Impact of Educational Interventions Based on the Implementation Intentions Strategy on the Oral Health of Schoolchildren

Denise Cristina Aceituno Braulio Simpriano, Fábio Luiz Mialhe


Objective: To compare the effectiveness of a traditional educational intervention with other two based on the implementation intentions psychological model on clinical and cognitive aspects related to the oral health of schoolchildren. Material and Methods: A sample of 160 children aged 7-10 years was divided into three groups: control (CG), Intervention 1 (IG1) and Intervention 2 (IG2). Plaque index (PI), gingival bleeding index (GBI) and knowledge on the oral health of schoolchildren were collected at baseline, 30, 60 and 120 days. All groups participated in educational lectures and had individual tooth brushing supervision and children from IG1 and IG2 participated in a self-regulatory strategy called implementation intentions aimed at facilitating behavior of brushing teeth at least three times a day. In addition, children from IG2 participated in a collaborative implementation intentions strategy with their parents in order motivate them to develop the behavior with their children. Results: All groups showed reductions in PI and GBI values and improvements in oral health knowledge, but IG1 and IG2 showed statistically significant differences in these variables compared to CG. Conclusion: The use of the Implementation Intentions psychological model in oral health educational programs showed a greater impact on the knowledge about oral health and plaque index of schoolchildren compared to traditional educational programs.


Psychological Theory; Oral Health Education; Experimental Psychology.

Full Text:



Scheerman JFM, van Loveren C, van Meijel B, Dusseldorp E, Wartewig E, Verrips GHW et al. Psychosocial correlates of oral hygiene behavior in people aged 9 to 19 - A systematic review with meta-analysis. Community Dent Oral Epidemiol 2016; 44(4):331-41. doi: 10.1111/cdoe.12224.

Kwan SY, Petersen PE, Pine CM, Borutta A. Health-promoting schools: an opportunity for oral health promotion. Bull World Health Organ. 2005; 83(9):677-85.

Breinbauer C, Maddaleno M. Youth: Choices and change: Promoting healthy behaviors in adolescents. Pan American Health Organization. ed. 2005.

Kassem NO, Lee JW, Modeste N, Johnston PK. Understanding soft drink consumption among female adolescents using the Theory of Planned Behavior. Health Educat Res 2003; 18(3):278-91. doi: 10.1093/her/cyf017.

Glanz K, Rimer BK, Viswanath K. Health behavior and health education: Theory, research, and practice. Jossey-Bass. ed. 2008.

Gollwitzer PM, Sheeran P. Implementation intentions and goal achievement: A meta-analysis of effects and processes. Adv Exp Soc Psychol 2006; 38:69-119.

Gollwitzer PM, Oettingen G. Planning promotes goal striving. In: Vohs KD, Baumeister RF. Handbook of self-regulation. Research, theory, and applications. New York, NY: Guilford Press. 2.nd. ed. 2011.

Gollwitzer PM, Oettingen G. The emergence and implementation of health goals. In P. Norman, C. Abraham, M. Conner (Eds.). Understanding and changing health behavior. From health beliefs to self-regulation. Oxford: Routledge. 2006. p. 229-60.

Sniehotta FF, Nagy G, Scholz U, Scwarzer R. The role of action control during the first weeks of health behavior change. Br J Soc Psychol 2006; 45(1):87-106. doi: 10.1348/014466605X62460.

Prestwich A, Kellar I. How can the impact of implementation intentions as a behavior change intervention be improved? Revue Européenne de Psychologie Appliquée 2014; 64(1):35-41. doi: 10.1016/j.erap.2010.03.003.

Simpriano DCA, São-João TM, Mialhe FL. Use of the theory of planned behavior and implementation intentions in dentistry: Evidence of literature. Pesqui Bras Odontopediatria Clín Integr 2015; 15(1):345-60. doi: 10.4034/PBOCI.2015.151.37.

Pakpour AH, Gholami M, Gellert P, Yekaninejad MS, Dombrowski SU, Webb TL. The effects of two planning interventions on the oral health behavior of Iranian adolescents: A cluster randomized controlled trial. Ann Behav Med 2016; 50(3):409-18. doi: 10.1007/s12160-015-9767-3.

Pine CM, McGoldrick PM, Burnside G. An intervention programme to establish regular toothbrushing: understanding parent’s beliefs and motivating children. Int Dent J 2000; 50(6):312-23.

Newman MG, Takei H, Klokkevold PR, Carranza FA. Carranza's clinical periodontology. Saunders; 12ns ed. 2014.

D’Cruz AM, Aradhya S. Impact of oral health education on oral hygiene knowledge, practices, plaque control and gingival health of 13- to 15-year-old schoolchildren in Bangalore city. Int J Dent Hyg 2013; 11(2):126-33. doi: 10.1111/j.1601-5037.2012.00563.x.

Paula JS, Leite ICG, Almeida AB, Ambrosano GMB, Pereira AC, Mialhe FL. The influence of oral health conditions, socioeconomic status and home environment factors on schoolchildren’s self-perception of quality of life. Health Qual Life Outcomes 2012; 10:6. doi: 10.1186/1477-7525-10-6.

Bastable SB. Nurse as educator: principles of teaching and learning for nursing practice. ed. Sudbury: Jones & Bartlett Learning; 2013.

Gagliardi L. Dental health education: lesson planning and implementation. ed. Long Grove: Waveland Press; 2007.

Wainwright J, Sheiham A. An analysis of methods of toothbrushing recommended by dental associations, toothpaste and toothbrush companies and in dental texts. Br Dent J 2014; 217(3):E5. doi: 10.1038/sj.bdj.2014.651.

Gollwitzer PM. Implementation intentions: strong effects of simple plans. Am Phychol 1999; 54(7):493-503.

Gill P, Stewart K, Chetcuti D, Chestnutt IG. Children’s understanding of and motivations for toothbrushing: A qualitative study. Int J Dent Hyg 2011; 9:79-86. doi: 10.1111/j.1601-5037.2010.00442.x.

Jenkins WMM, Papapanou PN. Epidemiology of periodontal disease in children and adolescents. Periodontology 2000 2001; 26(1):16-32. doi: 10.1034/j.1600-0757.2001.2260102.x.

Griffin SO, Barker LK, Wei L, Li CH, Albuquerque MS, Gooch BF. Use of dental care and effective preventive services in preventing tooth decay among U.S. children and adolescents - Medical Expenditure Panel Survey, United States, 2003–2009 and National Health and Nutrition Examination Survey, United States, 2005–2010. Morbidity and Mortality Weekly Report (MMWR) 2014; 63(2):54-60.

Friel S, Hope A, Kelleher C, Comer S, Sadlier D. Impact evaluation of an oral health intervention amongst primary school children in Ireland. Health Prom Int 2002; 17(2):119-26. doi: 10.1093/heapro/17.2.119.

Schüz B, Wiedemann AU, Mallach N, Scholz U. Effects of a short behavioral intervention for dental flossing: randomized controlled trial on planning when, where and how. J Clin Periodontal 2009; 36(6):498-505. doi: 10.1111/j.1600-051X.2009.01406.x.

Schüz B, Sniehotta FF, Wiedemann A, Seemann R. Adherence to a daily flossing regimen in university students: effects of planning when, where, how and what to do in the face of barriers. J Clin Periodontol 2006; 33:612-9. doi: 10.1111/j.1600-051X.2006.00967.x.

Christensen P. The health-promoting family: a conceptual framework for future research. Soc Sci Med 2004; 59(2):377-87. doi: 10.1016/j.socscimed.2003.10.021.

Goel P, Sehgal M, Mittal R. Evaluating the effectiveness of school-based dental health education program among children of different socioeconomic groups. J Indian Soc Pedod Prev Dent 2005; 23(3):131-3. doi: 10.4103/0970-4388.16885.

Okada M, Kawamura M, Kaihara Y, Matsuzaki Y, Kuwahara S, Ishidori H, Miura K. Influence of parent’s oral health behaviour on oral health status of their school children: an exploratory study employing a causal modelling technique. Int J Paediatr Dent 2002; 12(2):101-8. doi: 10.1046/j.1365-263X.2002.00338.x.

Cristi-Montero C, Bresciani G, Alvarez A, Arriagada V, Beneventi A, Canepa V, Espinoza P, Parraguez M, Toledo C, Valencia C, Rodriguez-Rodriguez F. Critical periods in the variation in body composition in school children. Nutr Hosp 2014; 30(4):782-6. doi: 10.3305/nh.2014.30.4.7694.


PBOCI is a member of CrossRef and all the content of its journals are linked by DOIs through CrossRef.