Dental Plaque Accumulation, Oral Hygiene Education
Conditions
Keywords
Faith-Based Health Promotion, Pretest sensitization, Sunnah, Community Health, Bangladesh;, Solomon Four-Group Design, Quasi-Experimental, Health Belief Model, Miswak, Tooth Brushing, Oral Health Education, Mosque-Based Intervention, Khutba, seremon
Brief summary
This quasi-experimental study evaluates a mosque-based oral health education intervention ("Smile With Prophet", SWP) among adult male mosque attendees in Dhaka, Bangladesh, using a Solomon four-group design. A total of 142 participants were enrolled across two mosques (intervention and control). The analytical sample comprises 80 adult male attendees (≥18 years) allocated to four groups: intervention and control, each with pretest-posttest and posttest-only arms (n=20 per group). The SWP intervention consists of oral health education delivered through Friday sermons (khutbas), supported by educational leaflets and provision of miswak. Outcomes are measured at baseline and 3-week follow-up and include oral health knowledge (14-item questionnaire), self-reported tooth brushing practices (15-item questionnaire), and clinical plaque scores (Greene-Vermillion Simplified Oral Hygiene Index, reversed). The primary objective is to evaluate the effect of the intervention on knowledge and plaque scores. The secondary objective is to assess self-reported practice changes.
Detailed description
Study design: Quasi-experimental study using a Solomon four-group design conducted in two mosques in Dhaka, Bangladesh, between January and December 2022. Participants: A total of 142 adult male mosque attendees (≥18 years) who attended three consecutive Friday congregational prayers were enrolled. Of these, 119 completed baseline assessment (pretest questionnaire and clinical plaque examination). Across the three-week study period, 80 participants completed all required follow-up assessments and are included in the final analysis (40 intervention, 40 control). Participants were allocated to four groups: intervention and control, each with pretest-posttest and posttest-only arms (n=20 per subgroup). Intervention: The "Smile With Prophet" (SWP) intervention comprises: (1) oral health education delivered through Friday sermons (khutbas) integrating scientific evidence with Islamic teachings (Sunnah); (2) educational leaflets for take-home reinforcement; (3) provision of miswak (traditional tooth cleaning stick); and (4) a dental health campaign with clinical examination. The control group receives standard khutbas without oral health content; the intervention is provided after study completion. Statistical analysis: Non-parametric tests will be used for data that are not normally distributed (Kolmogorov-Smirnov test). Mann-Whitney U tests will compare groups; Wilcoxon signed-rank tests will assess within-group changes; Kruskal-Wallis tests will compare all four Solomon groups simultaneously. The Solomon four-group design controls for pretest sensitisation. Attrition analysis will compare baseline characteristics of retained versus lost participants.
Interventions
BEHAVIORALSmile With Prophet (SWP)
"Smile With the Prophet (pbuh)" (SWP) intervention is an intervention specially designed for this intervention study. Composed of the following: Khutba: 15-minute Friday sermon (khutba) delivered by the Imam, integrating evidence-based oral health messages with Islamic teachings on hygiene (Sunnah); each supported by several Qur'an verses (ayah), or Islamic faith-based decrees. The messages were developed through consultation involving Advisory Committee board consisting of Islamic scholars and public health professionals. Booklet: A 4-page illustrated educational leaflet on proper tooth brushing technique and use of miswak, available in Bengali; Miswak \& Toothbrush :Provision of a miswak (traditional tooth cleaning stick) and a soft-bristled toothbrush
Sponsors
Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
3.12.1 Hiring Doctors: None of the doctors were used for second time for data collection campaigns to avoid examiners bias. A total of 10 doctors are hired for four dental check-up (pre and post test in intervention & control mosques). But they were not informed about the objectives of the study and whether the mosque was an intervention or control mosque, or whether the campaign was baseline data collection or for follow up data 3.2.1 Mosque Agreement: Written informed consent was obtained from heads of the mosque Committees or from imams or khatibs for their and their mosques' participation after describing required data collection procedures (without disclosing the desired objectives hypothesis of the study thus masking the intention) • Privacy and confidentiality were maintained strictly, as each of the participants was assessed separately and the dentist examined the participants with in a screened compartment of the mosque.
Intervention model description
In this Solomon four-group design, participants were allocated to four groups: intervention and control, each with pretest-posttest and posttest-only arms. Two similar mosques were selected conveniently. Within each site, participants were randomly assigned (pseudo-randomisation). Pretesting was conducted in one intervention and one control group. Baseline data were collected during the first Friday congregation, prior to a 15-minute sermon. A miswak was provided after clinical assessment. A reinforcement session (second 15-minute khutba) and distribution of educational leaflets were conducted during the second Friday. A soft-bristled toothbrush was given at this time as an intervention and attendance tracker. Final follow-up assessments (questionnaire and clinical examination) were conducted during the third Friday. The intervention mosque phase ran from 23 September to 7 October 2022. The control mosque phase ran from 14 October to 28 October 2022. Each phase lasted 3 weeks. Attend
Eligibility
Sex/Gender
MALE
Age
18 Years to 85 Years
Healthy volunteers
Yes
Inclusion criteria
* Respondent is willing to participate and gives consent. * Respondent is aged 18 years or older. * Respondent attends weekly congregation prayers at the selected mosque.
Exclusion criteria
• Respondent is mentally unstable or unable to understand the intervention (e.g., too old or cognitively impaired).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical Plaque Score (Reversed) | Baseline (Week 1, pretested groups only) and 3-week follow-up (Week 3, all groups) | Objective clinical measure of oral hygiene. Assessed using the Greene-Vermillion Simplified Oral Hygiene Index (reversed). Dental examiner evaluates plaque thickness along the gingival margin on four surfaces (distal, facial, mesial, lingual) of each tooth. Reversed score range 0-3. Higher reversed score indicates less plaque and better oral hygiene. This is the primary evidence of behavior change |
| Oral Health Knowledge Score | Baseline (Week 1, pretested groups only) and 3-week follow-up (Week 3, all groups) | Measured using a 14-item self-administered questionnaire assessing understanding of oral hygiene, tooth brushing frequency, miswak use, dietary effects on teeth, and gum health. Each correct answer scores 1 point. Total score range 0-14. Higher score indicates better knowledge. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Self-Reported Tooth Brushing Practice Score | Baseline (Week 1, pretested groups only) and 3-week follow-up (Week 3, all groups) | Subjective self-report measure. Assessed using a 15-item questionnaire on tooth brushing frequency, duration, technique, coverage of tooth surfaces, and miswak use. Each appropriate practice scores 1 point. Range 0-15. Higher score indicates better self-reported practices. Subject to recall and social desirability bias. |
Countries
Bangladesh
Outcome results
None listed