health care using the same questions used forbaseline examination.
Oral hygiene status will beassessed using OHI-S index by John C.Greene and Jack R. Vermillion, 1964
Gingival inflammation will be assessed using The Loeand Silness Gingival Index.,1963
Evaluation of effectiveness of MI and cross platform messagingapplication (WhatsApp messenger) will be assessed.
**Source ofdata/ sampling method:**
**Study setting**
The study will be conductedin Department of Obstetrics and Gynaecology, Yenepoya Medical College andHospital, Mangaluru.
Sampling method: Simplerandom sampling
After oral examination eligible participants will be randomly allocatedto any of the two groups using lottery method.
The study sample comprise of pregnant women of gestationalage of 8 weeks to 30 weeks
The total sample comprises of 2 groups
Group I: Cross platformmessaging application (WhatsApp messenger)
GroupII: Motivational Interviewing for oral health education
**Sampling method****:**Simple randomsampling
**Sample size (including sample size calculation)**
Sample size iscalculated by using G\* power software for independent sample t test.
At 5% level ofsignificance and 80% power with effect size of 0.575 from pooled standarddeviation 5.2 from related article by Bahri N et al 2 thetotal sample size in each group is 38
Total sample size n=76
At 10% non response errorrate, total sample size is 84, that is 42 samples in each group.
**Inclusion criteria:**
Those who consented toparticipate in the study
With confirmed pregnancy and aged 18 years and older( gestational agebetween 8 and 30 weeks)
Participant who possess a Smartphone at the time of allotment andfamiliar with the usage of Whatsapp.
Minimal educationqualification of schooling of 7th standard.
**Exclusion criteria**
History of smokingand alcohol consumption
Lack of access toparticipate in the second stage (follow up) of the study
Diseases that couldprevent dental examination( eg: COVID-19)
**Statistical analysis**
For continuous variable- will bepresented by Mean and Standard deviation.
For categorical variable- will be presented by frequency andpercentage.
Independent sample t -test will be used forcomparison of two groups. Data analysis will be done using SPSS24.0 (Statistical Package for Social Sciences).
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Not Yet Recruiting
- Sex
- Female
- Target Recruitment
- 84
- 1.Those who consented to participate in the study 2.
- With confirmed pregnancy and aged 18 years and older( gestational age between 8 and 30 weeks) 3.Participant who possess a Smartphone at the time of allotment and familiar with the usage of Whatsapp.
- 4.Minimal education qualification of schooling of 7th standard.
- History of smoking and alcohol consumption 2.
- Lack of access to participate in the second stage (follow up) of the study 3.
- Diseases that could prevent dental examination( eg: COVID-19).
Study & Design
- Study Type
- Interventional
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Oral hygiene status One month
- Secondary Outcome Measures
Name Time Method knowledge, attitude and behaviour of oral health care among pregnant women one month
Trial Locations
- Locations (1)
Yenepoya Medical College
🇮🇳Kannada, KARNATAKA, India
Yenepoya Medical College🇮🇳Kannada, KARNATAKA, IndiaPraveen JodalliPrincipal investigator09886244093praveenjodalli@gmail.com