Oral Health Knowledge, Reading Comprehension, and Behavior Change After Implementing the eBook for Oral Health Literacy© Curriculum with 3rd Graders During COVID-19: Implication for School Health Education

One year after the COVID-19 quarantine, we conducted an eight-week pilot study with third graders (n = 246), who took a repeating knowledge, attitude, and behavior pretest and a reading comprehension posttest from the eBook for Oral Health Literacy© curriculum. Our research questions were: 1) Will the knowledge, attitude, and behaviors of third graders change over time after reading eight chapters of the curriculum? 2) Is there a relationship between the knowledge, attitude, and behavior pretest scores and the reading comprehension and written spelling posttest scores of the oral health literacy curriculum? and 3) Is there a relationship between the class attendance of students and their pretest scores on eight chapters of the eBook for Oral Health Literacy© curriculum? Mixed-effects logistic regression models were employed. Pretest responses of oral health knowledge, attitudes, and behaviors were the dependent variables, and the eBook chapter numbers (n=8) were the independent variables to see if there were changes in students’ pretest responses over time. The model accounted for the age and gender of each student as fixed effects; a random effect was used to account for student variability. First, chapters of the curriculum were significant predictors of knowledge (Chapters 2, 4, 5, 6, 7, & 14/15) and behavior (Chapters 3, 4, 5, 6, 7 & 14/15), but not attitudes. Chapter 5 was a significant predictor of knowledge, attitude, and behavior pretest scores. Second, third graders significantly enhanced their oral health knowledge and behaviors as indicated by their posttest scores for reading comprehension and written spelling. Third, to determine the impact of pretest scores on student attendance during COVID-19, a generalized linear mixed model employed student attendance as the dependent variable and student pretest scores as the independent variables. Significant relationships resulted between student attendance and pretest answers on Behavior Question 1 for brushing teeth (p = 0.004); on Knowledge Question 2 for having a toothbrush (p = 0.001); and on Knowledge Question 8 for having any cavities (p = 0.020). Posttest scores for reading comprehension and spelling were significantly associated with student attendance (p = 0.009). A digital curriculum called the eBook for Oral Health Literacy© shows promise in changing oral health knowledge and behaviors among third graders after an eight-week intervention. Limitations include the lack of a control group and lack of curriculum time for health education instruction during COVID-19.