Evaluation of customized oral health promotion program for North Korean defector

Kiha Jeon; Suyoung Lee

doi:10.11149/jkaoh.2018.42.4.109

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Jeon and Lee: Evaluation of customized oral health promotion program for North Korean defector

Original Article

J Korean Acad Oral Health 2018;42(4):109-117.

Published online: 15 December 2018

DOI: https://doi.org/10.11149/jkaoh.2018.42.4.109

Evaluation of customized oral health promotion program for North Korean defector

Kiha Jeon¹, Suyoung Lee^2,

²Department of Dental Hygiene, Shinsung University, Dangjin, Korea

²Department of Dental Hygiene, Namseoul University, Cheonan, Korea

Corresponding Author: Suyoung Lee Department of Dental Hygiene, Namseoul University, 91 Daehak-ro, Seonghwan-eup, Cheonan 31020, Korea Tel: +82-41-580-2927 Fax: +82-41-580-2833 E-mail: batty96@nsu.ac.kr

Received 11 July 2018 Revised 7 December 2018 Accepted 19 December 2018

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

The purpose of this study was to evaluate the customized oral health promotion program for North Korean defectors (NKDs).

Methods

Using a pre-survey comprising phases 1-5 of the PRECEDE-PROCEED model, a customized oral health promotion program was created. The participants, a total of 129 NKDs, were allocated to the experimental group (n=64; 43 females and 21 males) or the control group (n=65; 46 females and 19 males). After the interventions, phases 7 to 9 of the PRECEDE-PROCEED model were executed to determine the effect of the program.

Results

The results for phase 7 revealed high satisfaction with the program, with an average of 2.89 out of 3 points. In phase 8, concerning the impact evaluation, it was found that oral health beliefs and oral health knowledge were improved, with statistically significance differences before and after the experiment. Phase 9, concerning the outcome evaluation, showed that there were statistically significant differences in the average within groups before and after education in oral health beliefs (OHB), O’Leary index scores, and CPI. In terms of the difference between the groups, there were statistically significant improvement in OHB, O’Leary index scores, and CPI after the education program.

Conclusions

The oral health promotion program developed in this study has made a positive contribution to improve the oral health status of NKDs.

Keywords: North Korea defector, Oral health, Oral health promotion program, PRECEDE-PROCEED

References

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Fig. 1.

Research Procedure using the PRECEDE-PROCEED Model.

Table 1.

Instrument for pre-survey

				Instrument	Cronbach’s a
1st	Social assessment		OHIP	OHIP-14¹⁷⁾	0.84
2nd	Epidemiological assessment	SOH		Researcher production	0.94
		OOH		Ol’eary index¹⁸⁾, CPI¹⁹⁾, DMFT index²⁰⁾
3rd	Behavioral, and environmental as-	Behavioral	OHB	OHB²¹⁾	0.70
	sessment	Environmental	AS	Correction of Lee’ instrument²²⁾	0.67
			OHPEN	Correction & supplement of Jin’ instrument²³⁾	0.60
4th	Educational and ecological assess-	Predisposing factors	OHBs	Correction & supplement of Jin’ instrument²³⁾	0.73
	ment	Reinforcing factors	OHK	Correction & supplement of Yoon’ instrument²⁴⁾	0.80
7th	Process evaluation		PS	Correction & supplement of Kim’ instrument²⁵⁾	0.60
8th	Impact evaluation			Instrument of Phase 4	0.70
9th	Outcome evaluation			Instrument of Phase 2 and 3	0.55

OHIP: Oral Health Impact profile-14, SOH: Subjective Oral Health, OOH: Objective Oral Health, CPI: Communication Periodontal Index, OHB: Oral Health Behavior, AS: Acculturative Stress, OHN: Oral Health Promotion Education Needs, OHBs: Oral Health Beliefs, OHK: Oral Health Knowledge, PS: Program Satisfaction.

Table 2.

General characteristics of the subjects

	Variables	Total (%)	Experimental (n=64)	Control (n=65)	c²	P^†
	Variables	Total (%)	N (%)	N (%)	c²	P^†
Gender	Male	40 (31.0)	21 (16.3)	19 (14.7)	0.19	0.71
	Female	89 (69.0)	43 (33.3)	46 (35.7)
Age	20-29	42 (32.6)	23 (17.8)	19 (14.7)	1.16	0.76
	30-39	38 (29.5)	17 (13.2)	21 (16.3)
	40-49	37 (28.7)	19 (14.7)	18 (14.0)
	≧50	12 (9.3)	5 (3.9)	7 (5.4)
Financial state in North	Upper class	5 (3.9)	3 (2.3)	2 (1.6)	5.68	0.59
Korea	Middle class	62 (48.1)	37 (28.7)	25 (19.4)
	Under class	62 (48.1)	24 (18.6)	38 (29.5)
Education in North Korea	Uneducated	4 (3.1)	2 (1.6)	2 (1.6)	2.81	0.42
	Elementary school	8 (6.2)	2 (1.6)	6 (4.7)
	Middle/high school	106 (82.2)	53 (41.1)	53 (41.1)
	College/university	11 (8.5)	7 (5.4)	4 (3.1)
Period of stay in third	Below 2 years	54 (41.9)	30 (23.3)	24 (18.6)	2.14	0.34
country	Over 2 years-Below10 year	42 (32.6)	21 (16.3)	21 (16.3)
	Over 10 years	33 (25.6)	13 (10.1)	20 (15.5)

^† P-value was calculated by chi-squared test.

Table 3.

Outcome measures at baseline

Variables	N	Experimental (n=64)	Control (n=65)	t	P^†
Variables	N	Mean (SD)	Mean (SD)	t	P^†
OHBs	129	66.97 (6.79)	68.4 (6.55)	―1.25	0.22
OHK	129	24.56 (2.54)	24.35 (1.82)	0.54	0.59
SOH	129	8.22 (1.61)	7.53 (1.87)	2.23	0.03
OHB	129	8.38 (1.45)	7.69 (2.60)	1.84	0.68
O’leary index	129	53.20 (21.68)	57.81 (17.95)	―1.31	0.19
CPI	129	2.23 (0.46)	2.11 (0.32)	1.66	0.10
DMFT index	129	5.66 (5.59)	4.37 (4.88)	1.42	0.16
DT index	129	2.25 (1.52)	1.02 (1.52)	3.28	0.01
MT index	129	2.86 (5.34)	1.94 (4.00)	1.11	0.27
FT index	129	1.41 (2.10)	1.34 (2.45)	0.17	0.86

OHBs: Oral Health Beliefs, OHK: Oral Health Knowledge, SOH: Subjective Oral Health, OHB: Oral Health Behavior.

^† P-value was calculated by independent t-test.

Table 4.

Oral health promotion program satisfaction of experiment group

Variables	Contents	Mean (SD)^†
PS	Was this customized oral health program beneficial to your oral health management?	2.92 (0.27)
	Have you usually and continuously practiced tooth brushing you learned during this customized oral health program?	2.81 (0.47)
	Are you satisfied with the education and information provided by this customized oral health program?	2.92 (0.32)
	Are you inclined, if chanced, to participate in this customized oral health program again?	2.86 (0.39)
	Are you willing to recommend this customized oral health program to your colleagues?	2.89 (0.32)
	Total	2.89 (0.29)

PS: Program Satisfaction.

^† Values are mean±SD.

Table 5.

The difference of oral health beliefs according to the oral health promotion program

			N	Baseline	7 weeks	t	P^†
			N	Mean (SD)	Mean (SD)	t	P^†
OHBs	Sensitivity	Experimental	64	7.52 (2.50)	7.00 (2.57)	1.57	0.12
		Control	65	6.75 (2.55)	6.43 (2.45)	1.18	0.24
		t		1.71	1.29
		P^‡		0.09	0.20
	Importance	Experimental	64	12.84 (1.97)	13.55 (1.43)	―2.81	0.01*
		Control	65	13.69 (1.77)	13.72 (1.62)	―0.11	0.91
		t		―2.58	―0.66
		P^‡		0.01*	0.51
	Disability	Experimental	64	15.55 (3.90)	16.27 (3.19)	―1.40	0.17
		Control	65	16.02 (3.57)	15.83 (3.86)	0.47	0.64
		t		―0.71	0.70
		P^‡		0.48	0.49
	Self Efficacy	Experimental	64	18.91 (2.74)	19.13 (3.02)	―0.60	0.56
		Control	65	19.31 (3.01)	19.62 (3.44)	―0.87	0.39
		t		―0.79	―0.86
		P^‡		0.43	0.39
	Benefit	Experimental	64	12.16 (2.35)	12.91 (1.84)	―2.15	0.04*
		Control	65	12.66 (1.76)	12.95 (1.62)	―1.33	0.19
		t		―1.39	―0.16
		P^‡		0.17	0.88
	Total	Experimental	64	66.97 (6.79)	68.84 (5.90)	―2.09	0.04*
		Control	65	68.43 (6.55)	68.55 (6.83)	―0.15	0.88
		t		―1.25	0.26
		P^‡		0.22	0.80

OHBs: Oral Health Beliefs.

^† P-value was by repeated measures t-test.

^‡ P-value was calculated by independent t-test.

Table 6.

The Difference of according to oral health knowledge and oral health promotion program

			N	Baseline	7 weeks	t	P^†
			N	Mean (SD)	Mean (SD)	t	P^†
OHK	OHK1	Experimental	64	5.81 (0.50)	5.86 (0.59)	―0.73	0.47
		Control	65	5.85 (0.57)	5.92 (0.27)	―0.96	0.34
		t		―0.36	―0.79
		P^‡		0.72	0.43
	OHK2	Experimental	64	2.80 (0.54)	2.61 (0.77)	1.84	0.07
		Control	65	2.66 (0.69)	2.62 (0.72)	0.42	0.68
		t		1.24	―0.46
		P^‡		0.22	0.96
	OHK3	Experimental	64	5.11 (1.11)	5.47 (0.98)	―2.68	0.01*
		Control	65	4.68 (1.00)	4.86 (1.09)	―1.20	0.23
		t		2.32	3.34
		P^‡		0.02*	0.00*
	OHK4	Experimental	64	2.61 (0.63)	2.88 (0.38)	―3.56	0.00*
		Control	65	2.57 (0.59)	2.74 (0.54)	―1.62	0.11
		t		0.37	1.67
		P^‡		0.71	0.10
	OHK5	Experimental	64	8.23 (1.40)	8.44 (1.36)	―1.29	0.20
		Control	65	8.60 (0.79)	8.52 (0.94)	0.61	0.55
		t		―1.83	―0.42
		P^‡		0.07	0.68
	Total	Experimental	64	24.56 (2.54)	25.25 (2.72)	―2.26	0.03*
		Control	65	24.35 (1.82)	24.66 (2.14)	―0.97	0.34
		t		0.54	0.59
		P^‡		1.37	0.17

OHK: Oral Health Knowledge, OHK1: Toothbrushing Knowledge, OHK2: Diet Knowledge, OHK3: Fluoride Knowledge, OHK4: Prevention Knowledge, OHK5: Smoking Knowledge, OHK: Oral Health Knowledge.

^† P-value was by repeated measures t-test.

^‡ P-value was calculated by independent t-test.

Table 7.

The difference of subjective oral health, OHB, O’leary index, CPI and DMFT index according to the oral health promotion program

		N	Baseline	7 weeks	t	P^†
		N	Mean (SD)	Mean (SD)	t	P^†
SOH	Experimental	64	8.22 (1.61)	10.05 (1.56)	―7.88	0.00*
	Control	64	7.53 (1.87)	10.12 (1.44)	―10.80	0.00*
	t		2.23	―0.29
	P^‡		0.03*	0.77
OHB	Experimental	64	8.38 (1.45)	9.44 (1.72)	―4.49	0.00*
	Control	65	7.69 (2.60)	8.12 (1.67)	―1.23	0.22
	t		1.84	4.40
	P^‡		0.07	0.00*
O’leary index	Experimental	64	53.20 (21.68)	44.80 (17.01)	2.80	0.01*
	Control	64	57.81 (17.95)	64.78 (13.54)	―3.40	0.00*
	t		―1.31	―7.35
	P^‡		0.19	0.00*
CPI	Experimental	62	2.23 (0.46)	2.05 (0.34)	3.02	0.00*
	Control	64	2.11 (0.32)	2.17 (0.38)	―1.43	0.16
	t		1.66	―2.19
	P^‡		0.09	0.03*
DMFT index	Experimental	64	5.66 (5.59)	5.84 (5.54)	―0.52	0.60
	Control	65	4.37 (4.88)	4.57 (4.72)	―1.30	0.19
	t		1.42	1.41
	P^‡		0.16	0.16

SOH: Subjective Oral Health OHB: Oral Health Behavior

^† P-value was by repeated measures t-test. p-value was calculated by independent t-test.

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