Exploring Malaysian schoolchildren's perception of the advantages and disadvantages of the ToothPoly board game: a qualitative study

The effectiveness of children’s oral health education (OHE) is determined by the appropriateness of the educational materials used, which can influence their attitude towards oral health. However, there is a lack of studies exploring the benefits of OHE materials from the perspective of schoolchildren. This study aimed to explore schoolchildren’s opinions on the newly developed ToothPoly board game as an OHE tool. A qualitative approach using focus group discussions (FGDs) was conducted among 44 schoolchildren aged 12 years old from a public school in Malaysia. Convenience sampling was employed to recruit the schoolchildren. The ToothPoly board game was playtested and FGDs were conducted after the playtesting session ended. Data collection and analyses were performed concurrently until data saturation was reached. The data were transcribed and coded using Atlas.Ti software version 9.1.3 followed by the framework method analysis. Mixed opinions were observed among the schoolchildren with a majority expressing favourable opinions on the advantages of the ToothPoly board game as an OHE tool. Five themes emerged from the advantages aspect, i.e., fun and enjoyable, promote focus, attention and oral health-related learning, attractive board game features, and enhance peer interaction. Meanwhile, two themes emerged that were related to the disadvantages of the board game, i.e., “competition with online games and media” and “not practical for a large group activity”. The findings showed that the ToothPoly board game was perceived as a useful, interactive, and enjoyable tool to learn about oral health in small groups. The findings of the study highlight the importance of tailoring OHE activities to fulfil the needs of specific target groups to ensure its acceptance and future success.

Dental health education; Oral health; Children; Pediatric dentistry

[1] World Health Organization. Global oral health status report: towards universal health coverage for oral health by 2030. 2022. Available at: https://www.who.int/health-topics/oral-health (Accessed: 26 January 2023).

[2] Karbownik MS, Wiktorowska-Owczarek A, Kowalczyk E, Kwarta P, Mokros Ł, Pietras T. Board game versus lecture-based seminar in the teaching of pharmacology of antimicrobial drugs—a randomized controlled trial. FEMS Microbiology Letters. 2016; 363: fnw045.

[3] Ghaffari M, Rakhshanderou S, Ramezankhani A, Noroozi M, Armoon B. Oral health education and promotion programmes: meta-analysis of 17-year intervention. International Journal of Dental Hygiene. 2018; 16: 59–67.

[4] Anwar AI, Supiaty HR. The effectiveness of game-based education on dental and oral health behavior: systematic review. Open Journal of Clinical and Medical Images. 2022; 2: 1018.

[5] Bramantoro T, Santoso CM, Hariyani N, Setyowati D, Zulfiana AA, Nor NA, et al. Effectiveness of the school-based oral health promotion programmes from preschool to high school: a systematic review. PLOS ONE. 2021; 16: e0256007.

[6] Ramlay MZ. Garis Panduan Perkhidmatan Kesihatan Pergigian Sekolah. 3rd Edition. Program Kesihatan Pergigian Kementerian Kesihatan Malaysia: Putrajaya, Malaysia. 2022. (In Malay).

[7] Siew Lian Y, Abd. Muttalib K, Teck Pei T, Che Salleh N, Ashikin Abdullah N, Aliyah Ismalil N, et al. The national health and morbidity survey 2017: national oral health survey of schoolchildren 2017: volume II: oral health status of 12-year-old schoolchildren. 2017. Available at: https://hq.moh.gov.my/ohd/images/pdf/research/NHMS%202017%20NOHSS%202017%20Vol%20II%20Oral%20Health%20Status%20of%2012%20yr%20olds.pdf (Accessed: 26 April 2023).

[8] Ab Mumin N, Yusof ZYM, Marhazlinda J, Obaidellah U. Exploring the opinions of secondary school students on the strengths and weaknesses of the school dental service in Selangor, Malaysia: a qualitative study. BMC Oral Health. 2021; 21: 394.

[9] Coil DA, Ettinger CL, Eisen JA. Gut check: the evolution of an educational board game. PLOS Biology. 2017; 15: e2001984.

[10] Respati T, Fitriyana S, Romadhona N, Ibnusantosa G, Frederrico R, Yulianto F A, et al. Gastronot: a pilot project for promoting healthy eating habits using mixed-method study design. F1000Research. 2021; 10: 1273.

[11] Martinez L, Gimenes M, Lambert E. Video games and board games: Effects of playing practice on cognition. PLoS ONE. 2023; 18: e0283654.

[12] Istiono W. Does the education games with adding some entertainment game elements will attract the children? International Journal of Advanced Trends in Computer Science and Engineering. 2021; 10: 2721–2726.

[13] Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007; 19: 349–57.

[14] Kallio H, Pietilä A, Johnson M, Kangasniemi M. Systematic methodological review: developing a framework for a qualitative semi-structured interview guide. Journal of Advanced Nursing. 2016; 72: 2954–2965.

[15] Merkens, H. Selection Procedures, Sampling, Case Construction. In Flick U, Von Kardorff E, Steinke I (ed(s).) A companion to qualitative research 165-171. SAGE Publications Ltd: London, UK. 2004.

[16] Adler K, Salanterä S, Zumstein-Shaha M. Focus group interviews in child, youth, and parent research: An integrative literature review. International Journal of Qualitative Methods. 2019;18.

[17] Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: a systematic review of empirical tests. Social Science & Medicine. 2022; 292: 114523.

[18] Etikan I. Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics. 2016; 5: 1.

[19] Syahraz NF, Mohd Nor NA, Mohd Yusof ZY, Yusop FD, Obaidellah UH, et al. ‘Development of oral health education board game for primary schoolchildren’, International Invention, Innovation & Design Expo (INoDEx 2021) Virtual expo 8-9 November. 2021. Institute of Nano Optoelectronics research and Technology (INOR): Pulau Pinang, Malaysia. 2021.

[20] Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology. 2013; 13: 117.

[21] Jang LF, Tan WG. Let’s play board game together: how board games benefit child development and learning. International Journal of Research Studies in Education. 2022; 11: 55–71.

[22] Suleiman-Martos N, García-Lara RA, Martos-Cabrera MB, Albendín-García L, Romero-Béjar JL, Cañadas-De la Fuente GA, et al. Gamification for the improvement of diet, nutritional habits, and body composition in children and adolescents: a systematic review and meta-analysis. Nutrients. 2021; 13: 2478.

[23] Lindgreen P, Stenov V, Willaing I, Basballe HG, Joensen LE. Playing with peers: exploring peer support mechanisms of a type 2 diabetes-specific board game. Qualitative Health Research. 2021; 31: 1990–2004.

[24] Nieh H, Wu W. Effects of a collaborative board game on bullying intervention: a group-randomized controlled trial. Journal of School Health. 2018; 88: 725–733.

[25] Pangeiko Nautwima J, Romeo Asa A, Panduleni Nendongo V. Integrating gamification into middle school mathematics curriculum: game-based learning approach in Namibia. International Journal of Operations Management. 2022; 2: 7–19.

[26] Markouzis D, Baziakou A, Fesakis G, Dimitracopoulou A. A systematic review on augmented reality applications in informal learning environments. International Journal of Mobile and Blended Learning. 2022; 14: 1–6.

[27] Malaysian Communications and Multimedia Commision. Internet Users Survey 2020. Malaysian Communications And Multimedia Commission. 2020. Available at: http://www.mcmc.gov.my (Accessed: 26 April 2023).

[28] Cavalcante JP, Machado DP, Marçal E, Silva PGB, Rolim JPML. Development and evaluation of a mobile oral health application for preschoolers. Telemedicine and e-health. 2019; 25: 492–498.

[29] Hainey T, Baxter G, Ford A. An evaluation of the introduction of games-based construction learning in upper primary education using a developed game codification scheme for scratch. Journal of Applied Research in Higher Education. 2020; 12: 377–402.

[30] Kaimara P, Fokides E, Oikonomou A, Deliyannis I. Potential barriers to the implementation of digital game-based learning in the classroom: pre-service teachers’ views. Technology, Knowledge and Learning. 2021; 26: 825–844.

[31] Yusof ZY, Jaafar N. Health promoting schools and children’s oral health related quality of life. Health and Quality of Life Outcomes. 2013; 11: 205.