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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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

12. 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.

13. 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.

14. 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.

15. 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

16. 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

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

18. 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)

19. 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

20. 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.

21. 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

22. 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)

23. 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

24. Implementing the Survey In this section:
Communication
Scheduling

25. 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

26. 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

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

28. 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

29. 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.

30. 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

31. 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: