The current research adheres to the principles outlined in the CONSORT guideline [21]. In this non-randomized experimental study, the target population included all students of Shahid Beheshti School of dentistry in the 7th semester as the intervention and in the 8th semester as the control group in the year 2023. The intervention group received the topic of oral health needs assessment by means of a mobile application and the control group had received the same topic as a self-learning activity. The educational content was the same in both methods and in accordance with the undergraduate dental curriculum.
Based on the undergraduate dental curriculum in Iran, the topic of “population oral health needs assessment” is taught in the community oral health course. The reference for teaching this topic is a manual entitled “Oral health surveys; basic methods” [14], a publication of the World Health Organization, in which the detailed explanation of standard oral health evaluation forms, different variables, measurement criteria and their options are provided. Essentially in this topic, dental students are expected to get familiar with the following two types of assessment forms during this course: a clinical examination sheet and a questionnaire inquiring about individuals’ oral health behaviors, the effect of oral health status on quality of life and some socio-economic variables affecting oral health.
In the clinical examination sheet, standardized forms for recording clinical oral health assessments are provided separately for adults and children. Each form includes more than 200 variables, and the questionnaire covers about 50 variables which are expected to be filled by dental students. Standard codes must be used for all sections of the forms otherwise processing the data and summarizing the results will be problematic. In addition, the manual includes 72 illustrations regarding to the major oral conditions which may be helpful in differential diagnosis of lesions, increasing accuracy of coding during the examination.
In the control group, students were provided with the book in a PDF format and were instructed to collaborate on translating specific sections of the book as part of group assignments. They were then tasked with creating a PowerPoint presentation based on their translations, presenting it to the entire class, and engaging in discussions under the guidance of the instructor. Subsequently, during the following session, students were given printed clinical forms and questionnaires. They were required to fill out these forms for two of their peers during an authentic dental examination using a single-use dental mirror in natural light. The instructor collected the completed forms for further evaluation and feedback provision.
In the intervention group, on the other hand, students received a link to download a specifically designed application on their smartphones. The application has been designed as a Rest API for a web version using Asp.net Core technology. For the back-end, C#.net, and for the front-end, Angular js, jQuery, HTML, and CSS have been employed. In the design and implementation of the database, Microsoft SQL Server 2019 has been employed incorporating stored procedures. The mobile version that was compatible with both Android and iOS platforms was implemented using Flutter. The mobile version interacted with the server by connecting to Web APIs for data exchange. The application contained the PDF version of the manual, allowing students to read it and obtain Persian translations when needed. Table 1 shows more details on different pages of the application. Like the control group, students in the intervention group were tasked with conducting dental examinations and completing questionnaires for two classmates. However, they entered the data directly into electronic forms and questionnaires within the application. The results were then submitted to the instructor for evaluation and feedback. The current study faced some administrative challenges that made it impossible to perform blinding for the students, the instructor, or the statistician. To compare these two educational methods, a questionnaire was employed to evaluate the level of the students’ knowledge at three stages as follows: for the intervention group, before the start of teaching (February 2023; pre-test) and after the end of teaching (July 2023; post-test), and for the control group just after the end of teaching (February 2023; post-test). The students’ average scores out of the different parts of the questionnaire were compared among the experimental group (pre- and post-test) and between experimental and control groups (post-test).
The questionnaire included the following sections: fifteen questions inquiring about the students’ background characteristics and general aspects of smartphone usage (Tables 2, 3), adopted with minor modifications from Koopaie et al. [22], twenty one questions about the students’ attitude towards learning based on mobile devices (m-learning) [23] (Table 4), and fifteen multiple choice questions (MCQ) to assess the students’ level of knowledge about the content of the book (Table 5). The latter MCQs were formulated by one of the authors (HG) with 15 years of experience in teaching the topic of “oral health needs assessment for the population” to general dental students. Face and content validity of the questionnaire was, moreover, discussed with and ultimately approved by all authors who are professors in the field of dental public health and medical education. The reliability coefficient (Cronbach alpha) for the relationship between items of the first two sections of the questionnaire was close to 0.6. The Chi-square test, Mann-Whitney U test, Independent sample T-test were employed for the statistical analysis.
The answers to different parts of the questionnaire were organized as follows: in the section focused on general mobile phone usage, students were asked to choose the option that most accurately represented their level of agreement with each question from a five-point Likert scale (very much, much, medium, few, and very few). For the attitude section, the participants were requested to express their degree of agreement with each statement regarding attitudes towards learning through mobile phones, utilizing a five-point Likert scale ranging from complete agreement (score of 5) to complete disagreement (score of 1). The cumulative score derived from 21 statements, with a possible theoretical range of 21 to 105, was interpreted as the respondents’ overall attitude, where higher scores reflected a more positive attitude. For the knowledge assessment questions, students received points for each question they answered correctly from a set of four possible answers.
The study was approved by the Ethics Committee of the Shahid Beheshti School of Dentistry under the ethical code IR.SBMU.DRC.REC.1400.081. The students’ agreement to complete the questionnaire was considered as informed consent for participation in the research. They were, also, guaranteed that their answers would be kept confidential and utilized solely for research purposes. This assurance was included in the introductory explanation of the questionnaire and reiterated when the questionnaire was distributed to them.
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