Document Type : Original Article
Authors
1 Department of Public Health, School of Health, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
2 Department of Health Education and Health Promotion, School of Health, Occupational Safety and Health Center, NICICO, World Safety Organization and Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Abstract
BACKGROUND: Mothers play an important role in oral health of children. The present study was
planned, implemented, and evaluated to determine the impact of mothers’ educational program based
on PRECEDE–PROCEED model on oral health promotion of Rafsanjan 3–6‑year‑old children, in 2020.
MATERIALS AND METHODS: This quasi‑experimental study was conducted on 100 mothers with
children aged 3–6 years divided into two groups. The research tool was developed and approved
based on the model phases in the form of demographic information, predisposing, enabling, and
reinforcing factors. At phase five, intervention planning was conducted and the program was
implemented in four sessions (45 min each) in 30 days. Follow‑up was done 2 months after the last
training session. The data were analyzed by SPSS18, using Chi‑square, paired t‑test, and independent
t‑test at the significance level of 0.05.
RESULTS: After implementing the program, a significant difference was observed between
predisposing, enabling, and reinforcing factors, as well as oral health‑related behaviors of the two
groups (P < 0.05). Finally, 30.4% of the changes in oral health‑related behavior resulted from the
implementation of the designed educational program.
CONCLUSION: Considering the importance of planning to promote children’s oral health and
hygiene, it is recommended that the PRECEDE–PROCEED model be used to design, implement,
and evaluate health evidence‑based interventions.
Keywords
1. AbdAllah EA, Metwalli NE, Badran AS. Effectiveness of a one year
oral health educational and preventive program in improving
oral health knowledge and oral hygiene practices of a group of
Autistic Egyptian children and their caregivers. Future Dent J
2018;4:9‑23.
2. Goodarzi A, Tavaffian S, Heidarnia A, Ziaoddini H. Health
literacy and oral health in primary school students of district 14
in Tehran, Iran. J Mil Caring Sci 2016;2:229‑37.
3. Smailikia M, Gholami‑Parizad E, Abedzadeh‑Zavareh MS,
Sayehmiri K, Ghazanfari Z. Predicting the status of children’s
dental oral health 3‑6 old city Ilam the health belief model. SJIMU
2015; 24 (3): 49‑58.
4. Sujlana A, Pannu PK. Family related factors associated with caries
prevalence in the primary dentition of five‑year‑old children.
J Indian Soc Pedod Prev Dent 2015;33:83‑7.
5. Mohammadi M, Raygani AA, Jalali R, Ghobadi A, Salari N.
Prevalence of decay of permanent and deciduous teeth in Iranian
children: A systematic review and meta‑analysis study. J Dent Sci
2018;15:180‑9.
6. Spanemberg JC, Cardoso JA, Slob EM, López‑López J. Quality of
life related to oral health and its impact in adults. J Stomatol Oral
Maxillofac Surg 2019;120:234‑9.
7. Pakpour A, Hidarnia A, Hajizadeh E. Oral health status
and related factors in sample of high school students. J Qaz Univ Med Sci 2011;15:55‑60.
8. Nejad EM, Shariat E, Begjani J, Abotalebi G. Evaluation of oral
health in primary school children in Saveh, Iran (text in Persian).
J Res Dev Nurs Midwifery 2011;8:74‑80.
9. Ruff RR, Senthi S, Susser SR, Tsutsui A. Oral health, academic
performance, and school absenteeism in children and adolescents:
A systematic review and meta‑analysis. J Am Dent Assoc
2019;150:111‑21.e4.
10. Dallal MM, Dargahi H, Mehrani F, Yazdi MK, Forushani A,
Miremadi SA. The role of streptococcus mutants in dental caries
in two groups of sensitive and resistance children age between 3
to 5 years. Payavard Salamat J 2013;6:467‑77.
11. Wulaerhan J, Abudureyimu A, Bao XL, Zhao J. Risk determinants
associated with early childhood caries in Uygur children:
A preschool‑based cross‑sectional study. BMC Oral Health
2014;14:136.
12. Goudarzi A, Heidarnia A, Tavafian SS, Eslamiyan M. Relationship
of social variables with oral health of students. Iran J Pediatr
2018;14:1‑10.
13. Janakiram C, RudrappaR, Taha F, Ramanarayanan V, Akalgud H,
Kadanakuppe S. Equity in oral healthcare in India: A review on
health system analysis. Econ Polit Wkly 2017;52:82‑9.
14. Naderifar M, Ghaljaei F, Akbarizadeh M. Determination of the
mothers; practice about orodental health of their children up to
six years old. Zahedan. J Res Med Sci 2010;12:43‑8.
15. Fard RG, al‑Ulumi ZB, Hosseini A, Samani ZJ, Mirzaeian A. The
effect of teaching methods to prevent premature tooth decay in
children awareness, attitude and practice of pregnant mothers.
Med Care 2020;22:25‑33.
16. Glanz K, Rimer B, Viswanath K. Health Behavior and Health
Education. Theory, Reserch, and Practice”. 5ed. USA; Wiley. 2015.
17. Hajimiri K, Sharifirad G, Hasanzade A. The effect of oral health
education based on health belief model in mothers who had
3‑6 year old children on decreasing dental plaque index in Zanjan.
J Adv Med Biomed Res 2010;18:77‑86.
18. Shirzad M, Taghdisi M, Dehdari T, Abolghasemi J. The impact of
educational intervention on mothers’ attitude, self‑efficacy and
perceived barriers to health oral preschool children. Iran J Health
Educ Heal Promot 2015;3:181‑7.
19. Ghaffari M, Rakhshanderou S, Asadpour M, Nasirzadeh M,
Mazar L. Design, implementation, and evaluation of a
PRECEDE‑PROCEED model‑based intervention for oral and
dental health among primary school students of Rafsanjan city:
A mixed method study. BMC public health. 2021; 21 (1):1‑0.
20. Ghaffari M, Rakhshanderou S, Asadpour M, Nasirzadeh M. Oral
health behavior and its relationship with quality of life among
12 year‑old children of Rafsanjan in 2017‑18. J Kerman Univ Med
Sci 2019;26:420‑9.
21. Ghaffari M, Rakhshanderou S, Mazar L, Nasirzadeh M. Effect of
children’s oral health on families’ quality of life: A cross‑sectional
study in Rafsanjan, Iran. Community Dent Oral Epidemiol
2020;9:65‑72.
22. Gisoure E, Salary Z, Shahrokhi E. Relationship between
socioeconomic status and quality of life affected by oral health in
preschool children in Kerman, Iran, During 2016‑2017. Natl Acad
Manag Staff Cult Arts Herald 2018; 3; 1084‑91.
23. Gomes MC, Perazzo MF, Neves ÉT, Martins CC, Paiva SM,
Granville‑Garcia AF. Oral Problems and Self‑Confidence in
Preschool Children. Braz Dent J 2017;28:523‑30.
24. Jahanshahi R, Mirzayi F, Sanagou A, Jouybari L. Survey of
oral health index in elementary school students in Nasrabad
village (Gorgan) based on Child‑OIDP index in 1397. Iran J Pediatr
2018;14:25‑36.
25. Krisdapong S, Prasertsom P, Rattanarangsima K, Sheiham A.
School absence due to toothache associated with sociodemographic
factors, dental caries status, and oral health‑related quality of
life in 12‑ and 15‑year‑old Thai children. J Public Health Dent
2013;73:321‑8.
26. Reza M, Amin MS, Sgro A, Abdelaziz A, Ito D, Main P, et al. Oral
health status of immigrant and refugee children in north America:
A scoping review. J Can Dent Assoc 2016;82:g3.
27. Mohammadi TM, Haji‑Zamani A. Indicators of Health and
Disease in Dentistry. 1st ed. Tehran: Darkob Publications; 2011.
28. al‑Aalim ZB, Suleimani A, Zandi H, Dastjerdi F, Rashidi M,
Nejad SA. Investigation of the effect of environmental factors and
presence of caries early childhood on streptococcus counts Mutans
Saliva in Yasd City for 3‑5 year old children. Toloo‑e‑behdasht J
2017;15:23‑4.
29. Hoover J, Vatanparast H, Uswak G. Risk determinants of dental
caries and oral hygiene status in 3‑15 year‑old recent immigrant
and refugee children in Saskatchewan, Canada: A pilot study.
J Immigr Minor Health 2017;19:1315‑21.
30. Kalantari B, Rahman J, Hatami H, Factory S, Farsar A,
Sharifpour A, et al. Prevalence of tooth decay and its related
factors in 6 and 7 year old children in Shemiranat health network.
J Health Field 2013;1:7‑13.
31. Takelou ZN, Tabatabai SA, Zul‑Ali F, Mohabbat M. Factors
influencing oral health promotion behaviors based on Boznoff’s
model elementary school boy students. J Health Res 2016;
2 (3):259‑73.
32. Rabiei L, MasoudiR, Shirani M. Evaluation of knowledge, attitude
and practice of mothers referring to health centers in Isfahan to the
oral health care of 2‑5 year old children. J Vulnerable Groups Nurs
2015;2:55‑64.
33. Chand S, Chand S, Dhanker K, Chaudhary A. Impact of mothers’
oral hygiene knowledge and practice on oral hygiene status of
their 12‑year‑old children: A cross‑sectional study. J Indian Assoc
Public Health Dent 2014;12:323‑9.
34. Gurunathan D, Moses J, Arunachalam SK. Knowledge, attitude,
and practice of mothers regarding oral hygiene of primary school
children in Chennai, Tamil Nadu, India. Int J Clin Pediatr Dent
2018;11.4:338.
35. Mehdipour A, Montazeri‑Hedeshi Ro, Asayesh H, Karimi A,
Omidi Kopayee R, Asgari H. Evaluation of knowledge, attitudes
and performance of the parents of preschool and primary
school children referred to health centers of Qom city about the
importance of preserving primary teeth and its related factors,
Iran. Qom Univ Med Sci J 2016;10:94‑105.
36. Alzaidi SS, Alanazi IA, Nawas OM, Mulla MA. Childhood oral
health: Maternal knowledge and practice in Tabuk, Saudi Arabia.
Egypt J Hosp Med 2018;70: 1544‑51.
37. Halawany HS, Al Badr A, Al Sadhan S, Al Balkhi M, Al‑Maflehi N,
Abraham NB, et al. Effectiveness of oral health education
intervention among female primary school children in Riyadh,
Saudi Arabia. Saudi Dent J 2018;30:190‑6.
38. Batra M, Shah AF, Virtanen JI. Integration of oral health in primary
health care through motivational interviewing for mothers of
young children: A pilot study. J Indian Soc Pedod Prev Dent
2018;36:86‑92.
39. Smith SR, Kroon J, Schwarzer R, Hamilton K. Parental
social‑cognitive correlates of preschoolers’ oral hygiene
behavior: A systematic review and meta‑analysis. Soc Sci Med
2020;264:113322.
40. Peyman N, Pourhaji F. The effects of educational program
based on the Health Belief Model on the oral health behaviors of
elementary school students. Mod Car J 2015;12:74‑8.
41. Gomes MC, Clementino MA, Pinto‑Sarmento TC, Costa EM,
Martins CC, Granville‑Garcia AF, et al. Parental perceptions of
oral health status in preschool children and associated factors.
Braz Dent J 2015;26:428‑34.
42. Ghorbani B, Shahnazi H, Hassanzadeh A. Improving student’s
self‑efficacy and perceived susceptibility toward oral and dental
health: A randomized controlled trial. Oman Med J 2018;33:423‑8.
43. Askelson NM, Chi DL, Momany ET, Kuthy RA, Carter KD, Field K, et al. The importance of efficacy: Using the extended
parallel process model to examine factors related to preschool‑age
children enrolled in Medicaid receiving preventive dental visits.
Health Educ Behav 2015;42:805‑13.
44. Nelson S, Slusar MB, Albert JM, Riedy CA. Do baby teeth
really matter? Changing parental perception and increasing
dental care utilization for young children. Contemp Clin Trials
2017;59:13‑21.
45. Soltani R, Sharifirad G, Mahaki B, Eslami AA. Determinants of
oral health behavior among preschool children: Application of
the theory of planned behavior. J Dent (Shiraz) 2018;19:273‑9.
46. Makvandi Z, Karimi‑Shahanjarini A, Faradmal J, Bashirian S.
Evaluation of an oral health intervention among mothers of
young children: A clustered randomized trial. J Res Health Sci
2015;15:88‑93.
47. Duijster D, Verrips GH, van Loveren C. The role of family
functioning in childhood dental caries. Community Dent Oral
Epidemiol 2014;42:193‑205.
48. Duijster D, de Jong‑Lenters M, Verrips E, van Loveren C.
Establishing oral health promoting behaviours in
children – Parents’ views on barriers, facilitators and professional
support: A qualitative study. BMC Oral Health 2015;15:157.
oral health educational and preventive program in improving
oral health knowledge and oral hygiene practices of a group of
Autistic Egyptian children and their caregivers. Future Dent J
2018;4:9‑23.
2. Goodarzi A, Tavaffian S, Heidarnia A, Ziaoddini H. Health
literacy and oral health in primary school students of district 14
in Tehran, Iran. J Mil Caring Sci 2016;2:229‑37.
3. Smailikia M, Gholami‑Parizad E, Abedzadeh‑Zavareh MS,
Sayehmiri K, Ghazanfari Z. Predicting the status of children’s
dental oral health 3‑6 old city Ilam the health belief model. SJIMU
2015; 24 (3): 49‑58.
4. Sujlana A, Pannu PK. Family related factors associated with caries
prevalence in the primary dentition of five‑year‑old children.
J Indian Soc Pedod Prev Dent 2015;33:83‑7.
5. Mohammadi M, Raygani AA, Jalali R, Ghobadi A, Salari N.
Prevalence of decay of permanent and deciduous teeth in Iranian
children: A systematic review and meta‑analysis study. J Dent Sci
2018;15:180‑9.
6. Spanemberg JC, Cardoso JA, Slob EM, López‑López J. Quality of
life related to oral health and its impact in adults. J Stomatol Oral
Maxillofac Surg 2019;120:234‑9.
7. Pakpour A, Hidarnia A, Hajizadeh E. Oral health status
and related factors in sample of high school students. J Qaz Univ Med Sci 2011;15:55‑60.
8. Nejad EM, Shariat E, Begjani J, Abotalebi G. Evaluation of oral
health in primary school children in Saveh, Iran (text in Persian).
J Res Dev Nurs Midwifery 2011;8:74‑80.
9. Ruff RR, Senthi S, Susser SR, Tsutsui A. Oral health, academic
performance, and school absenteeism in children and adolescents:
A systematic review and meta‑analysis. J Am Dent Assoc
2019;150:111‑21.e4.
10. Dallal MM, Dargahi H, Mehrani F, Yazdi MK, Forushani A,
Miremadi SA. The role of streptococcus mutants in dental caries
in two groups of sensitive and resistance children age between 3
to 5 years. Payavard Salamat J 2013;6:467‑77.
11. Wulaerhan J, Abudureyimu A, Bao XL, Zhao J. Risk determinants
associated with early childhood caries in Uygur children:
A preschool‑based cross‑sectional study. BMC Oral Health
2014;14:136.
12. Goudarzi A, Heidarnia A, Tavafian SS, Eslamiyan M. Relationship
of social variables with oral health of students. Iran J Pediatr
2018;14:1‑10.
13. Janakiram C, RudrappaR, Taha F, Ramanarayanan V, Akalgud H,
Kadanakuppe S. Equity in oral healthcare in India: A review on
health system analysis. Econ Polit Wkly 2017;52:82‑9.
14. Naderifar M, Ghaljaei F, Akbarizadeh M. Determination of the
mothers; practice about orodental health of their children up to
six years old. Zahedan. J Res Med Sci 2010;12:43‑8.
15. Fard RG, al‑Ulumi ZB, Hosseini A, Samani ZJ, Mirzaeian A. The
effect of teaching methods to prevent premature tooth decay in
children awareness, attitude and practice of pregnant mothers.
Med Care 2020;22:25‑33.
16. Glanz K, Rimer B, Viswanath K. Health Behavior and Health
Education. Theory, Reserch, and Practice”. 5ed. USA; Wiley. 2015.
17. Hajimiri K, Sharifirad G, Hasanzade A. The effect of oral health
education based on health belief model in mothers who had
3‑6 year old children on decreasing dental plaque index in Zanjan.
J Adv Med Biomed Res 2010;18:77‑86.
18. Shirzad M, Taghdisi M, Dehdari T, Abolghasemi J. The impact of
educational intervention on mothers’ attitude, self‑efficacy and
perceived barriers to health oral preschool children. Iran J Health
Educ Heal Promot 2015;3:181‑7.
19. Ghaffari M, Rakhshanderou S, Asadpour M, Nasirzadeh M,
Mazar L. Design, implementation, and evaluation of a
PRECEDE‑PROCEED model‑based intervention for oral and
dental health among primary school students of Rafsanjan city:
A mixed method study. BMC public health. 2021; 21 (1):1‑0.
20. Ghaffari M, Rakhshanderou S, Asadpour M, Nasirzadeh M. Oral
health behavior and its relationship with quality of life among
12 year‑old children of Rafsanjan in 2017‑18. J Kerman Univ Med
Sci 2019;26:420‑9.
21. Ghaffari M, Rakhshanderou S, Mazar L, Nasirzadeh M. Effect of
children’s oral health on families’ quality of life: A cross‑sectional
study in Rafsanjan, Iran. Community Dent Oral Epidemiol
2020;9:65‑72.
22. Gisoure E, Salary Z, Shahrokhi E. Relationship between
socioeconomic status and quality of life affected by oral health in
preschool children in Kerman, Iran, During 2016‑2017. Natl Acad
Manag Staff Cult Arts Herald 2018; 3; 1084‑91.
23. Gomes MC, Perazzo MF, Neves ÉT, Martins CC, Paiva SM,
Granville‑Garcia AF. Oral Problems and Self‑Confidence in
Preschool Children. Braz Dent J 2017;28:523‑30.
24. Jahanshahi R, Mirzayi F, Sanagou A, Jouybari L. Survey of
oral health index in elementary school students in Nasrabad
village (Gorgan) based on Child‑OIDP index in 1397. Iran J Pediatr
2018;14:25‑36.
25. Krisdapong S, Prasertsom P, Rattanarangsima K, Sheiham A.
School absence due to toothache associated with sociodemographic
factors, dental caries status, and oral health‑related quality of
life in 12‑ and 15‑year‑old Thai children. J Public Health Dent
2013;73:321‑8.
26. Reza M, Amin MS, Sgro A, Abdelaziz A, Ito D, Main P, et al. Oral
health status of immigrant and refugee children in north America:
A scoping review. J Can Dent Assoc 2016;82:g3.
27. Mohammadi TM, Haji‑Zamani A. Indicators of Health and
Disease in Dentistry. 1st ed. Tehran: Darkob Publications; 2011.
28. al‑Aalim ZB, Suleimani A, Zandi H, Dastjerdi F, Rashidi M,
Nejad SA. Investigation of the effect of environmental factors and
presence of caries early childhood on streptococcus counts Mutans
Saliva in Yasd City for 3‑5 year old children. Toloo‑e‑behdasht J
2017;15:23‑4.
29. Hoover J, Vatanparast H, Uswak G. Risk determinants of dental
caries and oral hygiene status in 3‑15 year‑old recent immigrant
and refugee children in Saskatchewan, Canada: A pilot study.
J Immigr Minor Health 2017;19:1315‑21.
30. Kalantari B, Rahman J, Hatami H, Factory S, Farsar A,
Sharifpour A, et al. Prevalence of tooth decay and its related
factors in 6 and 7 year old children in Shemiranat health network.
J Health Field 2013;1:7‑13.
31. Takelou ZN, Tabatabai SA, Zul‑Ali F, Mohabbat M. Factors
influencing oral health promotion behaviors based on Boznoff’s
model elementary school boy students. J Health Res 2016;
2 (3):259‑73.
32. Rabiei L, MasoudiR, Shirani M. Evaluation of knowledge, attitude
and practice of mothers referring to health centers in Isfahan to the
oral health care of 2‑5 year old children. J Vulnerable Groups Nurs
2015;2:55‑64.
33. Chand S, Chand S, Dhanker K, Chaudhary A. Impact of mothers’
oral hygiene knowledge and practice on oral hygiene status of
their 12‑year‑old children: A cross‑sectional study. J Indian Assoc
Public Health Dent 2014;12:323‑9.
34. Gurunathan D, Moses J, Arunachalam SK. Knowledge, attitude,
and practice of mothers regarding oral hygiene of primary school
children in Chennai, Tamil Nadu, India. Int J Clin Pediatr Dent
2018;11.4:338.
35. Mehdipour A, Montazeri‑Hedeshi Ro, Asayesh H, Karimi A,
Omidi Kopayee R, Asgari H. Evaluation of knowledge, attitudes
and performance of the parents of preschool and primary
school children referred to health centers of Qom city about the
importance of preserving primary teeth and its related factors,
Iran. Qom Univ Med Sci J 2016;10:94‑105.
36. Alzaidi SS, Alanazi IA, Nawas OM, Mulla MA. Childhood oral
health: Maternal knowledge and practice in Tabuk, Saudi Arabia.
Egypt J Hosp Med 2018;70: 1544‑51.
37. Halawany HS, Al Badr A, Al Sadhan S, Al Balkhi M, Al‑Maflehi N,
Abraham NB, et al. Effectiveness of oral health education
intervention among female primary school children in Riyadh,
Saudi Arabia. Saudi Dent J 2018;30:190‑6.
38. Batra M, Shah AF, Virtanen JI. Integration of oral health in primary
health care through motivational interviewing for mothers of
young children: A pilot study. J Indian Soc Pedod Prev Dent
2018;36:86‑92.
39. Smith SR, Kroon J, Schwarzer R, Hamilton K. Parental
social‑cognitive correlates of preschoolers’ oral hygiene
behavior: A systematic review and meta‑analysis. Soc Sci Med
2020;264:113322.
40. Peyman N, Pourhaji F. The effects of educational program
based on the Health Belief Model on the oral health behaviors of
elementary school students. Mod Car J 2015;12:74‑8.
41. Gomes MC, Clementino MA, Pinto‑Sarmento TC, Costa EM,
Martins CC, Granville‑Garcia AF, et al. Parental perceptions of
oral health status in preschool children and associated factors.
Braz Dent J 2015;26:428‑34.
42. Ghorbani B, Shahnazi H, Hassanzadeh A. Improving student’s
self‑efficacy and perceived susceptibility toward oral and dental
health: A randomized controlled trial. Oman Med J 2018;33:423‑8.
43. Askelson NM, Chi DL, Momany ET, Kuthy RA, Carter KD, Field K, et al. The importance of efficacy: Using the extended
parallel process model to examine factors related to preschool‑age
children enrolled in Medicaid receiving preventive dental visits.
Health Educ Behav 2015;42:805‑13.
44. Nelson S, Slusar MB, Albert JM, Riedy CA. Do baby teeth
really matter? Changing parental perception and increasing
dental care utilization for young children. Contemp Clin Trials
2017;59:13‑21.
45. Soltani R, Sharifirad G, Mahaki B, Eslami AA. Determinants of
oral health behavior among preschool children: Application of
the theory of planned behavior. J Dent (Shiraz) 2018;19:273‑9.
46. Makvandi Z, Karimi‑Shahanjarini A, Faradmal J, Bashirian S.
Evaluation of an oral health intervention among mothers of
young children: A clustered randomized trial. J Res Health Sci
2015;15:88‑93.
47. Duijster D, Verrips GH, van Loveren C. The role of family
functioning in childhood dental caries. Community Dent Oral
Epidemiol 2014;42:193‑205.
48. Duijster D, de Jong‑Lenters M, Verrips E, van Loveren C.
Establishing oral health promoting behaviours in
children – Parents’ views on barriers, facilitators and professional
support: A qualitative study. BMC Oral Health 2015;15:157.
)