Participatory Design Improves Oral Self-Care in High Caries Risk Children

Objectives: To use outcomes from a needs assessment to design and implement sustainable, community-driven interventions that reduce risk factors associated with dental caries in a rural Himalayan boarding school.
Methods: In 2017, 486 students from kindergarten (KG) to grade ten were examined during dental screens for the number of cavitated lesions and surveyed about dental pain and oral self-care behaviours. An evaluation of oral self-care perspectives and practices was assessed through focus interviews and observations of students, workers, and community members. The collective information was shared with school personnel and students to facilitate a participatory discussion around designing and implementing interventions to improve oral self-care among students. In 2018, the interventions were assessed for sustainability and their impact on changing oral health perspectives.
Results: In 2017, 62% of students presented with at least one carious lesion. Those students that had four or more carious lesions were mostly from younger age groups. Members of the school and community reported a high consumption of cariogenic foods, lack of oral self-care routines, and the loss of toothbrushes as contributing factors to high caries prevalence. Five interventions were designed and implemented that focused on reducing the identified risk factors. In 2018, almost 15% fewer students identified as not having a toothbrush, with the greatest improvement occurring in the younger age groups. Most significantly, there was a 46% increase in the number of students brushing once a day. Most students agree that the interventions implemented last year made them more aware of the importance of oral health.
Conclusions: A participatory design approach in the Spiti Valley has been effective in creating sustainable behavioural changes over a short period of time. Such methods can be effective in reducing the risk factors associated with dental caries and reduce the burden of dental disease in rural populations.