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Year : 2020  |  Volume : 18  |  Issue : 3  |  Page : 250-255

Content analysis of oral health information in science textbooks: A cross sectional study in schools of Pune, India

1 Department of Public Health Dentistry, Dr. D Y Patil Vidyapeeth, Dr. D Y Patil Dental College and Hospital, Pune, Maharashtra, India
2 Dr. D Y Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission09-Mar-2020
Date of Decision20-Mar-2020
Date of Acceptance22-Sep-2020
Date of Web Publication24-Oct-2020

Correspondence Address:
Pradnya V Kakodkar
Dr. D Y Patil Vidyapeeth, Pimpri, Pune, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_49_20

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Background: Since school textbooks form the base for acquiring knowledge, it is thus important that the information provided in it should be valid. Content analysis helps us evaluate the presence, extent, and validity of the information. Aim: To conduct content analysis of the oral health information in science textbooks of Standard I–X among the schools in Pune. Materials and Methods: A cross-sectional study was conducted among 25 schools, selected using quota sampling (Central Board of Secondary Education [CBSE] [n = 17]:Indian Certificate of Secondary Examination [ICSE] [n = 5]:International Board [n = 1]:Cambridge Assessment International Education [n = 1]:State Board [n = 1]). Convenience sampling was used to recruit the required number of schools. Content analysis was done using an assessment tool of oral health-related core components for different standards based on content, extent, and evidence The data were analyzed descriptively using Microsoft Excel 2013. Results: The study was completed in 21 (84%) schools affiliated to three boards only. A total of 242 pages were analyzed (565 oral health messages and 51 pictures). Of the little information that was present, it was found that the messages and pictures in the books of the CBSE (346 and 29), were more than that in the books of ICSE (166 and 6) and State Board (53 and 6), respectively. The results revealed that the textbooks of all the three boards were lacking in the oral health content with regard to the core components and coverage extent. Conclusions: Science textbooks are lacking in the oral health information, and there is an urgent need to improvise the textbook content.

Keywords: Health education, oral health education, oral health, schools

How to cite this article:
Dagar DS, Kakodkar PV, Shetiya SH. Content analysis of oral health information in science textbooks: A cross sectional study in schools of Pune, India. J Indian Assoc Public Health Dent 2020;18:250-5

How to cite this URL:
Dagar DS, Kakodkar PV, Shetiya SH. Content analysis of oral health information in science textbooks: A cross sectional study in schools of Pune, India. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2022 Dec 3];18:250-5. Available from: https://www.jiaphd.org/text.asp?2020/18/3/250/299003

  Introduction Top

Oral health is a key indicator of overall health, well-being, and quality of life.[1] Oral healthcare is given lesser importance as compared to general health care. Negligence toward oral healthcare in the early years of life leads to missing teeth in older ages of life.[2]

Approximately, 80% of the children globally attend school till primary classes which is almost 4 years of education, depending on gender and different countries.[3] About 60–90% of the school children suffer from gingivitis and dental caries.[2] Pain due to severe dental caries affects the child in different ways, such as discomfort, disfigurement, sleep disruption, and also absence from school.[4],[5] School is a place where the basic education starts about everything. Not only it provides education but also focuses on the personal development of the child. To make school a place not only for education but also as a health-promoting place, the World Health Organization (WHO) came up with the concept of health promoting schools in Ottawa Charter for Health Promotion (1986)[6] and Jakarta Declaration of the Fourth International Conference on Health Promotion (1997).[7]

Textbooks are the primary source of knowledge. School provides an ideal setting for promoting oral health, and it is found that children are receptive particularly from childhood, and earlier, the habits are established, the long-lasting impact it has.[8] Not only textbooks can impart knowledge, but it can also make an impact on a child's mind about habits and implementing them in their lifestyle. Organization for Economic Cooperation and Development, World Bank, and United Nations Educational Scientific and Cultural Organizations have acknowledged the role of textbooks in health education.[9]

Many studies have reported content analysis results of the school textbooks for different topics,[10],[11],[12],[13],[14],[15],[16],[17] and the results indicate lack of enough content and evidence of the published information.

It is important to reinforce health messages through different programs for schoolchildren as stated by the WHO.[7] Hence, schools play an important role in attainment, by making policies on regulating tobacco sale in and around the school and also regulating the intake of the sugar.[1]

Oral health is one of the important aspects affecting the quality of life from childhood, and hence, it is very important to incorporate oral health education on topics such as the importance of oral hygiene, deciduous dentition, and the importance of diet and oral health in the textbooks. Literature is not replete with information regarding content analysis of oral health information in the school textbooks from Standard I–X in India. For India, there is mention of only one study [11] in the literature that has been conducted in Tamil Nadu. It reported that the school textbooks have basic oral health information and it is important that periodic revision of the content and quality is essential. Every state in India prefers different publisher textbooks, and hence, it is important that content analysis be performed for every state. Against this background, the present study was undertaken to conduct content analysis of the oral health information in the science textbooks of Standard I–X among schools of Pune.

  Materials and Methods Top

A cross-sectional study was conducted to perform the content analysis of the oral health information in science textbooks. The ethical clearance was obtained from the Institutional Ethics Committee (Ref no: DPU/R&R (D)/971 (37)/16). The study was conducted from May 2017 to May 2018. List of all the schools representing five boards: Central Board of Secondary Education (CBSE), Indian Certificate of Secondary Examination (ICSE), International Board (IB), Cambridge Assessment International Education (CIE) and State Board in Pune, India, were obtained from the enrollment desk website.[18] There were a total of 262 schools (CBSE [87), ICSE [26], IB [6], CIE [6], and State Board [137)). The sample size was calculated by quota sampling. The sample size was as follows: CBSE (n = 17), ICSE (n = 5), IB (n = 1), CIE (n = 1), and State Board (n = 26). Since the State Board schools follow textbook of single publication house, for the purpose of content analysis, only one school was selected. Hence, 25 schools were selected for content analysis. The inclusion criteria were English-medium school representing the respective board and those willing to give consent for content analysis of the books.

The content analysis was done in three parts which included assessment of content, extent, and evidence. The content was assessed as per the different core components specified for the respective STANDARDs I, II–IV, V–VI, VII–VIII, and IX–X [Table 1] on the basis of Kasey's examples of age-specific dental subject material.[19] The content outcome with respect to the core components was marked as present or absent. The extent was expressed as the number of messages and pictures with respect to the core components for each standard [Table 1]. The evidence of the core components for the respective standard was recorded as correct or incorrect. For evidence assessment, the author (DD) read the health statements and by virtue of her knowledge judged that piece of information to be correct or incorrect. In case of doubt or ambiguity, the issue was resolved by discussion with the other investigators (PK and SH).
Table 1: Content analysis assessment tool for oral health related core components for each standard

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Pilot study was undertaken in one school. The author (DD) trained herself for undertaking the content analysis by practicing the analysis using the assessment tool for four times. The investigators (PK and SH) helped in the calibration of the author. The author (DD) performed the analysis and the results were cross-checked by the two other investigators (PK and SH).

After obtaining permission from the principal of the school, the science textbooks (Environmental Science, Science, and Biology) used in Class I–X were taken from the teachers or the library. Each book was visually scanned. The investigator then clicked photographs of the book pages containing oral health information, pictures, and any activity. The photograph printouts were taken, and the investigator marked the desired content in red. Information regarding the publication house of each book along with the number of pages containing oral health content was noted down. The number of statements and pictures was counted. One sentence was considered as one health message. If the same publication house is being repeated for the same standard (for CBSE and ICSE), it was not considered again for data collection.

Statistical analysis

All the data (i.e., total number of pages, publication house, health message present or absent, extent of the message, and scientific evidence) were entered in the excel sheet according to each board. Descriptive analysis (number and percentages) were calculated. After completing the analysis, intra-examiner reliability check was done by reassessing three different publications and matching the scores with the original checklist. Reliability was performed using the William Scott method.[17]

  Results Top

The response rate for the content analysis is presented in [Table 2]. Of the 25 recruited schools, the data collection was possible in CBSE (100%), ICSE (60%), and State Board (100%) schools. Overall, the response rate was 84% (n = 21). In total, books from 10 publication houses for CBSE, 5 for ICSE, and 1 for State Board were analyzed. The intra-examiner reliability rate for content analysis was 85%.
Table 2: Response rate for content analysis from 5 different boards

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The content analysis of core components for each standard is as follows: For Standard I: Of the two core components (oral hygiene and dentist visit/dentist role), only one component (oral hygiene) was covered in CBSE Board and none in ICSE and State Board. For Standards II–IV: Of four core components (benefits of teeth/oral hygiene/diet/dentist visit/dentist role), the results showed that majority, i.e., three components, were covered in CBSE Board as compared to the others. For Standard III, it was evident that two core components were covered in CBSE and ICSE books and only one for State Board, respectively. Standard IV had the highest coverage of core components in both CBSE and ICSE boards, while State Board covered none. For Standards V and VI, six core components were analyzed (benefits of teeth/oral structures/oral hygiene/dental disease/diet). For Standard V, three out of six were covered in CBSE, one out of six in ICSE and absolutely no information in the State Board books. For Standards VI, two out of six core components were present in CBSE books; majority, i.e., five out of six core components in ICSE books and no information in State Board books. For Standards VII and VIII, five core components (oral structure/dental disease/preventive measure/diet/tobacco) were analyzed. Only three out of five core components were present in CBSE books, and one out of five in State Board and no information in the ICSE books. For Standard VIII, two out of five core components were covered in CBSE books, and one out of five in ICSE books and no information in State Board books. For Standards IX and X, seven core components (oral structure, dental disease/preventive measure/diet/tobacco/mass media/dental care) were analyzed. Only ICSE Board covered four components for Standard IX while CBSE and State Boards covered no information for Standard IX. In Standard X, three out of seven core components were covered in CBSE books and one core component, respectively, was covered in State Board book. While no core component was covered in ICSE Board books. Except for Standards III, VII, and X, there was no oral health content in the State Board books. These data are presented in [Table 3].
Table 3: Content analysis result of core components of each standard

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The extent of the core components covered in terms of oral health messages and pictures. Oral health information was present on 242 pages. Overall, 156 pages were assessed from CBSE textbooks, 58 pages of ICSE books, and 28 pages of State Board. Overall, 565 oral health messages were analyzed (CBSE = 346, ICSE = 166, and State Board = 53). In total, 51 pictures were analyzed (CBSE = 39, ICSE = 6, State Board = 6). In CBSE books, no oral health message or picture was present for Standard IX. Oral health pictures were present in the books of Standards I, IV, VII, and VIII only. In ICSE books, there was oral health content present in the books of Standards III, IV, V, VI, VIII, and IX. Oral health pictures were present in the books of Standards III, IV, and IX. In State Board books, oral health content was present in books of Standards III, VII, and X. Pictures were present only for the Standards VII and X. The results showed that the highest number of oral health message were found in Standard IV, which had 170 messages with seven pictures in CBSE Board, followed by ICSE Board which had 44 oral health messages and four pictures. It was followed by Standard VII, having 121 oral health messages and 15 pictures in CBSE Board and 83 oral health messages with zero pictures in Standard VI in ICSE Board. These data are depicted in [Table 4].
Table 4: Extent of oral health messages

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The evidence of all the oral health messages was correct, except on two occasions in CBSE book – for Standard II, the number of deciduous teeth was mentioned wrongly as 28 milk teeth, and in Standard IV, the pictorial presentation of teeth was wrong.

  Discussion Top

School provides an ideal setting to introduce and to learn good habits in a child's life. The school children get basic education from the textbooks and through the reinforcement done by the teacher from time to time. The importance of the books in school have been recognized by WHO.[3]

The result of the present study indicates that the textbooks lack in content and extent of oral health information, while the evidence is correct majority of the times. Literature reports of only four studies [11],[12],[13] on the content analysis related to oral health. However, there are abundant studies which report content analysis of textbooks for topics such as general health messages,[9],[10],[20],[21] end-of-life content in the nursing textbooks,[22] gender representation,[15],[22],[23] nutrition messages,[14] sexuality and human immunodeficiency virus/acquired immunodeficiency syndrome,[16] community mental health ideology,[24] philosophy,[25] hearing health and protection,[26] environmental education,[27] addiction,[17] and national and civic education.[28] Majority of the studies have shown that the textbooks lack the sufficient content for developing an attitude toward a healthy lifestyle and to prevent the development of risky behavior.

For the Standard I, the core component for oral hygiene information was covered partially and no content about the dentist role/visit. These results are in contrast to the study done in Standards I–V by Geetha Priya et al., where the results showed that there was appropriate content in their textbooks.[11]

For Standards II–IV, the core components such as benefits of teeth, oral hygiene, and diet were covered to some extent. With exception for Standard IV, there was no content about dentist role/visit for the other standards. The results were in contrast with study done by Geetha Priya et al., while were supported by other studies.[11],[13],[14],[15]

For Standards V and VI, the core components such as benefits of teeth, oral structure, oral hygiene, dental disease, and diet were present to some extent in only CBSE and ICSE. Content on dentist role/dentist visit was absent in all the three boards. The highest proportion of messages was seen in CBSE followed by ICSE Board for Standard V, while in Standard VI, the highest proportion was seen in ICSE followed by CBSE board. The results were in contrast to the study done by Geetha Priya et al.[11] Studies done by Saito et al.[13] and de Irala et al.[15] reported that the books contained no information about the disease prevention behavior.

Overall, the present study results have differed in comparison to the study by Geetha Priya et al.[11] The reason been, in the latter, the study authors used self-designed assessment tool with only three parameters (anatomy, oral diseases, and practice behavior). The boards chosen were CBSE, State Board, and Matriculation and the textbooks of only Standards I–V were analyzed. However, in the present study, a detailed and standard assessment tool was used and analysis done was from I to X.

For Standards VII and VIII, the core components such as oral structure, dental disease, and diet were covered in CBSE to some extent and tobacco was covered in ICSE to some extent, while preventive measures were absent across the three boards. The highest proportion of the messages was seen in CBSE Board followed by State Board for Standard VII, while in Standard VIII, the highest proportion was seen in ICSE board followed by CBSE board. The results were comparable to the studies done by Barrio-Cantalejo et al.,[10] Saito et al.,[13] and de Irala et al.,[15] where they have reported that the textbook had the correct scientific evidence but lacked the information on the disease prevention behavior and tobacco content. Baysac MA et al.,[12] and Mirzamohammadi MH et al.[17] found that the books had done poor job in providing proper education about oral cancer, risk behavior related to it and components related to developing addiction. These findings corroborate the present study results. Further, Gilvand et al.[21] reported that health component is not fully covered in the text books, which was similar to the results in the present study.

For Standards IX and X, the core components such as dental disease, preventive measures, diet, and tobacco were covered to some extent across the three boards, while oral structure, mass media, and dental care were absent. The highest proportion of the messages was seen in ICSE Board for Standard IX, while in Standard X, it was seen in State Board followed by ICSE. These outcomes are in consensus with the different studies reported in the literature.[12],[13],[17]

In the present study, overall, the evidence was correct except for on two occasions. Barrio-Cantalejo et al. in their content analysis has reported of 100% correct scientific evidence for oral health messages.[10]

There are varieties of publishers for the CBSE schools, yet none of the books had great standards with regard to the complete oral health information as per the assessment tool. Again, with ICSE board books, the content was not fully covered. Further, it appeared that the State Board books had the least information and showed the same incompetency in covering the complete oral health information.

The limitation of the study was that information could not be collected from the CIE and IB board school who did not give permission to conduct the study. Further, since only Science books were selected for content analysis, probably some content about teeth and oral health maintenance (in the form of poem or activity) in the English and other language textbooks would have been missed.

  Conclusions Top

The present study revealed that the textbooks of all the three boards were lacking the oral health content with regard to the core components and coverage extent. Whatever little information that was published in the books had correct evidence. Based on the results of the study, the following recommendations are proposed:

  1. During the stages of development of the contents of the textbook, a dentist should be on the panel so that there is correct and complete oral health information in the textbooks of each board
  2. Information regarding regular dental checkup along with the workshops for school teachers should be conducted so that reinforcement can be made in learning good oral habits and maintaining oral hygiene
  3. Teachers should be trained to teach the children about the proper brushing technique as well as to reinforce the good oral hygiene habits among them
  4. Recommending to the board panel, inclusion of oral health core components which are missing in the textbooks.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4]


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