Preparation and evaluation of a multimedia oral health education software for teenagers

Abstract

Background

Maintaining good oral and dental hygiene is one of the most crucial components of a healthy lifestyle. Health education is implemented through various techniques, such as lectures, movie screenings, printed materials, etc. This study aimed to develop a multimedia teaching instrument for oral and dental health education and assess its effectiveness in raising teenagers’ knowledge and satisfaction.

Methods

the research’s sample size included 70 teenagers, who were chosen randomly. The users were given access to the program before and after using the software, and its efficacy was assessed from their perspective using questionnaires. The data analysis was performed using descriptive statistics indices and analytical tests, SPSS version 26. A significance level of 0.05 was considered.

Results

The average age and educational grade of software users were 14.49 years and 8.49 years, respectively. Before using the software, 67.76 ± 19.8% of the questions were answered correctly, while after using the software, 86.85 ± 10.21% of the questions had an accurate response. Before and after utilizing the program, there was an increase of 22.9 ± 17.8% in the mean correct response.

Conclusion

Useful training in the mentioned software, along with multimedia content and easy access of teenagers to the training, will facilitate and increase the speed of health education and reduce the time and cost of subsequent oral and dental health disorders.

Introduction

Good oral and dental hygiene is one of the critical elements of a healthy lifestyle [1, 2]. Despite the efforts of developed countries, dental caries are progressing alarmingly and have increased in some developing countries due to lifestyle changes [3, 4]. In developing nations, many children and adolescents have limited access to oral and dental health services and suffer from caries of their permanent teeth [5, 6]. Mouth and tooth pain is one of the problems associated with dental caries that makes teenagers unable to take full advantage of their educational environment [7].

Poor oral and dental health can affect adolescents’ performance in school and daily life, so more than 54 million school hours are lost annually because of oral and dental diseases [8]. During adolescence, people can acquire the necessary skills to create a healthy lifestyle [9]. This is achieved through proper training, gathering scientific information, and strengthening desirable and stable attitudes during their years of education [10]. For this purpose, it is necessary to train oral health guidelines in schools under the supervision of various health groups, especially dentists [11].

Dentists could efficiently help with primary oral health care delivery, such as oral hygiene education and oral cancer screenings [1]. Correct planning of a school health education program requires selecting a suitable method. Since the primary goal of health education is to develop programs designed based on audience characteristics for a more significant impact and ultimately improve the health of the target groups, it is essential to choose the relevant oral hygiene methods to capture the audience’s attention and transfer knowledge and other skills, as well as deliver correct and appropriate messages to them. Teaching methods have become more diverse with significant advances in educational technology, although the effectiveness and efficiency of many of them are doubtful [1, 12].

However, there are doubts about the effectiveness and efficiency of many of them. Traditional education is based on providing information about dental caries and how to brush and floss the teeth [13]. This information is expected to make a change, but it is necessary to change the method because the Decayed, Missing, and Filled Teeth (DMFT) index was high in teenagers due to their lifestyles [14]. Various approaches use molasses and printed materials to implement health promotion programs, including lectures, small-group discussion groups, role-playing, shows, and movies [15]. In this regard, one of the relatively new methods is using educational multimedia software, which is suggested to improve education at elementary and advanced levels [16]. Some researchers have argued that using media, especially visual media, is one of the best educational approaches with long-term durability [17].

Visualized health education, such as cinema, television, and especially educational films, is among the most effective methods of persuading and encouraging community members and target groups to comply with health standards and regulations [18]. In Iran, research on the effectiveness of different educational methods has grown significantly, and the effectiveness of different educational methods has often been compared [19]. Understanding the effectiveness of various educational methods can help analyze other factors affecting learning, and its results are effective in future educational planning. Since educational software can be considered a new type of high-quality multimedia with much more potential, this study aimed to prepare multimedia software for oral and dental health education and evaluate its satisfaction and impact on the level of oral health knowledge in teenagers.

Methods

Research design

This study was applied as a production research (software design). The professors of the Department of Dental Public Health and the Department of Public Health of Shiraz University of Medical Sciences verified and analyzed all stages of preparing oral health education software for teenagers, including algorithm design of oral health educational content, software design, and software development.

Sample size and sampling method

The study employed a simple random sampling method to ensure an unbiased selection of participants. Adolescents aged 13 to 17 years from grades 7 to 11 were randomly selected from multiple schools to enhance the diversity and representativeness of the sample. The sample size was determined based on a power analysis to detect a significant difference in knowledge scores before and after the intervention. Assuming a medium effect size (Cohen’s d = 0.5), a significance level of 0.05, and 80% power, the minimum required sample size was estimated to be 63 participants. To account for possible dropouts or incomplete responses, 70 students were recruited, all of whom completed the study (Fig 1).

Fig. 1

Welcome and registration page of the oral health education software, displaying the application title, introductory information, and user sign-up options including email/phone entry and one-time password verification

Data collection

Adolescents’ oral health knowledge was assessed before and after training using a researcher-developed questionnaire. The questionnaire’s validity was confirmed through content validity assessment by a panel of eight oral health specialists, and its reliability was established with a Cronbach’s alpha of 0.78 (Fig 2).

Fig. 2

User registration interface of the oral health education software, displaying fields for email or phone number, password entry, and the option to log in using a one-time password

In addition to knowledge assessment, participant satisfaction with the multimedia tool was evaluated using a post-intervention questionnaire. This questionnaire included four key items assessing [1] general opinion about the software [2], perceived usefulness in gaining new knowledge [3], overall satisfaction level, and [4] ease of use. Responses were measured using a five-point Likert scale (1 = very dissatisfied to 5 = very satisfied) for general opinion and satisfaction level, while usability and knowledge gain were assessed with binary (yes/no) responses. The satisfaction questionnaire aimed to gauge user experience, engagement, and perceived effectiveness of the intervention. The collected data were analyzed using descriptive statistics (mean, standard deviation, frequency) to summarize participant feedback (Fig 3).

Fig. 3

Instructional page on brushing teeth, featuring a text explanation about the importance of brushing followed by an embedded educational video demonstrating proper brushing technique

Procedure

Software development and study procedure

This research was performed in three phases:

Phase 1: content development and pilot testing

The development of the multimedia oral health education software involved collaboration with health education specialists, dental public health experts, and adolescent representatives to ensure that the content was both scientifically accurate and engaging for teenagers. Reliable sources, including evidence-based oral health guidelines and input from adolescents, were used to develop educational content tailored to their needs and preferences (Fig 4).

Fig. 4

Overview of the software content structure, listing core topics including pre-test, brushing, dental floss, mouthwash, healthy diet, and instructions on fluoride mouthwash, beginning with a descriptive text about its benefits in preventing tooth decay, followed by a step-by-step video demonstrating correct usage techniques

Before full implementation, the software underwent pilot testing with a small group of ten teenagers who were not part of the final study sample. The pilot phase aimed to assess usability, clarity of content, engagement level, and technical functionality. Participants provided feedback through structured interviews and questionnaires, leading to minor modifications, such as simplifying navigation, refining quiz questions, and adjusting video durations for better engagement. This step ensured that the software was accessible, user-friendly, and suited to the learning needs of the target population.

Phase 2: software design, accessibility, and features

The validated educational content and instructional algorithms were implemented into the software using PHP, HTML5, JavaScript, and MySQL database to develop a web-based application: “Oral and Dental Health Education Web Application for Teenagers.” The software was designed to be interactive and engaging, integrating multimedia features such as instructional videos, quizzes, and progress tracking.

The program consists of the following sections:

• Registration: Users registered by providing their name and contact number and received a one-time login code to verify authenticity, prevent duplicate entries, and ensure security.

• Training course: This section included structured educational modules covering key oral health topics, such as:

  • The importance of oral hygiene.

  • Proper brushing techniques (demonstrated through video tutorials).

  • Correct flossing methods.

  • The role of fluoride in preventing cavities.

  • The impact of diet on oral health.

  • Common oral health problems and prevention strategies.

  • As users progressed through the course, their completion status was tracked. Upon finishing all modules, users received a digital certificate and a small incentive reward to encourage engagement.

• Interactive elements and gamification: The software included quizzes at the end of each module to reinforce learning and test comprehension. Users could track their progress through a visual interface. To increase motivation, gamification elements such as achievement badges and rewards were incorporated.

• Software guide: This section provided an educational video on how to navigate the platform.

• FAQs and support: The software overview included frequently asked questions (FAQs), a general description of the software’s purpose, and information on compatible operating systems and devices (Android, iOS, Windows, tablets, smart TVs, etc.). It also featured “Contact Us” and “About Us” sections with details on the development team.

To ensure accessibility, the software was not distributed via commercial app stores (Google Play or Apple Store) but was instead made available through a dedicated web-based platform. Participants accessed it via a direct link provided by the research team, ensuring controlled enrollment and preventing external users from interfering with the study. The web-based format allowed compatibility across multiple devices, including smartphones, tablets, and computers, without requiring installation.

Phase 3: participant enrollment, duration of use, and data collection

Seventy teenagers were randomly selected to participate in the study. After signing up, they were granted access to the software and completed the entire training course at their own pace. The duration of participant interaction with the software varied, but on average, users spent 45 to 60 min completing all educational modules before taking the post-test questionnaire. Participants were instructed to complete the training within one week of enrollment to ensure consistent exposure to the material.

To evaluate the software’s effectiveness, participants completed a structured questionnaire at two time points:

• Pre-test: Assessed their baseline knowledge of oral health before using the software.

• Post-test: Evaluated their knowledge after completing the training course. The same questionnaire was used for both assessments to ensure consistency.

• Satisfaction survey: Upon finishing the training, participants also completed a user satisfaction questionnaire, which assessed their general opinion of the software, perceived effectiveness, ease of use, and engagement level. Responses were measured using a five-point Likert scale (for general satisfaction and usability) and binary (yes/no) responses for knowledge gain and ease of navigation.

Statistical analysis

The data analysis was performed with descriptive statistics indices (mean, standard deviation, frequency) and analytical statistics tests such as paired t-test, independent t-test, and regression using IBM SPSS Statistics, version 26 (IBM Corp, Chicago IL, USA). A significance level of 0.05 was considered (Fig 5).

Fig. 5

Example of a pre-test question page within the software, illustrating the format used to assess baseline knowledge of oral health topics among adolescent users

Ethical considerations

All 70 students voluntarily agreed to participate in the study and signed a written informed consent form. This study was approved by the ethics committee in Shiraz University of Medical Sciences with the code of IR.SUMS.DENTAL.REC.1401.095.

Results

In this study, 70 students aged 13–17 completed the training course and answered pre- and post-questionnaires. In total, 37 boys and 33 girls, with an average age of 14.49 ± 0.89, participated in this research. The demographic data of the participants is presented in Table 1.

Table 1 Demographic information

The average correct responses to the questions before and after using the software were 76.64 ± 19.8% and 85.86 ± 10.21%, respectively. The average responses to the questions before and after using the software showed a 25.1% ± 17.8 increase.

The minimum scores at the beginning and after using the software were 2 and 6, respectively. The maximum scores at the beginning and in the final questionnaire were.

14 and 15, in order. The initial and final questionnaire scores are compared in Table 2.

Table 2 Comparison of questionnaire scores before and after of intervention

Table 3 displays how the demographic variables affected the change in the questionnaire score.

Table 3 The effect of demographic variables on the change of questionnaire score (∆)

For age, mean variable mean values with at least a common letter in superscript were not statistically different (Tukey’s post-hoc test).

The 13-year-old group’s average delta (∆) score in the text was noticeably greater than the 15-year-old group’s. Group 13’s average delta (∆) was higher than group 14’s, but the difference was not statistically significant. Groups 14 and 15 did not significantly differ from each other.

Four items concerning software appraisal were included in the posttest questionnaire that the users were shown. (Table 4).

Table 4 Levels of satisfaction and efficiency of the software

Discussion

The study aimed to design, implement, and evaluate a smartphone-based software for oral health education targeted at teenagers. A sample of 70 students from the 7th to 11th grades participated, completing all training courses and answering both pre- and post-intervention questionnaires. The key findings of this study indicated a significant increase in the average knowledge scores of teenagers before and after using the software, suggesting that multimedia-based education software is effective in enhancing oral health knowledge among this age group. Notably, the increase was significant among students aged 13 to 15 but not among those aged 16 and 17, which may reflect varying levels of engagement or different learning needs across age groups.

Comparing these results with previous studies provides a broader context for evaluating the effectiveness of various educational methods. Zarabadipour et al. (2022) evaluated the effects of oral hygiene training on dental plaque index in 9-year-old children using face-to-face training methods. Their study showed a significant reduction in dental plaque index after the educational intervention, highlighting the effectiveness of direct and personalized instruction in improving oral hygiene​ [20]. Angelopoulou et al. (2014) compared experiential learning (EL) and traditional lecturing (TL) in a school-based oral health education program for 13-year-old students. They found that EL was more effective than TL in improving oral health behavior, attitude, and clinical outcomes such as oral hygiene and gingival health over an 18-month period​ [21]. This aligns with our findings that interactive and engaging educational methods, like multimedia software, can significantly enhance knowledge and potentially influence behavior more effectively than traditional methods.

Stein et al. (2017) conducted a systematic review and meta-analysis on the effectiveness of oral health education in schoolchildren, concluding that while traditional educational methods improve knowledge, they often fall short in sustaining behavior change and improving clinical outcomes​ [22]. The current study’s approach of using multimedia software addresses some of these limitations by providing an engaging and interactive platform that can be regularly updated and easily accessed by teenagers, thereby maintaining their interest and reinforcing positive behaviors over time. The study by Ahmad et al. (2019) demonstrated the effectiveness of health education delivered by trained students in improving oral hygiene among primary school children in Pakistan. Their findings emphasized the importance of peer-led education and its impact on children’s oral health practices​ [23]​. This peer-led approach, although effective, requires considerable coordination and training, whereas the multimedia software can be used independently by students, reducing the need for continuous supervision and training.

According to the survey results, most of the audience perceived the software as informative, efficient, helpful, and user-friendly. The average satisfaction score level was 66.4 (on a 5-point score ranking), a significant score. Much research has been conducted to investigate the impact of oral health education approaches on the oral health of different people [24]. In some cases, the effect of multimedia content on people’s awareness was similar to the impact of direct training of dentists and health promotion experts. On the other hand, in some other cases, the necessity of online and multimedia training is mentioned as a supplement to face-to-face training and to help improve the health education process [25]. Considering the rapid evolution of connection pathways through the population, especially in the youth, the novel use of multimedia for dental hygiene education could be a perfect supplement to their education.

Consistently, Radentz showed a combination of different educational methods, such as television programs, video film screenings, and self-taught programs, and found the same successful results as individual direct training [26]. In another research, Glavind et al. showed that self-taught oral health education programs are as effective as dental training. They classified 55 patients into three groups: the group that the dentists trained, the group trained by the self-taught programs, and the control group. It was found that self-education can be as effective as education by a dentist [27]. Lees et al. conducted a study on 65 patients aligned with these results. It has been shown that self-taught health and oral care programs at home can be as effective as oral health education in the clinic. In addition, these programs require less executive personnel and time [28].

Traditional training by health experts and dentists is time-consuming [29]. An increase in the daily number of patients will lead to less time on each person because there is a significant correlation between the number of daily patients and the time spent on each person by the dentist [30]. Another valuable characteristic of the utilized software was the lack of need for dentists or other medical staff to spend their time in oral health education. Another advantage of the software is that it is web-based and can be used on all operating systems, including Android, iOS, Windows Phone, etc. This software can also be easily modified and updated. The regular user’s access to oral and dental health education allows them access if necessary. In this software, the training programs were designed according to simple and valuable principles so that the most comprehensive training was available to the user in the shortest possible time.

Strengths and limitations

One major strength of this study was raising teenagers’ knowledge of novel multimedia formats and multimedia software through attractive and informative short films rather than long and tedious texts. No software similar to the one designed in the research was available, so we cannot compare it with other software. In future studies, the effectiveness of this software can be evaluated in different ethnic and socio-economic groups, or a comparison can be made if similar software is available.

One limitation of the study is the absence of a control group, which makes it challenging to attribute knowledge gains solely to the multimedia tool. Although methodological controls were implemented to minimize potential confounding factors, future studies should consider a randomized controlled design for stronger causal inference. Additionally, our study assessed only short-term knowledge changes, without a follow-up evaluation to measure long-term knowledge retention. Future research should incorporate longitudinal assessments to determine the sustainability of learning outcomes and the potential need for reinforcement strategies. Another limitation of the software is that it does not account for users’ individual and geographical differences. Since teenagers across various regions may have different facilities and limitations, a supplementary study should be conducted to adapt the training process and educational content based on social, cultural, and financial contexts. Lastly, the simultaneous effect of other types of training (e.g., videos with infographic images) was not controlled, which may have influenced the results. Further studies are recommended to examine the impact of different multimedia content formats on teenagers’ self-awareness and learning outcomes.

Conclusion

This study demonstrated that a multimedia-based oral health education tool significantly improved adolescents’ knowledge, highlighting its potential as an effective and engaging learning method. Given the widespread use of digital platforms among teenagers, integrating such multimedia tools into school-based oral health education programs could enhance knowledge retention and promote better oral hygiene practices. The software’s accessibility, ease of use, and interactive nature make it a scalable solution for improving oral health awareness beyond traditional educational settings.

From a public health perspective, implementing digital learning tools in schools and community programs can help bridge gaps in oral health education, particularly in areas with limited access to dental professionals. Additionally, this approach reduces the reliance on face-to-face instruction, making health education more cost-effective and sustainable. Future studies should assess the long-term impact of such interventions on behavior change, including improved brushing and flossing habits, reduced dental caries incidence, and overall oral health improvement. Enhancing the software with personalized feedback, gamification, and periodic reinforcement could further support sustained learning and behavior modification.

By leveraging technology-driven education, policymakers and educators can create more engaging and effective health promotion strategies, ultimately contributing to better oral health outcomes in adolescents.