Psychosocial Factors in Acquiring Sanogenous Behaviors in Preschoolers

Abstract

The aim of the study was to identify psychosocial factors that contribute to the acquisition of children's sanogenous behaviors, on a sample of 90 preschool children divided in two groups and their mothers, who answered independently to an oral health questionnaire. The questionnaire was applied to children in three stages and they received a sanogenous education program. Results show significant differences between age, education level and the mother's income in relation to their knowledge and with two groups of children from kindergartens with or without medical staff, by gender and by education consecutively.

Full text

Procedia - Social and Behavioral Sciences 187 ( 2015 ) 16 – 21
Available online at www.sciencedirect.com
1877-0428 © 2015 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of the Scientific Committee of PSIWORLD 2014.
doi: 10.1016/j.sbspro.2015.03.004
ScienceDirect
PSIWORLD 2014
Psychosocial Factors in Acquiring Sanogenous Behaviors in
Preschoolers
Georgeta Zegan
a
, Cristina Gena Dascălu
a
*, Angela Mariana Enache
a,b
,
Radu Bogdan Mavru
a
a
University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
b
Municipal Emergency Hospital Pascani, Romania
Abstract
The aim of the study was to identify psychosocial factors that contribute to the acquisition of children’s sanogenous behaviors, on
a sample of 90 preschool children divided in two groups and their mothers, who answered independently to an oral health
questionnaire. The questionnaire was applied to children in three stages and they received a sanogenous education program.
Results show significant differences between age, education level and the mother’s income in relation to their knowledge and
with two groups of children from kindergartens with or without medical staff, by gender and by education consecutively.
© 2015 The Authors. Published by Elsevier Ltd.
Peer-review under responsibility of the Scientific Committee of PSIWORLD 2014.
Keywords: oral health; preschooler, kindergarten education; sanogenous behavior; psychosocial status.
1. Introduction
Oral health is one of the most important public health problem, not only in our country but also worldwide.
According to estimates by the World Health Organization (WHO), more than 5 billion out of 6.5 billion people in
the world are affected by tooth decay (http://www.who.int). The onset of tooth decay can begin immediately after
teeth eruption and preschool age may be a risk for the child’s oral health and for overall health of the future adult
(Athanasiu, 1998). The specialists emphasize that the attitude to any condition, including oro-dental diseases is
determined by internal factors related strictly to a person and over which we can not interfere, but also by external
factors, that can be modeled through education (Paúca, 2006).
* Corresponding author. Tel.: +40-766-456205.
E-mail address: cdascalu_info@yahoo.com
© 2015 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Peer-review under responsibility of the Scientific Committee of PSIWORLD 2014.

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Georgeta Zegan et al. / Procedia - Social and Behavioral Sciences 187 ( 2015 ) 16 – 21
The period of "childhood" can be defined by biological criteria completed by the psychological and the social
environment of schooling. The child’s concrete and animistic thinking is less distinct than fantasy and playing
completes this picture of psychological characteristics (Margineanu, 1944). Based on these characteristics, our study
aims to answer three essential questions regarding the shaping of sanogenous behaviors in preschoolers: How
important is the role of the mother? How important is the influence of mother’s social-demographic variables? Can
education in schools compensate for the deficiency of information? The study is focused on the conception of
illness-health, in our case oro-dental diseases and the variables of age, gender, education and financial condition in
the preschool group and their mothers. The aim of our study was to identify psychosocial factors that may contribute
to the development of attitudes and behaviors that ensure the child a proper oral health.
2. Method
2.1. Participants
Th
e study was conducted by the Department of Orthodontics and Dentofacial Orthopaedics at UMF "Grigore T.
Popa", Iasi, Romania, during January-April 2013. The sample consisted of 90 preschool children (45 boys and 45
girls) aged between 4 and 6 years and their mothers. They were asked to answer an anonymous oral health
questionnaire. Informed consent was obtained from mothers of the subjects. The study was conducted in accordance
with the Helsinki Declaration of 1975, as revised in 2000. Children were enrolled in kindergartens in three social-
demographic different neighborhoods from Iasi. Children were divided into two groups: group A (n=30), one
kindergarten with a nurse; group B (n=60), two kindergartens without a nurse. Kindergarten nurses previously
conducted oral health education lessons for children.
2.2.Instruments
The structure of the questionnaire that assessed the level of knowledge of oral prevention measures consisted of
18 items (e.g., "Did you know why do we brush our teeth?", "Do you know when we may eat sweets?", "Did you
know that decayed teeth could hurt your heart?"), to which the answer was rated as "yes - has knowledge on the
subject of the question" (score=1) or "no - no knowledge on the subject of the question "(score=0). It provided the
following information: (1) social-demographic status (age, gender, education and financial situation of the mother);
(2) knowledge of oral hygiene; (3) knowledge of food hygiene; (4) knowledge of preventing dental caries; (5)
knowledge of preventing malocclusions; (6) knowledge of prevention periodontal disease; (7) knowledge of
preventing disease outbreak.
2.3. Procedure
T
he questionnaire was applied to mothers, once, at the beginning of the study and separately, to the children, in
three stages: pre-test, initially; inter-test, after five sessions of oral health education (lectures and practical
demonstrations); post-test, at the end of oral health education sessions. The questionnaire was applied at all stages
face to face by one calibrated operator, previously trained, both in terms of medical knowledge and the knowledge
of communication with preschool children.
Statistical analysis was performed using the SPSS 16.0 package (SPSS Inc., Chicago, IL) for Windows. We
identified the score of correct answers to each of the questionnaire’s items and we aggregated the items score based
on their subject. We used Pearson's chi-square test (F
2
) to compare the mothers’ correct answers and between the
groups of children and gender. For all the statistical tests we used the significance level of p d 0.05 corresponding to
a co
nfidence interval of 95%.
3. Results
All mothers had over 50% correct answers to the questionnaire topics. Statistical significant differences occurred
amongst the responses of mothers: by age interval regarding the knowledge on oral hygiene and nutrition,

18 Georgeta Zegan et al. / Procedia - Social and Behavioral Sciences 187 ( 2015 ) 16 – 21
prevention of dental caries and malocclusion; by level of education and income, oral hygiene and nutrition and the
prevention of dental caries (table 1).
The children’s correct answers of the pre-test questionnaire according to the social-demographic status of their
mothers are only limited to the knowledge about oral hygiene and nutrition which are highly significant different for
children with mothers of different ages and to those about preventing malocclusions for children with mothers with
different income state (table 2).
Table 1. Relation between mother’s correct answers and the social-demographic status (*p<0.05; **p<0.01; ***p<0.001)
Variables Oral
hygiene
Nutrition
hygiene
Dental decay
prevention
Malocclusion
prevention
Periodontal
disease prevention
Disease outbreak
prevention
n% n % n % n% n% n %
Correct answers 465 64.6 135 75.0 216 60.0 99 55.0 49 54.4 45 50.0
20-25 years (n=24) 111 57.8 30 62.5 45 46.9 18 37.5 14 58.3 12 50.0
26-30 years (n=33) 186 70.5 48 72.7 84 63.6 42 63.6 16 48.5 21 63.6
31-35 years (n=33) 168 63.3 57 83.4 87 65.9 39 59.1 19 57.6 12 36.4
Chi-square 7.93 8.73 9.54 8.37 0.75 4.91
p value 0.019** 0.013** 0.009** 0.015** 0.688 0.086
Medium studies (n=36) 168 58.3 48 66.7 72 50.0 33 45.8 20 55.6 15 41.7
Superior studies (n=54) 297 68.8 87 80.6 144 66.7 66 61.1 29 753.7 30 55.6
Chi-square 7.75 3.73 9.32 3.48 0.03 1.16
p value 0.005** 0.053* 0.002** 0.062 0.863 0.281
Medium incomes (n=48) 219 57.0 66 68.8 105 54.7 51 53.1 26 54.2 24 50.0
High incomes (n=42) 246 73.2 69 82.1 111 66.1 48 57.1 23 54.8 21 50.0
Chi-square 19.82 3.60 4.38 0.15 0.03 0.04
p value 0.0001*** 0.057* 0.036* 0.698 0.955 0.842
Table 2. Relations between children's correct answers to the pre-test questionnaire and the social-demographic status of mothers (*p<0.05;
***p<0.001)
V
ariables Oral
hygiene
Nutrition
hygiene
Dental decay
prevention
Malocclusion
prevention
Periodontal
disease prevention
Disease outbreak
prevention
n%n%n % n% n % n %
20-25 years (n=24) 99 51.6 12 25.0 0 0.0 6 12.5 0 0.0 0 0.0
26-30 years (n=33) 111 42.0 21 31.8 0 0.0 15 22.7 0 0.0 0 0.0
31-35 years (n=33) 111 42.0 9 13.6 0 0.0 12 18.2 0 0.0 0 0.0
C
hi-square 5.88 6.20 - 1.94 --
p value 0.
0529* 0.0450* - 0.3791 --
Medium studies (n=36) 132 45.8 15 20.8 0 0.0 9 12.5 0 0.0 0 0.0
S
uperior studies (n=54) 186 43.1 27 25.0 0 0.0 24 22.2 0 0.0 0 0.0
Chi-square 0.43 0.22 - 2.12 --
p value 0.
5120 0.6390 - 0.1454 --
Medium incomes (n=48) 180 46.9 21 21.9 0 0.0 9 9.4 0 0.0 0 0.0
Hi
gh incomes (n=42) 138 41.1 21 25.0 0 0.0 24 28.6 0 0.0 0 0.0
Chi-square 2.60 0.10 - 9.78 --
p value 0.
1069 0.7518 - 0.0018*** --

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Georgeta Zegan et al. / Procedia - Social and Behavioral Sciences 187 ( 2015 ) 16 – 21
The children in group A had more correct answers than the group B children concerning knowledge about oral
hygiene and nutrition and the prevention of malocclusions at the pre-test questionnaire. Those concerning the
prevention of other oro-dental diseases are non-existent for both groups of children. During learning, the children’s
knowledge significantly improves, as tested by the inter-test questionnaire. However, at the final testing, the
children’s knowledge are not fairly 100%, but different for the two groups, group A having better results, except
those regarding the prevention of periodontal disease (figure 1a) and between the two genders (figure 1b).
Fig. 1. The evolution of children's correct answers (a) the two groups; (b) the two genders
We found statistically significant differences comparing the groups of children’s results: the three questionnaires
for oral hygiene knowledge; inter-test and post-test questionnaires for knowledge concerning the prevention of
dental caries; post-test questionnaire for knowledge about disease outbreak prevention (table 3).
Table 3. Statistical results of the three tests from the two groups of children (**p<0.01; ***p<0.001)
Variables Oral
hygiene
Nutrition
hygiene
Dental decay
prevention
Malocclusion
prevention
Periodontal
disease prevention
Disease outbreak
prevention
F
2
p value F
2
p
value
F
2
p value F
2
p value F
2
p value F
2
p value
Pre-test 9.64 0.0019*** 0.03 0.8625 - - 2.05 0.1522 - ---
Inter-test 13.23 0.0003*** 0.03 0.8625 11.21 0.0008*** 0.65 0.4201 2.76 0.0966 0.63 0.4274
Post-test 6.97 0.0083** 0.83 0.3623 20.06 0.0001*** 3.32 0.0684 3.13 0.0769 4.07 0.0437*
We found statistically significant differences between the two genders, comparing the children’s results: the three
questionnaires for oral hygiene knowledge; inter-test and post-test questionnaires for knowledge about disease
outbreak prevention; post-test questionnaire for knowledge about food hygiene, prevention of dental caries, of
malocclusion, periodontal disease and disease outbreak (table 4).
Table 4. Gender related statistical results of the three tests on children (*p<0.05; **p<0.01; ***p<0.001)
Variables Oral
hygiene
Nutrition
hygiene
Dental decay
prevention
Malocclusion
prevention
Periodontal
disease prevention
Disease outbreak
prevention
F
2
p value F
2
p value F
2
p value F
2
p value F
2
p value F
2
p value
Pre-test 4.74 0.0295* 0.78 0.3771 -- 0.15 0.6985 -- - -
Inter-test 11.24 0.0008*** 0.57 0.4503 0.05 0.8231 0.58 0.4463 1.25 0.2636 3.98 0.0460*
Post-test 16.91 0.0001*** 5.81 0.0159** 5.36 0.0206* 16.51 0.0001*** 1.42 0.2334 23.62 0.0001***

20 Georgeta Zegan et al. / Procedia - Social and Behavioral Sciences 187 ( 2015 ) 16 – 21
Our research dealt with the identification of deep and nuanced information that lead us to an understanding of the
importance of complex psychosocial gradients in shaping strategies for oral health education of preschool children.
Our study is distinguished by the originality of the method and the specificity of the study group.
Our results are related to some aspects of the formation of attitudes and behaviors towards oral health of
preschool children. Thus, there were differences in age, education level and income of mothers in relation to their
knowledge of oral hygiene and nutrition and the prevention of dental caries. These topics accessible to common
knowledge were observed in younger mothers with higher education and high income, which would be reflected in
the sanogenous behavior of their children. On the same demographic variables, only the maternal age was
significantly involved in the children's knowledge and was only related to knowledge about oral hygiene and
nutrition. Mother's education level proved statistically significant and had no influence on the level of knowledge of
children in any of the six categories of studied items. There were differences between the income of mothers of
children in relation to their knowledge about prevention of malocclusions, a condition that brings a critical prejudice
to facial aesthetics. Mothers’ knowledge about prevention of malocclusions, periodontal disease and disease
outbreak were sketchy, regardless of age, income or education, which emphasizes the idea that this information is
not accessible to common knowledge. The same poor percentage of knowledge was also recorded in preschoolers, at
the first application of the questionnaire.
Oral health education and acquisition of sanogenous behavior significantly depended on the information received
in education classes, the quality of information and their presentation, by means of comparative statistical analysis
of children's responses to the pre-test and post-test questionnaires. Nurse’s presence turns out to have significant
implications regarding the children's knowledge, only in the case of oral hygiene and nutrition and the prevention of
dental caries. Concerning malocclusion prevention, periodontal disease and disease outbreak there were differences
in the acquisition of knowledge between the groups with and without medical assistance in the institution, which
lead to the conclusion that for such specialty topics specialized staff is needed in order to be explained and
understood. During learning, there was noted an increased responsiveness, with a better assimilation of knowledge
in case of girls rather than boys.
Our study nuances findings of a group of American specialists, who developed a conceptual model of the most
important result of social epidemiology studies in the last 25 years, comprising five key determinants parts in the
oral health of children: genetics and biology, social environment, physical environment, health-influencing
behaviors and medical care. The study supports the significant impact of the level of education, income and family
structure on children's oral health, while stressing the importance of education in school, which may decrease the
risk to the child's illness, beyond social-economic inequalities (Fisher-Owens et al., 2007). Also, our results are in
consensus with another U.S. study of a multidisciplinary team that performed dynamically at 3, 8 and 14
measurements of demographic variables, medical and psychosocial and appreciated that maternal psychosocial
factors can significantly influence oral health of future teenagers (Nelson, Lee, Albert, and Singer, 2012). Our
results fall in the direction that WHO promoted in terms of improving the oral health of children by adopting
effective education programs at all levels of education, as early as possible, by showing that health education classes
carried out in schools by trained personnel can correct family deficiencies caused by psychosocial factors (Kranz &
Rozier, 2011).
4. Conclusions
The present study demonstrates that the family alone cannot induce desirable sanogenous behaviors, though it is
important in the early education for the child’s oral health. The need to introduce in Romania of some oral health
educational programs in all kindergartens comes about, providing the necessary information, supplied by trained
staff with medical and pedagogical knowledge to ensure proper and adequate assimilation since preschool age.
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