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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 1  |  Issue : 2  |  Page : 56-59

Application of write-and-draw technique in pediatric dentistry: A pilot study


Department of Paedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India

Date of Web Publication22-Dec-2016

Correspondence Address:
Rupak Kumar Dasarraju
Department of Paedodontics and Preventive Dentistry, Narayana Dental College and Hospital, Nellore - 524 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2468-8932.196482

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  Abstract 

Background: Write-and-draw technique, which has been gaining popularity as a tool to capture views of children in the field of medicine, can be applied to seek views of children on pediatric dentists and dental operatory. Aim: The aim of the study was to seek the views of children on what they think about visiting a dental care setting and also to ascertain the views of children on pediatric dentists and dental operatory. Methodology: Fifty children aged 7-14 years selected on convenience sampling included in the study after obtaining informed assent were divided into two groups; Group A (n = 25) included children with the past dental experience and Group B (n = 25) included children without previous dental experience. Children with special health-care needs were excluded from the study. Those teachers involved in the data collection process were given a full script (quote) to follow. Results: Data analysis was performed using Riley's technique (1996) of coding data through the use of colored highlighter pens to identify common themes. Common themes emerged from the analysis were empathy, painless injection, white coat anxiety, and play area. Conclusion: Write-and-draw technique can be effectively applied as a tool to identify the opinions of children regarding pediatric dentists and dental operatory and dental operatory.

Keywords: Emotional status, Riley′s technique, write-and-draw


How to cite this article:
Dasarraju RK, Nirmala S, Kolli NK, Inthihas S, Nuvvula S. Application of write-and-draw technique in pediatric dentistry: A pilot study. Int J Pedod Rehabil 2016;1:56-9

How to cite this URL:
Dasarraju RK, Nirmala S, Kolli NK, Inthihas S, Nuvvula S. Application of write-and-draw technique in pediatric dentistry: A pilot study. Int J Pedod Rehabil [serial online] 2016 [cited 2021 May 15];1:56-9. Available from: https://www.ijpedor.org/text.asp?2016/1/2/56/196482


  Introduction Top


Acceptable/positive behavior of children in a dental setting is governed by several factors such as their attitude toward dentistry [1] and the emotional status. [2] Subjective scales that are used to measure the anxiety of children undergoing dental treatment, [3] child's perception of dental treatment, [4] parental attitude toward behavior guidance technique employed on their child, etc., cannot assess the attitude of a child toward dentistry. However, the reliability and validity of these scales are questionable, limiting them from measuring the attitude of children. [5]

Drawings, considered as familiar and enjoyable activity, [6] can be used to assess the emotional status of children as it was established that art projects the inner experience of children. [7] It could also act as a sign of pain experience in children. [8] "Write/talk and draw technique" or "Draw and write/talk" is a method that involves making a child to draw as well as write/talk about their views (operator can write if needed) which enable us to understand child's beliefs, views, and values [9] so that their attitude and emotional issues can be assessed. [6] This technique involves making the children to draw a picture regarding a situation or experience by giving prompts and also to write about their views on which a dominant qualitative data could be generated that provide instant information and promising themes. [10]

This enables every child to participate in the research process, and the opinions of every child will be given due weight unlike the focus groups in which opinions of the children who were more vocal, were considered and participation of younger children is limited due to temporal restraints. [11]

In the field of medicine, drawings were used to find out views of hospitalized children regarding hospital environment and doctors. [12] In the field of dentistry, drawings were proved to act as narrative of child's experience and inner emotions. [8] In the present study, we employed this technique (write-and-draw) to ascertain children's views on pediatric dentists and dental setting.

The aim of the study was to seek the views of children on visiting a dental care setting as well as to ascertain the views of children on pediatric dentists and dental operatory.


  Methodology Top


After obtaining the Institutional Ethical Clearance, a two-arm parallel, cross-sectional study was conducted in a government school, using write-and-draw technique to assess the views of children regarding dental care setting and pediatric dentists. Methodology followed in a previous study was adopted but modified; no focus group meeting was conducted; entire subjects of interest were divided into two groups; and also, prompts given to children were modified. [13] Fifty children aged 7-14 years selected on convenience sampling were included in the study after obtaining informed assent. They were divided into two groups; Group A (n = 25) included children with the past dental experience and Group B (n = 25) included children without previous dental experience. Children with special health-care needs were excluded from the study.

Those teachers involved in the data collection process were given a full script (quote) to follow including the instructions on how to gain consent or assent. Once the rapport with the child was established and the assent obtained, teachers/dentists used the prompts from the provided script to help the individual child to complete the exercise. The participating children were asked to draw a picture about the dentist and dental setting as well as write about their thoughts on an A4 size sheet provided to them [Figure 1]. The teacher was asked to help with the drawings of the children, if necessary. Common themes were colored and presented as results upon completion of task using colored highlighter pens.
Figure 1: Sample of children's drawings

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Prompts were given to children in our vernacular language (Telugu) in the following method:

  • Today, we will be talking about what dentists can do to care for children and young people who visit the dental hospital
  • As you had a previous dental experience, I expect that you have some ideas about the dentists and dental setting (Group I)
  • We want to listen to your thoughts about coming to a dental hospital and what helps you feel better when dentists care for you (Group II)
  • Can you draw a picture about the dentist and dental setting? What do you think on how the dentist can help children feel better when you visit dental hospital?
  • The important point is that I really want to know what you think, so it does not matter even if the picture is not perfect and it will still be very special as you have drawn it
  • Do not worry; this is not a test. I would want you to draw your ideas and then write about your ideas. If you need me to help, I will be here with you
  • You have a sheet of paper, and on the front, you have a space to write your first name. If you could do that first
  • I am really interested in your ideas, rather than how well you can draw or write
  • If you would want me to write for you, just tell me what you want me to write and I will write down what you want me to communicate
  • Thank you. We hope that you have enjoyed drawing and writing your story about children's dentists and dental setting.
Older children might just write a list of what they think, children's dentists should do, etc., on the reverse page of the instrument.

Precautions

We should make prompts only to make them draw pictures and write about them but never try to rub our own ideas onto them. Never draw comparisons of pictures drawn by children among themselves which can limit their participation. There could be a danger of child perceiving the researcher as an authority figure, which can create inherent imbalance in the relationship between the researcher and the child. [10]

The primary outcome measures were description and analysis of those attributes which children believe that pediatric dentists of the future should possess and of those factors which inhibit or enhance childhood dental care.


  Results Top


Data analysis was done using Riley's technique (1996) of coding data through the use of colored highlighter pens to identify common themes (views). The following is the list of few views/themes [Table 1] emerged from the present study, from which common themes coded and presented as results:

Common themes coded and emerged from the analysis were as follows.
Table 1: Themes/views obtained from children


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  • Communication - Empathy
  • Professional competence - Painless injection
  • Professional appearance - White coat anxiety
  • Environment - Play area.

  Discussion Top


Although there are few scales for rating behavior and attitude toward the behavior guidance techniques, there is no tool to measure children's attitude toward dentistry. This write-and-draw technique acts as a good tool for that purpose with benefits of application in children for whom the topic of research might appear undescribable.

Alderson's seminal work for Barnardos has highlighted the necessity for researchers to conduct research with, rather than on, children. Critical appraisal of the write-and-draw technique highlighted the method as being useful in providing opportunities to capture the views of children on a variety of topics. [2]

The draw and write technique, used in the present study, showed that white coat fear and fear of injection were observed among children as well as they expect a play area in the dental care setting. Themes emerged in the present study were consistent with the findings of other studies.

Playing was known to minimize the waiting time and change the behavior of children positively. [14] Children in the present study expected play area in dental clinic. This finding was consistent with a study in which most of the participants chose playing in the dental waiting area. [15] One of the findings of present is that there is lack of communication of dentists with the children and their relying on the opinions of parents than children, which could be improved by playing, as it was known to improve communication process among children, parents, and professionals and thus contribute to improve the care delivery. [16]

Children in the present study preferred colored attire to white coat. It was consistent with a study which showed that 69.9% of the anxious children preferred colored attire, [17] whereas another study reported that 90% of the children preferred dentist to wear white coat; [3] however, dental anxiety was not an area of the present study. Recent evidence suggests that formal attire was suggested as more appropriate for anxious children. [18]

Children in the present study reported that they expect pain-free injection. Findings from another study suggested that one of the most feared items for children in dentistry was injections. [19]

This write-and-draw technique can also explore parents' socioeconomic status, dental health education levels, dental health awareness, as well as the need for dental health promotion, as the "Article 12 of the UN Rights Convention for Children states that the child's right to freely express his or her views and to have those views duly taken into account without discrimination; in particular, the right to be heard in judicial and administrative procedures affecting the child."[20]


  Conclusion Top


Write-and-draw technique can be effectively applied as a tool to identify the opinions of children regarding pediatric dentistry and dental operatory. Further studies with large sample size are needed to explore the opinions of children so that higher number of themes could be evolved which could enhance the pediatric dentistry.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Alsarheed M. Children′s perception of their dentists. Eur J Dent 2011;5:186-90.  Back to cited text no. 1
    
2.
Guthrie A. Separation anxiety: An overview. Pediatr Dent 1997;19:486-90.  Back to cited text no. 2
    
3.
Cox IC, Krikken JB, Veerkamp JS. Influence of parental presence on the child′s perception of, and behaviour, during dental treatment. Eur Arch Paediatr Dent 2011;12:200-4.  Back to cited text no. 3
    
4.
Venham LL, Gaulin-Kremer E. A self-report measure of situational anxiety for young children. Pediatr Dent 1979;1:91-6.  Back to cited text no. 4
    
5.
Guinot Jimeno F, Yuste Bielsa S, Cuadros Fernández C, Lorente Rodríguez AI, Mercadé Bellido M. Objective and subjective measures for assessing anxiety in paediatric dental patients. Eur J Paediatr Dent 2011;12:239-44.  Back to cited text no. 5
    
6.
Backett-Milburn K, McKie L. A critical appraisal of the draw and write technique. Health Educ Res 1999;14:387-98.  Back to cited text no. 6
    
7.
Aminabadi NA, Ghoreishizadeh A, Ghoreishizadeh M, Oskouei SG. Can drawing be considered a projective measure for children′s distress in paediatric dentistry? Int J Paediatr Dent 2011;21:1-12.  Back to cited text no. 7
    
8.
Pala SP, Nuvvula S, Kamatham R. Expression of pain and distress in children during dental extractions through drawings as a projective measure: A clinical study. World J Clin Pediatr 2016;5:102-11.  Back to cited text no. 8
    
9.
Pridmore P, Bendlow G. Images of health: Exploring beliefs of children using the ′draw-and-write′ technique. Health Educ J 1995;54:473-88.  Back to cited text no. 9
    
10.
Horstman M, Bradding A. Helping children speak up in the health service. Eur J Oncol Nurs 2002;6:75-84.  Back to cited text no. 10
    
11.
Peterson-Sweeney K. The use of focus groups in pediatric and adolescent research. J Pediatr Health Care 2005;19:104-10.  Back to cited text no. 11
    
12.
Brady M. Hospitalized children′s views of the good nurse. Nurs Ethics 2009;16:543-60.  Back to cited text no. 12
    
13.
Fletcher T, Glasper AE, Prudhoe G, Battrick C, Coles L, Weaver K, et al. Building the future: Children′s views on nurses and hospital care. Br J Nurs 2011;20:39-45.  Back to cited text no. 13
    
14.
Nascimento LC, Pedro IC, Poleti LC, Borges AL, Pfeifer LI, de Lima RA. Playing in the waiting room of a children′s outpatient clinic: The view of health professionals. Rev Esc Enferm USP 2011;45:465-72.  Back to cited text no. 14
    
15.
Panda A, Garg I, Shah M. Children′s preferences concerning ambiance of dental waiting rooms. Eur Arch Paediatr Dent 2015;16:27-33.  Back to cited text no. 15
    
16.
da Silva Pedro IC, Nascimento LC, Poleti LC, Garcia de Lima RA, Falleiros de Mello D, Rosa Luiz FM. Playing in the waiting room of an infant outpatient clinic from the perspective of children and their companions. Rev Lat Am Enfermagem 2007;15:290-7.  Back to cited text no. 16
    
17.
Asokan A, Kambalimath HV, Patil RU, Maran S, Bharath KP. A survey of the dentist attire and gender preferences in dentally anxious children. J Indian Soc Pedod Prev Dent 2016;34:30-5.  Back to cited text no. 17
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18.
Nirmala SV, Veluru S, Nuvvula S, Chilamakuri S. Preferences of dentist′s attire by anxious and nonanxious Indian children. J Dent Child (Chic) 2015;82:97-101.  Back to cited text no. 18
    
19.
Mungara J, Injeti M, Joseph E, Elangovan A, Sakthivel R, Selvaraju G. Child′s dental fear: Cause related factors and the influence of audiovisual modeling. J Indian Soc Pedod Prev Dent 2013;31:215-20.  Back to cited text no. 19
[PUBMED]  Medknow Journal  
20.
The Right of the Child to be Heard. General Comment No. 12, Convention on the Rights of the Child, United Nations. 2009. p. 1-28. Downloaded from http://www2.ohchr.org/english/bodies/crc/docs/AdvanceVersions/CRC-C-GC-12.pdf. [Last accessed on 2016 Nov 28].  Back to cited text no. 20
    


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