Is the Intention Being Realized in Execution: Evaluation of Oral Health Promotion Program at a South Indian University

Viswa C Chandu; Srinivas Pachava; Viswanath Vadapalli; Suresh Sanikommu

doi:10.4103/jofs.jofs_140_18

ORIGINAL ARTICLE

Year : 2018 | Volume : 10 | Issue : 2 | Page : 121-126

Is the Intention Being Realized in Execution: Evaluation of Oral Health Promotion Program at a South Indian University

Viswa C Chandu¹, Srinivas Pachava¹, Viswanath Vadapalli¹, Suresh Sanikommu²
¹ Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
² Public Health Dentistry, King Faisal University, Al-Ahsa, Saudi Arabia

Date of Web Publication

2-Jan-2019

Correspondence Address:
Dr. Viswa C Chandu
Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, III Floor, Guntur, Andhra Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jofs.jofs_140_18

Abstract

Introduction: There are accessibility problems for rural Indian population with respect to oral health care. Dental Council of India envisioned that establishment of satellite clinics would be a beneficial strategy for rural population to have better access to oral health care, curtailing the accessibility problems and financial barriers for oral health care utilization to some extent. Aim and Objective: The aim of this study was to procure data on the functioning of these satellite clinics and evaluate an oral health promotion program in a satellite clinic located in a South Indian university. Materials and Methods: A total of 301 participants were selected through two-stage random sampling to evaluate the functioning of a dental satellite clinic located in a South Indian university. The data collected include demographics, utilization of services at the satellite clinics, and self-reported oral and general health status. Results: The utilization of services was only 9.3%, and a majority of the participants were not aware of the existence of the clinic. Promotion of available services and provision of oral health education were the major suggestions received from the study participants. Conclusion: Evaluation of satellite clinics both from the students’ perspective and with regard to oral health status of concerned populations must be seriously undertaken.

Keywords: Evaluation, oral health promotion, perceived unmet dental needs

How to cite this article:
Chandu VC, Pachava S, Vadapalli V, Sanikommu S. Is the Intention Being Realized in Execution: Evaluation of Oral Health Promotion Program at a South Indian University. J Orofac Sci 2018;10:121-6

How to cite this URL:
Chandu VC, Pachava S, Vadapalli V, Sanikommu S. Is the Intention Being Realized in Execution: Evaluation of Oral Health Promotion Program at a South Indian University. J Orofac Sci [serial online] 2018 [cited 2023 Apr 1];10:121-6. Available from: https://www.jofs.in/text.asp?2018/10/2/121/249088

Introduction

It is beyond doubt that there has been improvement in the people’s awareness of oral health and utilization of oral health care services over the past few years. However, oral health disparities continue to exist with poor oral health being a routine observation among the marginalized sections and those who are geographically disadvantaged.^[1],[2],[3] Literature suggests that rural areas are dentally underserved as the existent public health system in India does not integrate dental surgeons as much as it needs to^[4],[5],[6]; there is urban preference among dental graduates in the establishment of clinical practices.^[7],[8],[9] In light of these findings, it is important that prospective strategies for promotion of oral health in rural areas and for the marginalized sections of people be seriously considered both by the public administrators and the dental fraternity.^[10] Teaching dental institutions play a significant role in the promotion of oral health by reaching out to people through community outreach programs. The Dental Council of India made it imperative for all the teaching dental institutions in India to establish satellite clinics in rural areas, which benefit the people residing in these areas.^[11] These clinics address the accessibility issues to a great extent and also offer services at nominal costs. Satellite clinics possess an invaluable potential to implement common risk factor approach, which serves to integrate oral health with the general health of people.

Community outreach programs differ from individual care in that they primarily focus on population, including those persons who do not and cannot access care. Evaluation of such initiatives is an intricate and complex task that has been customarily neglected and often underfunded.^[12] Evaluation of outreach programs is important as a source of development of good practice, as a guide for making best use of the available resources, and to inform policy development.^[13] Thus, evaluation is beneficial not only in curtailing the execution-related issues but also in mitigating the problems pertaining to the formulation of the future programs. In this context, the aim of this study is to evaluate the effectiveness of oral health promotion in one such satellite clinic located in a South Indian university.

Materials and Methods

This cross-sectional study was conducted in a South Indian university located on the Kolkata–Chennai national highway,^[7] that spreads over 293 acres. The university has six colleges within the campus, and the student strength of the campus is over 5000. It is a destination university for diverse students from Iran, Iraq, Nepal, Bhutan, Tanzania, Ethiopia, and Libya. The satellite clinic in the campus established by a teaching dental institution provides free oral health services that include screening, prophylaxis, restorations, extractions, and referral services.

Ethical approval for the study (133/IEC/SIBAR/2018) was obtained from the Institutional Ethical Committee. The study was conducted between June and August 2018. A two-stage random sampling was performed in which three groups were selected from the seven academic groups at the university (students from each of the six colleges and staff) in the first stage by simple random sampling. In the second stage, a random sample of participants was selected from each chosen group, proportional to the population size of that group. The sampling details of the study are presented in [Figure 1].

Figure 1 Sampling details of the study

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The effectiveness of oral health promotion was evaluated based on the perceived unmet dental needs in spite of the free services available. In view of the provision of free oral health services and setup of satellite clinic within the university, it is apparent that accessibility and cost of treatment, the two most common barriers for utilization of dental services, were taken out of the equation in our study.^[14] In light of these relatively favorable conditions, beneficiaries are expected to convert their needs to demand, at least the perceived needs if not the normative. A self-administered questionnaire was developed seeking information on the perceived dental needs in the past 12 months, which remained unmet in spite of the above-mentioned favorable circumstances. The expression “perceived unmet needs” refers to these needs, which remained unmet despite perception. The questionnaire also included the self-rated of oral health status and self-rated general health status on a five-point Likert scale. Information was also sought on the utilization of dental services at the satellite clinic. Demographic data were collected on age, gender, and academic group. The questionnaire was administered to all the participants during the working hours of the university. The principal investigator (VCC) made himself available, at the time of administration, for the participants to clarify doubts, should there be any.

The questionnaire was readministered to 40 randomly selected participants, after a period of 10 days, with a purpose of correlating the scores on the two occasions. The observed agreement between the responses was found to be considerably greater than the expected agreement by chance, as was assessed by Cohen’s Kappa (0.89). Statistical analysis was performed using IBM SPSS statistics for Windows, Version 20.0 (IBM Corp, Armonk, New York, USA). The data on self-rated oral and general health status were dichotomized as “good” (very good/good) and “poor” (fair/poor/very poor) to facilitate in identification of the possible discrepancies between the two measures.^[15] Parametric and nonparametric tests were performed as appropriate. The study has been conducted in full accordance with the World Medical Association Declaration of Helsinki (as amended in Edinburgh, 2000). Informed consent was obtained from the principals of the selected colleges and the participants.

Results

Sample distribution according to gender, age, self-reported oral and general health status, perceived unmet dental needs in the past year, and utilization of services at the satellite clinic was presented in [Table 1]. Around 80% of the participants belonged to the age group of 16 to 25 years, and the mean age of the study population was 23.19 ± 8.742 years, indicating a considerably wider spread of age among the study participants. Significant differences were observed between the academic groups with regard to self-rated oral health status. The details of the distribution of responses on self-rated oral and general health status on Likert scale are provided in [Figure 2] and [Figure 3], respectively. The tendency of the participants to report oral health and general health status toward “good” and “very good” can be clearly observed in these diverging stacked bar diagrams. On dichotomization of Likert responses as aforementioned, it was identified that 40.9% of the respondents reported poor oral health status, whereas only 32.9% reported poor health status. A total of 30.69% of those participants, who reported their health status to be good, rated their oral health status as poor. Spearman correlation test showed significant weak positive correlation (r = 0.226) between the self-rated oral and general health status of the participants (P = 0.000).

Table 1 Sample distribution according to gender, age, self-reported oral health and general health, perceived unmet dental needs in the past year, and utilization of services at the satellite clinic

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Figure 2 Diverging stacked bar diagram comparing self-rated oral health between academic groups

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Figure 3 Diverging stacked bar diagram comparing self-rated general health between academic groups

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Nearly 33% of the participants reported having perceived unmet dental needs in the past 12 months. There was no significant difference between the three academic groups with respect to the perceived unmet dental needs in the past year. Among the 100 participants with perceived unmet dental needs, 73 were unaware of the existence of dental satellite center at the university. The common reasons for not utilizing the services at the satellite clinic were lack of knowledge about existence of satellite clinic (60.8%), absence of dental needs (25.61%), poor perception of importance of oral health (9.63%), and lack of confidence in the quality of services offered (1.8%). Only 9.3% of the study population utilized the services at the satellite center. Utilization of available services was significantly higher among staff compared to the students from the two selected colleges (P = 0.012) [[Table 1]]. The percentage of study participants unaware of existence of satellite center was 60.8% (183/301). Promotion of available services was the major suggestion received from the participants (79.4%) followed by provision of oral health education (13.95%).

Discussion

There could be two reasons for the low prevalence of unmet dental need in our study. The participants may have had a dental problem in the past 12 months for which he/she had sought dental care or the classic mismatch between normative need and perceived need may have played a role.^{[16],[17],[18]} An important finding in this study is the discrepancy between an individual’s self-rated oral and self-rated general health. More than one-third of the participants with good self-rated general health reported poor oral health. This emphasizes that the campaign “oral health is an integral part of general health” has not been well received by the general population.^{[19],[20],[21],[22]} Care was taken in formatting the questionnaire in such a way that inquiry on self-reported oral health status was reserved to the end, virtually eliminating the scope for respondents to disreckon oral health while responding on perceived health status, which could have happened if these questions were posed in a sequential manner. However, the authors admit that this is too complex a conclusion to draw from a questionnaire study. But the inference opens new avenues and lays foundation for future research in this direction.

The utilization of available oral health services was low (9.3%) in the present study. This is comparable with the utilization rates at satellite clinics in Nigeria^[23] and the utilization of oral health services in India, in general.^[24] A majority of participants were not aware of the existence of the satellite clinic, signifying the need for promotion of the available oral health services, which must be pursued by the dental institutions and the local authorities where the satellite clinics are located. The fact that the care provided by the dental students at this satellite clinic is currently procedure based, where no one student is solely responsible for the execution of the sequential treatment plan unlike comprehensive care, could be a reason for the low utilization observed as the patients may feel disenfranchised with different care providers providing care under the supervision of different faculty members each time they visit.^[25] However, this was not explicitly mentioned by any of the participants. Information through patients’ surveys has proven to be a successful way of strategic evaluation and improving the quality of health services.^[26] Therefore, suggestions were received from the target population on what could be done to improve the services at the satellite clinic. In light of lack of knowledge about existence of satellite clinic, promotion of available services was the major suggestion received followed by oral health education. To ensure that the rationale and aims of outreach programs are met, health education is necessary.^[27]

It should also be noted here that satellite clinics possess an invaluable potential to implement common risk factor approach, which serves to integrate oral health with the general health of people.^[28] Evaluation of functioning of satellite clinics helps us better understand the outreach activities and thereby improve the quality of services provided. It is recommended to use established criteria for evaluation of these programs.^[29] Another important concern is the quality of community exposure to dental students. Qualitative interviews must be conducted on dental students and faculty members to tailor the outreach programs that best benefit the cause and also to make necessary modifications in the planning of future dental curriculum. Although this aspect of outreach programs was given due importance across many parts of the world, students’ perspectives regarding outreach activities were not well documented in India.^{[30],[31],[32]}

Limitations of this study are seeking dental care through other oral health care resources was not considered, which could have been a reason for nonutilization of services at the satellite center. Clinical evaluation of oral health status of the individuals could have been performed to evaluate the normative need and consequently to determine any mismatch between the perceived and the normative needs.

Policy Recommendations

India is a vast geographic extending over 3287,263 km² and stands at 7th position globally in terms of the geographical area. The number of dental institutions in the country has grown phenomenally over the years, with 313 functioning dental institutions in the country at present. If a policy guideline can be formulated, which mandates each dental institution to establish four satellite clinics at a distance of 15 km covering the entire perimeter of the institution, each institution could cover an area of around 700 km², providing necessary oral health services for the population residing in that area. This translates to covering an area of around 215,330 km², when all the dental institutions in the nation are taken into account, which is over 15% of the geographical area of the country. However, this percentage must be interpreted with caution owing to the uneven distribution of dental institutions in the country across its states and clustering of few dental institutions in certain areas, the consequence of which is that such dental institutions does not cover mutually exclusive areas. Therefore, clear policy guidelines on the number of satellite clinics to be established by a dental institution and the distance between satellite clinics and corresponding dental institutions must be established.
Guidelines should also include the range of oral health services that must be available in the satellite clinics in view of the fact that a great proportion of oral health care provided at satellite clinics constitute tooth extractions.
Special emphasis must be placed on methods and strategies for oral cancer diagnosis while formulating policy guidelines, as the incidence of oral cancer in India has been on a constant rise. The role of satellite clinics in habit cessation counseling must also be established.
Guidelines must ensure periodic evaluation of satellite clinics both in terms of improvement in oral health status of corresponding populations and the improvement in diagnostic and clinical competence of dental students.

Conclusion

Evaluation of satellite clinics both from the dental students’ perspective and with regard to oral health status of concerned populations must be seriously undertaken, as periodic evaluation and critical appraisal are as important as the formulation and execution of oral health promotion programs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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