Evaluation of Oral Health Education Programs for Visually Impaired Children: Knowledge, Attitudes, and Practices in Kerala

Abstract

Background: Visually impaired children have unique challenges to getting and maintaining oral health: not having access to traditional visual learning resources, relying on others to care for them and not being able to see the plaque on their teeth. The use of non-visual sensory methods for oral health education has been suggested as an effective intervention but there is little evidence in the South Indian context.

Objective: The Multisensory Oral Health Education (OHE) program's effectiveness in improving knowledge, attitudes, and practices (KAP) among visually impaired children attending special schools in Kerala was assessed.

Methods: The 150 children aged 8-16 from six residential schools for the blind were selected for the quasi-experimental, single group pre test–post test study. A KAP questionnaire was validated and administered at baseline, immediately following the four-session multisensory intervention (tactile dentition models, braille leaflets, audio modules and modified Audio-Tactile Performance technique) and at three months. Paired t tests, the McNemar test and analysis of variance were used to analyze the data, and the significance level was set at p < .05.

Results: All assessments were completed with 142 children (94.7%) of the 150 enrolled. At the end of the intervention, mean knowledge scores increased from 6.8 (±2.1) at baseline to 12.1 (±1.8) immediately after the intervention (p < .001) and remained at 11.3 (±1.9) at 3 months. There were similar, statistically significant improvements in attitude and practice scores. The percentage of children who brush twice a day increased from 28% to 61%, and fluoride toothpaste use increased from 41% to 79%. Children with low vision had scores which were slightly higher than those of the children with total blindness, but both groups significantly improved scores.

Conclusion: The structured multisensory OHE programme achieved considerable and mostly sustained gains in the oral health KAP of visually impaired children in Kerala. The learning methods of tactility and hearing should be introduced in the routine health program of special schools, and be reinforced on a regular basis.