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Available online at ajdhs.com 

Asian Journal of Dental and Health Sciences 
Open Access to Dental and Medical Research 

Copyright  © 2023 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the 

original author and source are credited 
 

 

 

Stair poster media as an effort to improve the dental health behavior of 
elementary school children 

Nita Noviani1, Ngatemi2, Indrayati Fadjeri3, Tedi Purnama4*, Sekar Restuning5 

1,2,3,4 Department of Dental Health, Health Polytechnic of Jakarta I, Jakarta, Indonesia 

5 Department of Dental Health, Health Polytechnic of Bandung, Bandung, Indonesia 

Article Info: 
_______________________________________ 
Article History: 

Received 11 August 2023     
Reviewed  18 August 2023 
Accepted 12 September 2023 
Published 15 September 2023 

_______________________________________ 
Cite this article as:  

Noviani N, Ngatemi, Fadjeri I, Purnama T, 
Restuning S, Stair poster media as an effort to 
improve the dental health behavior of 
elementary school children, Asian Journal of 
Dental and Health Sciences. 2023; 3(3):14-18 

DOI: http://dx.doi.org/10.22270/ajdhs.v3i3.48        

_______________________________________
*Address for Correspondence:   

Tedi Purnama, Department of Dental Health, 
Health Polytechnic of Jakarta I, Jakarta, 
Indonesia. 

Abstract 
___________________________________________________________________________________________________________________ 
The prevalence rate of dental caries has experienced an increasing trend from year to year, so that the 
condition of dental and oral health problems in Indonesia is still worrying, especially for elementary 
school children. The high number of dental health problems is caused by many factors, one of which is 
the low level of dental health maintenance behavior. Promotive and preventive measures are needed to 
prevent dental and oral health problems, namely by providing dental and oral health education. Poster 
media is a medium or prop/tool that can be used to convey messages from communicators to the 
audience. Staircase poster media is a development of general poster media, this media is designed for 
the sequence/stages of maintaining dental health which are attached to the school steps. Objective: This 
research is to analyze the effectiveness of stair poster media in improving the dental health behavior of 
elementary school children. Method: This research used a non-equivalent control group quasi-
experimental design. The research sample was 125 people taken using purposive sampling technique. 
The intervention group was given dental health education using posters, while the control group was 
given dental health education using filpchart. Data were tested using Wilcoxon test analysis, namely a 
pre-post design, while to compare the means of the treatment and control groups, the Mann Whitney 
test was used. Results: The results of the test of differences in knowledge, attitudes and actions of 
brushing teeth show that the p-value between the intervention group and the control group is 0.000 (p 
<0.05), meaning that there is a difference between the values of knowledge, attitudes and actions of 
brushing teeth after dental health education with children's poster media. steps and dental health 
education with filpchart. Conclusion: dental health education using stair poster media is more effective 
in increasing the knowledge, attitudes and actions of brushing teeth in elementary school children 
compared to dental health education using flipcharts 

Keywords: Stair poster, media, dental health, behavior 

 

INTRODUCTION  

Dental and oral health problems can have an impact on a 
person's quality of life, because teeth have a function in 
speaking, chewing and appearance. The health of a child's 
teeth and mouth will affect their growth and development. 
Tooth decay in children can cause pain, thereby reducing 
appetite, and incomplete breakdown of food in the mouth, 
which interferes with the absorption of nutrients needed by 
the human body, thus causing malnutrition in children. In 
addition, children are a vulnerable age group because at that 
time the milk teeth begin to fall out one by one and are 
replaced by permanent teeth. Newly erupted permanent teeth 
are immature and therefore easily damaged, they only grow 
once in a lifetime, so they need to be cared for and cared for to 
avoid dental problems. If children neglect to keep their teeth 
and mouth clean, this will increase the risk of plaque forming 
on the surface of the teeth which can cause dental caries and 
periodontal disease.1–4 

The results of the 2018 Basic Health Research stated that the 
prevalence of caries according to the characteristics of ages 5-
9 years in Indonesia was 92.6% and ages 10-14 years was 
73.4% with the proportion of damaged, cavities or diseased 
teeth in the 5-9 years age group being 54%, and the aged 10-
14 years is 41.4%. Gum problems and/or abscesses increased 

11% for ages 5-9 years, and 11.3% for gum problems and/or 
abscesses at ages 10-14 years. This data shows that the dental 
and oral diseases most suffered by children are dental caries 
and periodontal disease. One of the causes of these two 
diseases is behavioral factors.5,6 

People's behavior that ignores dental and oral health care 
causes dental and oral health problems. This is based on a lack 
of knowledge about the importance of maintaining oral health. 
Budiharto's research, knowledge, attitudes and actions are 
forms of behavior. Children's behavior regarding maintaining 
dental health includes knowledge, attitudes and actions aimed 
at preventing plaque accumulation as a cause of caries and 
periodontal disease.7–9 

Efforts to improve behavior include promoting dental health, 
which places more emphasis on vulnerable groups of school 
children. The school environment is an extension of the family 
in laying the foundation for healthy living behavior for school 
children. Health promotion is an effort to increase a person's 
knowledge and abilities through practical techniques or 
instructions with the aim of influencing human behavior both 
individually and in community groups to increase awareness 
of the importance of health so as to change their behavior into 
healthy living behavior.10,11 

Dental health promotion cannot be separated from the media 

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Noviani et al                                                                                                                                Asian Journal of Dental and Health Sciences. 2023; 3(3):14-18 

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because through the media, the messages conveyed can be 
more interesting and understood. Posters are an outreach 
medium in the form of printed media with images and 
delivered using the lecture method. Posters have often been 
used as an outreach medium and are able to increase the 
target's knowledge from not knowing to knowing and 
ultimately wanting to change behavior.10,12,13 

Step poster media is a development of mini poster media. 
Staircase posters are an effective graphic medium for 
presenting certain messages, in the form of a series/steps 
containing pictures or writing about maintaining dental health 
which are then attached to the steps. 

MATERIAL AND METHOD 

The research design used was a quasi-experimental study with 
a pretest-posttest control group design. The aim of the study 
was to analyze the effectiveness of stair poster media in 
improving the dental health behavior of elementary school 
children. The research was conducted in June to August 2023 
at SDN 02 Pangkalanjati and SDN 02 Cinere, Cinere District, 

Depok City. The research sample was 125 students, with a 
purposive sampling technique. The intervention group was 
given dental health education using posters as a medium for 
64 students, while the control group was given dental health 
education using filcharts as many as 61 students. 

Data collection was carried out on each group on day 1, 
carrying out a pre-test to measure knowledge, attitudes and 
actions of brushing teeth, then education was provided 
according to the planned intervention. On the 3rd day, dental 
health education was conducted and on the last day, on the 
21st day, a post-test was carried out to determine changes in 
elementary school children's knowledge, attitudes and teeth 
brushing actions. 

The instruments used in this study were a knowledge and 
attitude questionnaire and a tooth brushing checklist to 
measure the act of brushing your teeth. Data analysis used the 
Wilcoxon test, namely a pre-post design, while to compare the 
means of the treatment and control groups, the Mann Whitney 
test was used. 

 

 

RESULT  

Table 1: Frequency Distribution based on respondent characteristics 

Variable 
Intervention Control 

N % N % 

Age     

10 years 13 20,3 16 26,2 

11 years 43 67,2 38 62,3 

12 years 8 12,5 7 11,5 

Total 64 100 61 100 

Gender     

Man 34 53,1 34 55,7 

Women 30 46,9 27 44,3 

Total 64 100 61 100 

Table 1 shows that the ages of children in the intervention and control groups have the same proportion, most of whom are 11 years 
old and male. 

 

Table 2: Data normality test 

Variable 
Groups 

Intervention Control 

Knowledge pre-test 0,000 0,000 

Knowledge post-test 0,000 0,000 

Attitudes pre-test 0,001 0,000 

Attitudes post-test 0,000 0,000 

Actions of brushing teeth pre-test 0,000 0,000 

Actions of brushing teeth post-test 0,000 0,000 

Table 2 shows the results of the normality test for knowledge, attitudes and actions of brushing teeth in the intervention and control 
groups with an abnormal distribution, because the p-value < 0.05, the non-parametric test was continued, using the Wilcoxon test, 
namely a pre-post design, while to compare the means. from the treatment and control groups, Mann Whitney was used. 

 

 



Noviani et al                                                                                                                                Asian Journal of Dental and Health Sciences. 2023; 3(3):14-18 

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Table 3: Test the effectiveness of knowledge, attitudes and actions of brushing teeth before and after intervention in the intervention 
and control groups 

Groups 
Knowledge Attitudes Actions 

Mean+ SD P-value Mean+ SD P-value Mean+ SD P-value 

Intervention 
Pre-test 5,08+ 1,238 

0.000 
39,36+5,214 

0.000 
4,67+1,183 

0.000 
Post-test 8,81+ 0,889 43,45+2,889 9,16+0,597 

Control 
Pre-test 5,62+ 1,157 

0.763 
40,41+2,877 

0.188 
4,69+1,041 

0.285 
Post-test 5,61+ 1,130 40,52+2,826 4,75+0,960 

Table 3 shows the results of the data effectiveness test before and after being given dental health education using posters as media, 
showing the knowledge p-value of the intervention group was 0.000, the p-value of attitude was 0.000 and the p-value of the action 
of brushing teeth was 0.000 (p < 0.05) means that dental health education using posters as media is effective in increasing 
knowledge, attitudes and actions of brushing teeth in elementary school children. The control group's p-value for knowledge was 
0.763, the attitude p-value was 0.188 and the p-value for the action of brushing teeth was 0.285, meaning that dental health 
education using flipcharts was not effective in increasing the scores of knowledge, attitudes and actions of brushing teeth in 
elementary school children. 

 

Table 4: Test differences in knowledge, attitudes and actions of brushing teeth before and after intervention in the intervention and 
control groups 

Groups 
Knowledge Attitudes Actions 

Mean  P-value Mean P-value Mean P-value 

Intervention 8,81 
0.000 

43,45 
0.000 

9,16 
0.000 

Kontrol 5,61 40,52 4,75 

Table 4 shows the results of the difference test in knowledge, attitudes and actions of brushing teeth, showing that the p-value 
between the intervention group and the control group is 0.000 (p <0.05), meaning that dental health education using children's 
posters is more effective in increasing knowledge, attitudes and actions of brushing teeth. compared to the control group. 

 

DISCUSSION 

Efforts to improve dental and oral health include promotive, 
preventive, curative and rehabilitative efforts. One 
promotional effort to improve people's behavior is through an 
educational process regarding the importance of maintaining 
healthy teeth and mouth. For children aged 6-12 years, this is 
the age where children are in the transition period or mixed 
dentition period, namely the period of change between 
deciduous teeth (children) to permanent teeth (adults). At this 
age, children still lack behavior in terms of maintaining dental 
and oral hygiene, resulting in the potential for damage to 
dental tissue in the form of caries.9,14,15 

Behavior that is based on correct knowledge will greatly 
influence the incidence of children's dental and oral health 
problems. Knowledge is the result of knowing about an object 
that a person obtains through the senses and is mostly 
obtained from the eyes and ears. A person has the ability to re-
express the knowledge he knows in the form of an answer to a 
stimulus in the form of a question, either verbally or in 
writing. Dental and oral health knowledge is all the data an 
individual has to understand what oral disease is, how the 
disease arises, and understand protective measures. This 
knowledge will lead to changes in behavior that guide 
individuals to make changes in everyday life.7,16,17 

Knowledge can be increased through health promotion. Health 
promotion is an action or activity aimed at increasing the 
abilities or activities of individuals, groups and communities in 
terms of knowledge, attitudes and skills to achieve the best 
healthy living standards. Promoting health in elementary 
school age is an ideal time to practice motor skills and 
improve cognition. Children's attention spans are short, so 
they need training that is fun and motivating. Using attractive 

integrated media for health promotion can increase 
knowledge and change behavior.18–20 

Dental health education as an effort to provide knowledge 
about dental health basically emphasizes aspects of dental 
health which are closely related to targeted daily efforts in 
maintaining dental health, so that the selection of education 
material is prioritized regarding efforts to maintain dental and 
oral health, where efforts are common and common. by 
students and adults in general is brushing their teeth and 
efforts to control themselves in consuming food and being 
selective in choosing types of food that are good and that can 
facilitate tooth decay. The selection of extension materials and 
extension priorities must consider the magnitude of the 
impact of the problem/material to be presented.11,21,22 

Health promotion media is a tool used in health promotion so 
that targets understand the information conveyed. Media that 
promote health must be regulated based on the principle that 
humans receive or capture information obtained through the 
five senses. The choice of media is one of the factors that can 
influence the promotion of oral health, the media can foster 
children's motivation and attention to learning, and the 
meaning of the information conveyed will be clearer, so that 
children can understand and better understand the learning 
objectives.8,23,24 

The media used by researchers in conducting research is 
poster media which is a development of mini poster media. 
Staircase posters are an effective graphic medium for 
presenting certain messages, in the form of a series/steps 
containing pictures or writing about maintaining dental health 
which are then attached to the steps. In this study, researchers 
made two packages of stair posters which were displayed on 
all the school stairs with material on 9 tips for maintaining 
healthy teeth and steps for brushing your teeth properly. 



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Based on the results of the data effectiveness test before and 
after being given dental health education using poster posters, 
the knowledge p-value of the intervention group was 0.000, 
the p-value of attitude was 0.000 and the p-value of the action 
of brushing teeth was 0.000 (p <0.05) This means that dental 
health education using posters as media is effective in 
increasing the knowledge, attitudes and actions of brushing 
teeth in elementary school children. The p-value of the control 
group on knowledge is 0.763, the p-value of attitude is 0.188 
and the p-value of the action of brushing teeth is 0.285, 
meaning that dental health education using flipcharts is not 
effective in increasing the scores of knowledge, attitudes and 
actions of brushing teeth in elementary school children. 

The results of different tests also show that knowledge, 
attitudes and actions of brushing teeth show that the p-value 
between the intervention group and the control group is 0.000 
(p <0.05), so it can be interpreted that dental health education 
using children's poster media is more effective in increasing 
knowledge, attitudes and actions of brushing. teeth compared 
to dental health education with flipcharts. This is because 
education using posters as media has the advantage of 
attracting children's attention more easily and stimulating 
children's understanding. Counseling with posters on stairs 
can also make children see interesting pictures at the same 
time related to the material provided, where every day when 
children go to school when they enter the classroom on the 
2nd floor, they are sure to read it every day, giving rise to a 
response and motivation in them to follow the material in stair 
poster media.  

With the hope that the child's emotional response will emerge, 
the child will eventually become enthusiastic or motivated to 
want to take part in the next activity. Stimulus-Organism-
Response (SOR) theory of behavior change which says that the 
cause of behavior change depends on the stimulus or stimuli 
given.25 So it can be interpreted that the staircase poster 
media can stimulate children to know more about maintaining 
dental health, especially brushing their teeth.  

This is in line with research by Jumilah et al. proves that there 
is an increase in dental and oral health knowledge in Saigon 
Village Public Elementary School students after being exposed 
to posters for 7 and 14 days. Wayudi's research states that 
poster media is effective in increasing students' attitudes and 
intentions to act in maintaining dental health. Another study 
by Sukarsih et al showed that there was an increase in 
knowledge of how to brush teeth at high criteria before being 
given counseling by 29.41% to 82.35% after being given 
counseling using poster media. There was an increase in skills 
on how to brush teeth with good criteria by 25% to 86.76% 
after being given counseling on how to brush teeth using 
poster media..26–28 

CONCLUSION 

Based on the results of the study, it can be concluded that the 
dental health education using stair poster media is more 
effective in increasing the knowledge, attitudes and actions of 
brushing teeth in elementary school children compared to 
dental health education using flipcharts. 

ACKNOWLEDGEMENTS 

The authors thank to all participants and research assistants. 

CONFLICT OF INTEREST 

The authors declare that they have no conflict interests. 

 

 

ETHICAL CLEARANCE 

This research has received a certificate of appropriate 
research ethics from the Yogyakarta Health Research Ethics 
Commission No.DP.04.03/e-KEPK.2/773/2023  

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