Development and Implementation of an Oral Health Survey Oral Health Module Survey Development and Implementation of an Oral Health Survey

Overview Practical steps to consider including: Organizing & Planning Surveys Training and Calibration Implementing the Survey Reporting on the Results

Organizing & Planning an Oral Health Survey In this section: Determining the Objectives Budget Methodology and Sampling Planning Committee Partnership Ethics and other Approvals Personnel for the Survey Selecting Survey Tools Qualitative Survey Tool Clinical Survey Development Testing/Validating Survey Tools Survey Design Considerations Instrument & Equipment

Determine the Objectives Knowing what you want to achieve from the survey will help to define its parameters and target age groups. Consider whether the survey will focus on a: -type of client -particular age group -type of disease/condition The resulting decision will help frame the survey

Budget Knowing how much money is available for the survey defines the survey parameters. The available budget determines: -the size of the survey -how many sites can be covered (travel considerations) -whether a sex split is possible in the age groups -the type and number of personnel that can be contracted -the type of equipment that can be used -the communication documents for implementation & for dissemination of results -the depth of analysis

Methodology and Sampling To assist with preparing the sampling frame one needs to determine: -whether the services of a methodologist or an epidemiologist is required -the size of the population to be surveyed -the age groups to be assessed -the prevalence rates per age groups for the various factors to be assessed if not known: a “mini-survey” could help to define the prevalence rates

Planning Committee Bring together researchers, regulators, professional and government officials from the outset of the planning stage. -To help guide the development, implementation & analysis of the survey (including survey tool development) -To discuss licensure requirements of the examiners

Partnership Establish and formalize partnerships early in the planning stage of the survey. -Detail the authority, roles & responsibilities of all players -Outline the financial commitment of all players -Define the decision making authority, communication, the analysis and dissemination requirements of all parties -Clarify expectations of both parties

Ethics and other approvals Need to arrange approvals to examine the population from the proper authority. Ensure that a review by the proper research ethics board(s) is (are) conducted as required. Review legislation about the protection of personal information. Confirm approach for consent to participate in the survey. legal age of consent for children/need for a proxy

Personnel for the Survey Consider the number & type of personnel required to implement the survey. Use of existing staff/hiring new staff Determine the full costing, licensing requirements, training costs & travel of staff. Consider the roles and responsibilities for all personnel.

Selecting Survey Tools The original objectives of the survey will assist with determining the required elements within the survey tools. Including: Measures of interest Age group of interest Consider the following: Qualitative versus clinical examination or both Use of existing qualitative and clinical tools Need to develop new questions

Qualitative Survey Tool Choose questions based on what you are trying to assess. Conduct a search to find already used questions. These questions have been already tested & allow for comparisons to be made If developing new questions: Focus test questions to better determine If the questions will be understood by target population Prepare an interview guide to clarify potential queries from the respondents about the questions.

Clinical Survey Tool Development Decide on the elements to be examined based on the objectives of the survey. Choose indices to be used for examination. i.e. Dean’s index vs. Tooth Surface Index of Fluorosis (TSIF) Consider age/health restrictions for certain questions. i.e. <18- no root assessments Haemophiliac- no periodontal probing Consider expected minimum/maximum values for answers. Will assist with accuracy of data collection Determine if there are any skip patterns (based on age, restrictions, dentate status, etc). Consider the order of questions to maximize skips.

Test/Validate Survey tools Perform mock tests on the tools. Pre-test the tools with various age groups. -Do skips and edits function as expected? -Does the order of questions make sense? -How long do the tools take to administer? Revise tools as necessary.

Survey Design Considerations: Paper based versus data entered into a software program Security of data Training requirements for data entry If paper based consider what statistical program will be used to analyze the results (i.e. excel) If computer entered consider the availability of technical support

Instruments & Equipment Instruments Consider -Disposable versus reusable instruments Cost implications Sterilizing process /Frequency of spore testing -Number of instruments required for the number of exams Equipment Consider -Portable versus fixed -Size of room available Infection Control Consider -the materials required to maintain the cleanliness of the room i.e. surface cleaner, gloves, plastic sleeves for chair/tray, masks

Training & Calibration In this section: Training and Calibration Consideration (for the dental examiners) Considerations for the Calibration Session Dental Recorder Training Ongoing Training Requirements

Training & Calibration Considerations for the oral health examiners Training on: Purpose of the survey The indices & how to conduct exam Calibration on indices to: -Increase validity (success in measuring what you set out to measure) -Increase reliability (exam giving the same result on repeated inspections) -Increase intra-reliability (reproducibility within examiners) -Increase inter-reliability (reproducibility between examiners)

Consideration for the Calibration session Location Need dental chairs available (i.e. dental training facility) Trainers To run the session and to whom the examiners calibrate against Coordinator Logistics/obtaining consent & health restrictions/entering data Respondents Variety of ages & dental conditions Fluorosis & Periodontal Indices Difficult to calibrate; allow enough time Analyzing results Simsat program used to obtain % agreement & kappa scores

Calibration session Sample Calibration schedule continued on next slide Day 1   Day 2 Time Chair 1 Chair 2 Chair 3 9:00-12:00 Classroom Session Presentations/Fluorosis Training 9:00-10:15 Statistics/Fluorosis 10:15-10:30 Break 10:30-11:45 Patient 4 Patient 5 Patient 6 11:45-12:00 Discussion/questions 12:00-1:00 Lunch 1:00-2:00 Patient 1 Patient 2 Patient 3 Patient 7 Patient 8 Patient 9 2:00-3:00 Discussion/Questions 3:00-3:15 Patient 10 Patient 11 Patient 12 4:15-5:00 Discussion/Fluorosis training 3:15-5:00 Discussion Fluorosis Notes on the schedule above All patients (except for the repeats) will be examined by all dentists including the trainer. The results of the examinations will then be compared to the trainer for inter-reliability. Repeat patients will be examined by all dentists who are getting trained (not the trainer). The results from these examinations will be compared to their own previous exams for intra-reliability.

Calibration schedule continued…   Day 3 Day 4 Time Chair 1 Chair 2 Chair 3 9:00-10:15 Statistics Review 10:15-10:30 Break 10:30-11:45 Patient 13 Patient 14 Patient 15 Repeat*** 1 Repeat 2 Repeat 3 11:45-12:00 Discussion/Questions Lunch 1:00-2:00 Patient 16 Patient 17 Patient 18 Repeat 4 Repeat 5 Repeat 6 2:00-3:00 Patient 19 Patient 20 Patient 21 2:00-2:30 2:30-3:15 Final Fluorosis Testing Statistical Review 3:00-3:15 3:15-5:00 Discussion Fluorosis as necessary Discussion Questions Finish

Dental Recorder Training Consider covering: -A review of the roles & responsibilities of the dental recorder covering: Managing the daily operations of the oral health room. Recording the oral health clinical exam Monitoring dental supplies and ordering as needed Performing the spore tests (if required by the dental recorder) -A review of the oral health clinical tool -An overview & practice on the operation of the autoclave (as required)

Ongoing Training Requirements Consider incorporating training sessions throughout data collection period to increase consistency of results. For example: A mini recalibration session at the start & middle of each site Ongoing training and testing on fluorosis Retraining sessions for recorders as required

Implementing the Survey In this section: Communication Scheduling

Communication Consider the communication needs of the respondent -information package on survey/consent process Establish protocols for communication with respondents, local media & stakeholders -communicating results -scheduling clinic appointments

Scheduling Prepare daily & weekly schedules that take into consideration -the time to ask qualitative questions -the time to do the clinical examination -how long it takes to clean & set up between respondents -capacity of the clinic

Reporting the Results of the Survey In this section: Analysis Tables for Presenting the Results Reports

Analysis -Consider whether the analysis of the results can be done in house or if outside expertise is required -Compare results to past surveys conducted on the same population Note any changes -Compare results to international surveys on similar populations Note similarities/difference

Tables for Presenting Results The use of tables are excellent vehicles for displaying results by different variables. Characteristics such as: age, sex, income, education, smoking status, can be displaced on one side of the table with elements of the indices on the other side (i.e. decay, missing, filled, DMF) Offers the ability to communicate information in a concise format.

Mean number of permanent teeth Decayed, Missing and Filled Sample Table Characteristic Prevalence Mean number of permanent teeth Percent with DMFT > 0 Decayed Missing Filled Decayed, Missing and Filled %   95% CI mean All Female Male Higher income Middle income Lower income Income missing Highest Household Education= degree/diploma Highest Household Education < degree/diploma

Reporting the Results Reports need to be geared for the audience Consider creating 2 reports -1 for the academics -1 for the general public Consider reporting results back to the survey respondents For example: http://www.fptdwg.ca/assets/PDF/CHMS/CHMS-E-summ.pdf http://www.fptdwg.ca/assets/PDF/CHMS/CHMS-E-tech.pdf