Evaluation of tooth brushing behavior change by social marketing approach among primary students in Qom, Iran: A quasi-experimental controlled study
Evaluation of tooth brushing behavior change by social marketing approach among primary students in Qom, Iran: A quasi-experimental controlled study
Ali Asghar Habibi 0 1
Mahdia GholamiID 1
Ahmad Reza ShamshiriID 1
0 School of Dentistry, Tehran University of Medical Sciences , Tehran , Iran , 2 Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences , Tehran , Iran , 3 Research Center of Tooth Caries Prevention, Research Center of Dentistry Sciences, Tehran University of Medical Sciences , Tehran , Iran
1 Editor: Ghobad Moradi, Kurdistan University of Medical Sciences , ISLAMIC REPUBLIC OF IRAN
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
Funding: The authors received no specific funding
for this work.
Competing interests: The authors have declared
that no competing interests exist.
Nowadays traditional training methods for promotion of oral health behaviors cannot meet
the demand of the society and there is a need for effective new methods. The aim of this
study was to evaluate the effect of social marketing approach versus the traditional method
on promotion of tooth brushing habits in primary school students of Kahak and Jafariyeh,
Materials and methods
This study was conducted in the 2016–2017 academic year. First, the reasons for lack of
interest in proper tooth brushing were evaluated. Forgetting and laziness were determined
as the most important reasons. According to these results, appropriate intervention tools
related to proper tooth brushing habits were designed. Then, the students’ tooth brushing
habits were recorded before the intervention. Students in Kahak that were considered
nonrandomly as intervention group received the designed educational package according to the
social marketing approach for one and a half months. In Jafariyeh (control group), the
students received training only through pamphlets as traditional method. After the intervention,
the tooth brushing habits of the students were recorded. The habits before and after the
intervention were compared using statistical tests.
Increased length of tooth brushing to at least two minutes was 28.0% in Kahak and 14.0% in
Jafariyeh (P<0.001) and increased frequency of tooth brushing to at least two times per day
was 30.5% in Kahak and 11.8% in Jafariyeh (P<0.001). Improvement in tooth brushing
habits (at least two minutes twice daily) was 32.9% in Kahak and 13.0% in Jafariyeh (P<0.001).
The use of the social marketing approach is more effective than traditional methods in
promoting oral health behaviors.
One of the WHO global goals for oral health objectives 2020 is to decrease the rate of DMFT,
especially D (decayed tooth), in subjects under 12 years with particular attention to high-risk
]. This objective cannot be achieved unless oral health principles are observed.
According to the recommendations of the American Dental Association, people are required
to brush their teeth with a soft-bristled brush twice daily for at least two minutes (at least 30
seconds per each quadrant) [
Different models have been proposed to promote oral health. One of these models is social
marketing proposed by Kotler and Zaltman in 1971 [
]. Social marketing is the use of
commercial marketing principles for analysis, design, implementation, and assessment of
programs aiming at affecting voluntary behaviors of the target population to enhance the
wellbeing of people and the society [
]. Social marketing has unique characteristics that are absent
in other models. These characteristics include the following: 1. It is based on “behavior”
change, 2. It is completely client-centered and follows the client’s needs, 3. It relies on
proposing interesting offers to persuade the client to change his/her behavior [
]. Different tools can
be employed to organize the activities during social marketing, including the Social Marketing
Assessment and Response Tool (SMART) developed by Neiger and Thackeray in 1998. This
tool has seven phases including Preliminary planning (Problem identification, goal setting,
assessment method), Audience analysis (identification and needs assessment), Channel
analysis (identification of appropriate communication channels), Market analysis (identification of
supporting factors and competitors for behavior change, market mix principles (4P: product,
price, place, promotion)), Development (preparation of intervention tools), Implementation,
and Evaluation, in the mentioned sequence [
A systematic review in 2010 showed that social marketing principles were necessary and
effective in designing the campaigns of oral and dental health [
]. Similarly, oral health
promotion campaigns in China and Russian, which were based on the social marketing approach,
caused a significant improvement in the frequency of brushing to at least twice per day [
Some other studies have also shown the success of the social marketing approach in increasing
the awareness and improving the performance of the subjects regarding the necessity of
regular oral visits for detection of oral cancer [
]. Moreover, another study in Iran in 2014
showed improved awareness of adults about periodontal diseases following a mass media oral
health promotion campaign [
Since, children should undertake the responsibility of oral health care at the end of six years
and parents have a supervisory role, considering its coincidence with the start of primary
school education, oral health interventions in this period can provide a good opportunity to
establish oral health behaviors in the children [
Health messages can be transmitted through various types of mass media such as film,
newspaper, pamphlet, the Internet, etc. [
]. Meanwhile, the pamphlet is yet one of the most
popular, simplest and efficient tools for message transmission and oral health education that
has been proven to be effective in many studies [
]. Considering the confirmed positive
role of the pamphlet in this area, we can use it as a traditional intervention compared to the
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intervention based on social marketing that is a new approach particularly in the field of oral
health, which is less widely used and evaluated.
Considering the importance of tooth brushing in oral health promotion and since no
similar study has evaluated the effect of the social marketing approach on the tooth brushing
behavior change in the target population, we decided to conduct this study. The aim of this
study was to enhance tooth-brushing behavior in terms of its length and frequency in primary
school students using the social marketing approach.
Materials and methods
This quasi-experimental controlled trial had a parallel design. The study was conducted in two
small cities of Kahak and Jafariyeh with low socio-economic status, located in Qom province,
Iran. There are cultural, social and geographic similarities among these two cities. In this
study, all primary school students (grade 1 to 6) of Kahak and Jafariyeh in the 2016–2017
academic year were eligible to join the study. Non-cooperation of the students and their parents’
unwillingness were the exclusion criteria. Considering the relatively small number of students
in the two cities, sampling was not done and the whole target population entered the census.
The students in Kahak were selected non-randomly as intervention group. Data collection was
conducted at three stages. First we evaluated reasons of students’ disinterest in tooth brushing
by a checklist to design appropriate intervention tools. Second, another checklist including
school information (city, school name, grade), demographic characteristics (age, gender,
parents’ education) and tooth brushing habits (frequency and length of tooth brushing) were
distributed among the participants before the intervention (baseline evaluation). Third, the
same check list to the baseline was filled out again after the intervention to evaluate changes in
tooth brushing habits. The checklists were completed by students themselves at the forth to the
sixth grade and completed by parents in first to third grade students.
Intervention group (Kahak). In this city, intervention was done according to the social
marketing approach. The SMART model was used to organize different phases of social
marketing in the following order [
Phase 1: Preliminary planning. The main problem, to overcome which this study was
designed, was lack of interest in tooth brushing with the proper length and frequency.
Therefore, the main objective of the study was to improve tooth-brushing habits as at least two times
a day for at least two minutes each time. The main method that was used for project
assessment was a self-report checklist before and after the intervention and comparison of the
Phase 2: Audience analysis. All the primary school students of the two cities (Three
primary schools in Kahak and six primary schools in Jafariyeh) were identified as the target
population. To evaluate and prioritize the reasons for students’ irregular or no tooth brushing, from
the perspective of parents (for the students in grade first to third) and the perspective of the
students in grades forth to sixth, a checklist was provided and its results were used in designing
the intervention tools.
Phase 3: Channel analysis. Since most of the students’ time was spent at home or school,
communication channels to educate the students were defined in these environments. For
example, school-related channels included face-to-face training sessions, educational materials
that can be installed in the school such as poster. Home-related channels included teaching
children by parents, application of oral hygiene kits.
Phase 4: Market analysis. In this study, one of the supporting factors was the performance
of some teachers that considered a day of the week as the “tooth brush day”. On this day, the
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teachers asked the students to bring their toothbrushes and brush their teeth under the
One of the identified competitors was the parents’ low level of oral health knowledge in
]. Another competitor was the common belief among the students that brushing the
teeth once a day is enough [
The second part of market analysis was implementation of market mix principles or 4P as
1. Product: The main product was prevention of tooth decay and the real product was tooth
brushing two times a day for two minutes each time.
2. Price: The time spent in the class (about 30 minutes), time spent on brushing the teeth and
commitment to completing the tooth brushing calendar were among the expenses that
the participants met.
3. Place: The place that was considered for the intervention was the students’ schools and
houses because they were easily accessible.
4. Promotion: All the tools that were designed to persuade students to brush their teeth are
placed in this group. These tools were planned based on the results of the first checklist.
Phase 5: Development. In this study, a sample of the education tools was presented to
health authorities of education department and managers of target schools in Kahak and
Jafariyeh to collect their comments about the appearance and content of the tools legally and
culturally. The intervention tools were approved and no comments were received.
Phase 6: Implementation. In this phase, the project was implemented as designed in the
previous phases, and interventions were applied in the schools. First, a checklist containing
questions on students’ tooth-brushing habits was completed before the intervention. After the
checklists were collected, the intervention was continued for one and a half months. At the
beginning of the intervention phase, an educational workshop about proper tooth brushing
habits was held for the students by a research member (HA). Then intervention tools such as
pamphlets, toothbrushes, calendars for recording brushing habits, small hourglasses for
checking length of brushing and stickers containing messages about tooth brushing were distributed
among the students and the explanation about each tool was given to the participants. Also
educational posters were installed in school halls. Content of the poster and the pamphlet was
related to importance of oral diseases, role of dental plaque in development of the diseases,
importance of oral hygiene and proper tooth brushing habits. In addition, teachers and health
educators were asked to check the calendar of recording brushing habits every week and
review proper tooth brushing habits with students as reminders. In the third and sixth weeks
of the intervention phase, the students who perfectly filled out the calendar were given
stationery as a reward.
Phase 7: Evaluation. The participants completed the tooth-brushing habits checklist before
and after the intervention to evaluate the changes following the intervention.
Evaluation of the reasons of disinterest in tooth brushing and designing the
intervention. In this phase, of 1720 primary school students (535 in Kahak and 1185 in Jafariyeh),
1178 participants (319 in Kahak, 859 in Jafariyeh) completed the checklist (response
rate = 68.4%) containing eight items regarding reasons of disinterest in tooth brushing. These
items included “Not having a suitable toothbrush for children”, “Not having a toothbrush due
to high prices”, “Lack of information about the necessity of brushing”, “Lack of knowledge
about correct Tooth brushing Method”, “Lack of parental support for brushing at home”,
“laziness”, “dislike of toothpaste flavor” and “Forgetting”. The respondents could select more than
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one item simultaneously. The results showed that the most important reasons of students’
disinterest in tooth brushing were forgetting (53.5%) and laziness (30.2%). Other items were
selected by less than 10% of the respondents. According to these results, appropriate
intervention tools were designed for Kahak to meet these needs. The designed tools were:
1) Tools appropriate for problem of forgetting
a) Providing stickers with the motto of the project to remind children of brushing their
teeth (the motto was “brush twice a day in morning and night, each time two minutes).
Number: 535 (for whole students of Kahak primary schools)
b) Designing a tooth brushing calendar for recording the frequency of tooth brushing. In
this calendar there were two tables for each week to mark tooth brushing at mornings
and nights. Number: 417 (students eligible for the intervention)
c) Providing stationery with the project motto included pen and notebook. Number: from
each one 417 (students eligible for intervention)
d) Providing posters appropriate for the students’ age and exhibiting them in different
parts of the school. Number: 15 (for three primary schools of Kahak)
e) Reviewing proper tooth brushing habits during the week and checking the calendar
regularly by teachers and health teachers.
2) Tools appropriate for problem of laziness
f) Holding an educational workshop about proper tooth brushing habits by a member of
the research team. Number: 1 in each school (at the beginning of project)
g) Preparing educational pamphlets in two separate parts for students and parents. In the
student part, the text was suitable for children. In the parent part, it was asked from the
parents to have supervision on brushing habits of their children. Number: 535 (for
whole students of Kahak primary schools)
h) Preparing small hourglasses for students to show the time needed for brushing (two
minutes). Also the project motto was printed on them. Number: 417 (students eligible
i) Preparing tooth brushes with special designs for children. Number: 535 (whole students
of Kahak primary schools)
Control group (Jafariyeh). The students in Jafariyeh completed the tooth-brushing habits
checklist before the intervention (similar to students in Kahak). After collecting the checklists,
since this city was considered as the control group, a traditional intervention, i.e. pamphlet
that had exactly similar content to the pamphlet distributed in Kahak was applied
(Number:1185 for whole students of Jafariyeh primary schools). The pamphlet was distributed
between the students and we asked them to read it themselves and their parents. Then, the
changes in tooth brushing habits were assessed through completing the same checklist for a
second time, after the intervention.
We considered three variables including Length of tooth brushing, Frequency of tooth
brushing and tooth brushing habit as outcome variables. The target behavior of our study included
Length of tooth brushing at least two minutes and Frequency of tooth brushing at least two
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times a day. The participants who did not undertake at least one of the items correctly (length
or frequency) before the intervention but did both correctly after the intervention were
regarded as improved cases of tooth brushing habit. The outcomes measured two times (before
and after the intervention) with interval of one month and a half between the measurements.
Among the demographic variables, parents’ education had missing data and the Little test was
used to impute these data. Since significant level was less than 0.001, it characterized that
missing data in parental education variable was MAR (missing at random). Afterward missing data
insertion was done using the EM algorithm (and by predictors of age, gender, and school).
Chisquare test was used to compare two variables of “recommended frequency of tooth brushing”
and “recommended length of tooth brushing” between the two groups. Logistic regression was
applied to evaluate the effect of possible confounders (gender, grade and parents’ education
level) on the correction of tooth brushing behavior among intervention and control groups.
At post-intervention assessment, and with a response rate of 75.5% for intervention group
and 68.2% for control group, we tested for patterns in lost samples [
]. For this purpose, we
compared demographic characteristics of the respondents and non-respondents using the
Chi-square test (Table 1). Since the differences between the two groups were statistically
significant in two variables, we did sensitive analysis with worst case scenario in which all lost
(N = 102)
samples in intervention group considered as "unimproved" and lost samples in control group
imputed with same frequency of improvement to intervention group (e.g., 33.7%
improvement in frequency, 32.1% improvement in duration and 34.3% improvemnent in both
frequency and duration) [
To identify the subgroups of students who benefit more from the intervention, the analysis
of the subgroups was carried out by logistic regression test with the consideration of the
interaction between the independent variables (gender, grade and parents’ education level) with the
intervention variable. We analyzed the data using the IBM SPSS statistics version 24 (IBM
Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM
Corp.) and considered P values less than 0.05 significantly.
Participation in this study was voluntary. We obtained informed written consent from parents
of all students. For this purpose, there was a section at the beginning of the checklists include
explanations onthe study objectives and how the students participated in different phases of
the study and asked the parents for their permission. The parents, who agreed to have their
child participate in the study, signed the paper. For confidentiality reasons, all checklists were
anonymous and coded. The Ethics Committee of Tehran University of Medical Sciences
approved this study (ethics code: IR.TUMS.VCR.REC.1395.852). Also this study is registered
in Iranian Registry of Clinical Trials (IRCT) with trial number of IRCT2016123131675N1.
Pre and post intervention assessment
Fig 1 shows different phases of the study.
1. Demographic characteristics
The demographic characteristics of the students who participated in the pre- and post-
intervention phases are presented in Table 1. In relation to educational level of students’ parents,
majority of the parents, at the both groups of intervention and control had lower education
than high school diploma. So that 76.5% and 70.9% of the fathers at the intervention and
control groups had under high school diploma, respectively. These figures were 70.7% and 71.55%
for the mothers, correspondingly.
2. Results of tooth brushing habits
The results of tooth brushing habits before and after the intervention and their comparison are
shown in Table 2. At baseline, most of the students in the intervention and control groups
stated that they brush their teeth under parents’ supervision (71.2%, 63.6% respectively).
However, these measures got better after the intervention at both groups (81%, 73.5% respectively).
The percent of the individuals in the intervention group who mentioned brushing their teeth
in two minutes and more improved from 47.7% before the intervention to 74.8% after the
intervention. This improvement was also seen in the control group but its value was negligible
(42.1% to 48.7%). In addition, 34.5% of the participants of intervention group reported
brushing their teeth twice a day or more at baseline and improved to 65.5% after the intervention.
These corresponding measures in the control group were 35% and 40.6% that represented a
minor improvement in this group.
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Fig 1. Flow chart of study participants.
Who brushed the teeth?
Student without parents’ supervision 106 (25.4)
Student with parents’ supervision 297 (71.2)
Father or mother 2 (0.5)
Does not brush 12 (2.9)
Total 417 (100)
Length of tooth brushing
Two minues and more 197 (47.7)
Less than two minutes 203 (49.4)
Does not brush 12 (2.9)
Total 412 (100)
Frequency of tooth brushing
Twice a day or more 144 (34.9)
Less than twice a day 257 (62.2)
Does not brush 12 (2.9)
Total 413 (100)
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3. Changes of tooth brushing habits after the intervention
As mentioned in statistical method, to estimate the effect of students lost to follow-up on final
conclusion we repeated data analysis with all of them in worst case scenario. The worst case
scenario was defined as follow: all students lost to follow-up in intervention group considered
as "unimproved" and behaviour changes for those lost to follow-up in control group was
considered similar to the frequency of improvements of intervention group (e.g., 33.7%
improvement in frequency, 32.1% improvement in duration and 34.3% improvemnent in both
frequency and duration). For all endpoints, behaviour changes remain significant
(improvement in frequency of tooth brushing OR:1.75, 95%CI:1.32–2.32, p-value<0.001; improvement
in length of tooth brushing OR = 1.88, 95%CI:1.42–2.50, p-value<0.001; improvement in both
frequency and length of tooth brushing OR = 1.54, 95%CI:1.17–2.02, p-value = 0.002).
In subgroup analysis, the interaction between background variables (gender, grade and
parents’ education level) and intervention was not significant except for gender and grade for
correcting the length of brushing, indicating a quantitative and qualitative interactions,
]. Although the intervention was significantly effective in both sexes, it was more
effective in male students (OR = 3.36, 95%CI:2.11–5.36 in boys and OR = 1.79, 95%CI:1.13–
2.82 in girls). For the effect modification effect of grade on intervention, we found that the
intervention was effective in low grades (grades 1–3) and ineffective in higher grades (grades
4–6) (OR = 3.50, 95%CI:2.29–5.36, p-value<0.001 in grades 1–3 and OR = 1.41, 95%CI:0.86–
Behavior change N (%)
Kahak (n = 315) Jafariyeh (n = 615)
OR (95% CI)
2.31, p-value = 0.17 in grades 4–6). In more details, actually female students in grades 4–6
didn’t get benefit from intervention (17.3% vs. 20.3%).
This study reports the effect of the social marketing approach on the tooth brushing behavior
change in terms of its length and frequency among primary school students. After the
intervention, the social marketing approach caused a significant improvement in length of tooth brushing
(at least two minutes), frequency of tooth brushing (at least two times a day), and tooth brushing
habits (twice a day, two minutes each time) in comparison with the traditional method.
Through categorization of the target audience and attention to their demands, the social
marketing model can design interventions leading to increased participation and acceptance
of the desirable behavior (product), while traditional interventions cannot meet the demands
of the target population and cause behavior change due to having one solution for all people.
For this reason, before designing an intervention, we conducted a research to identify the
target population’s needs and their barriers, including the reasons for irregular or no tooth
brushing. The results showed that the main reasons were forgetting and laziness.
There are several studies evaluating the effects of social marketing approach in health issues.
For example; in a study by Kassegne et al., a social marketing intervention to promote use of
oral rehydration salts among caregivers of children under five was relaunched in 2006 in
Burundi. Results showed that oral rehydration salts use among caregivers at their children’s
last diarrheal episode increased significantly after the intervention. Evaluation analysis showed
that a higher level of exposure to the social marketing campaign was associated with greater
use of oral rehydration salts and with significant improvements in perceived availability,
knowledge of the signs of diarrhea and dehydration, social support, and self-efficacy [
In other study by Shams et al, in 2011 in Tehran, a social marketing model to reduce risky
driving behaviors among taxi drivers was done. An 8-week educational program was
implemented, then risky driving behaviors were assessed by checklists and compared. Results
showed that the intervention caused statistically significant reductions in the target behavior
in the intervention group compared to the control group [
In a study by Rienks et al in 2013 in San Francisco, social marketing techniques were used
to develop and implement three campaigns to increase awareness regarding infant mortality
disparities and proper infant sleep position and to take action to reduce disparities. This study
showed social marketing is an effective tool to increase disparity awareness, especially among
groups disproportionately affected by the disparity [
This evidence suggests the social marketing approach can produce positive change in health
knowledge and behaviour across population. The findings of these studies are in line with our
study demonstrated the efficacy of social marketing approach in behavior change.
In the field of oral health, there are also a number of studies to assess the effect of social
marketing interventions on oral health promotion. Redmond et al conducted a cluster
randomized controlled trials in students with a mean age of 12.1 years from 28 schools of England
in 1996. They used an school-based dental health education program to improve knowledge
and self-reported behavior. resulted in an improvement in knowledge of dental disease and an
increase in the reported duration of brushing. The percentage of the students who reported
tooth brushing for more than one minute increased significantly after 12 months of
intervention but no significant difference in the frequency of brushing occurred [
], while our
intervention resulted in improvement of frequency and length of tooth brushing. Although it is
necessary to consider the methodological differences between the two studies and compare the
results with caution. In addition, it is important to note that assessment of the results in our
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study has been done in the short term compared to Redmond study that had a longer
followup time. However, the strength of our study is related to social marketing approach that
resulted in designing the interventions based on the audience’s needs.
In a study by Hiiri et al, the rate of brushing twice a day increased significantly after the
intervention in children aged 6–15 years [
], which was consistent with our results. This finding can
be due to the high similarity of this study to the principles of social marketing since the authors
performed a needs assessment to evaluate the current situation before applying the intervention.
Another study that was in line with our results was a campaign conducted in China in
1989–1992 that caused a significant increase in the rate of brushing at least twice a day in
children and adults, indicating the success of the campaign [
]. The reasons for this success seem
to be related to duration of the campaign, the repetition of interventions and reminders that
led to behavior change.
Fallah et al conducted a study in Saveh, Iran to evaluate the effect of an educational
intervention for teachers on the students’ oral health but found no significant change in the frequency of
tooth brushing defined as at least once a day [
], which is different with the results of our study
that used the social marketing approach. Comparison of the results of this study with our
findings indicates the needs for interventions based on the social marketing approach.
The external validity (generalizability) of the study was acceptable since no sampling was
done and all the target population with maximum heterogeneity was included in the study [
We succeeded to implement the intervention components completely for the intervention
group. In the present study, systematic blinding was not done, however no bias probably
occurred due to the distance was long enough between the two cities. In this situation, it was
almost impossible for someone in the control group to receive the intervention of another group.
All students from first to sixth grades were considered in this study. However, considering
the possible differences between students’ perceptions and tastes in the first to third grades
compared to fourth to fifth grades, we suggest that the interventions be designed and
implemented separately for the two groups of primary students (first to third and fourth to sixth
grades) in future studies.
This study had some limitations. The quasi-experimental design due to non-randomly
selection of the intervention group might be the main limitation. In addition, the effect of
social marketing approach on tooth brushing habits has been assessed in short term. A loss of
30% that occurred at post-intervention assessment could affect the result validity. However, to
estimate the effect of lost sample on final conclusion, we did sensitivity analysis and repeated
data analysis with all sample in worst case scenario. The analysis showed tooth brushing
improvement remained significant.
Considering the results of this study, the social marketing approach had positive effect to
promote tooth brushing habits and caused desirable behavior changes in the target population,
although the effect was shown in the short term. More studies with long follow-ups are
therefore necessary to assess this improvement. However, findings of the present study suggest
policymakers to consider budget for designing programs based on social marketing approach for
improving oral health behaviors.
S1 Fig. Flow chart of study participants.
S1 Data. The SPSS file of study data.
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S1 Trend. The TREND checklist of study.
S1 Protocol. The trial study protocol (in original language). The English version of it could
be found in the link that is uploaded in Data Review URL section of attached files.
The authors wish to thank Dr. Shams for valuable comments in health education and the staff
of Kahak and Jafariyeh primary schools.
Conceptualization: Ali Asghar Habibi, Mahdia Gholami, Ahmad Reza Shamshiri.
Data curation: Ali Asghar Habibi, Ahmad Reza Shamshiri.
Formal analysis: Ahmad Reza Shamshiri.
Funding acquisition: Mahdia Gholami.
Investigation: Ali Asghar Habibi.
Methodology: Mahdia Gholami, Ahmad Reza Shamshiri.
Project administration: Ali Asghar Habibi, Mahdia Gholami.
Resources: Ali Asghar Habibi.
Software: Ahmad Reza Shamshiri.
Supervision: Mahdia Gholami, Ahmad Reza Shamshiri.
Validation: Mahdia Gholami, Ahmad Reza Shamshiri.
Visualization: Ali Asghar Habibi.
Writing – original draft: Ali Asghar Habibi.
Writing – review & editing: Mahdia Gholami, Ahmad Reza Shamshiri.
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