Dental Santri School Program (DENTSPRO) as Integrated Learning Dental Health Education in Miftahul Ulum Al Yasini Islamic Boarding

School
Aditya Mukti Setyaji Faculty of Dentistry, Airlangga University Surabaya Indonesia

ABSTRACT Background : Islamic boarding school has an important role for national progress and development into the next generation of leaders who have moral integrity. Unfortunately, a boarding school is often seen as a slum educational environment, poorly maintained, and far from the health values, particularly on dental and oral health. It can be seen from our first sample, 18 of 21 santri had decays and only 2 of them have treated by dentist. Thus, it is needed an integrated educational programs between educational boarding school and the dental health education that can improve the quality of dental health in Islamic boarding school in order to create a caring environment and to respond to oral and dental health. Purpose : This research aimed to give awareness about dental health education by innovative learning method and also create health cadres to be responsible to the dental health of Islamic boarding school society. Methods : The sample was 22 students will get DENTSPRO training to be a cadre. The training form as one group only, given the DENTSPRO methods. The measurements will be taken in three aspects, cognitive by questionnaire, psychomotoric by using PHP index, and afective by group parameter. Result : There was significant development between before and after in each aspect p-value < 0.05. Conclusion : It can be concluded that DENTSPRO methods provide improved level of three aspect in increasing the level of oral health in Islamic boarding school. Keyword : Dental Santri School Program (DENTSPRO), Dental Health Education, Integration Program Correspondence : Aditya Mukti Setyaji, Faculty of Dentistry, Airlangga University. Jl. Prof. Dr. Moestopo 47 Surabaya 60000, Indonesia. E-mail: adityasetyaji@gmail.com

Introduction Boarding School or pesantren is the oldest Islamic institution which is a product of Indonesian culture. The existence of boarding school in Indonesia started in Islam entered the country by adopting a system of religious education has actually evolved long before the advent of Islam. As an educational institution that has long been entrenched in this country, the boarding school which is recognized to have contributed greatly to the history of nation.1 Boarding school is one institution that has an important role for the development and progress of the nation, especially for Muslims. Boarding school create a cadre who have the ability in the field of science and technology also have faith and piety and to become a caliph or ruler of the people one day later. Boarding school was originally a center of cultivation of the values of Islam and religious broadcasting. However, in its development, it has increasingly widened the area that is not only accelerated the vertical mobility (with the cultivation of religious materials), but also horizontal mobility (social consciousness). Boarding school is no longer dwell on the

religious-based curriculum (regionally-based curriculum) and tend to soar, but the curriculum also touches the issue of contemporary society (society-based curriculum). Thus, schools can no longer be charged solely as a purely religious institution, but also (should) be a living social institution that continues to respond to the messy issues around.2 But in fact, the boarding school education was always seen as a slum neighborhood, not maintained, and much of the health values. This is evident from the pattern of daily life of the students who ignore health, especially dental health. For example, they generally use a toothbrush together. This can lead to easy transfer of bacteria and germs between individuals one with another individual that can lead to easy transmission of various diseases. Besides the lack of the students to clean their teeth twice a day as recommended by dentist causes the buildup of plaque, which can lead to various diseases of the oral cavity. The oral cavity is the entrance of germs, so that when the mouth is not kept clean will affect or aggravate health problems in other body parts. Such occurrence or worsening of heart disease 1

caused by the entry of germs go into the bloodstream.

Figure 1. Picture of oral health conditions in the boarding school of Miftahul Ulum Alyasini

Lack of knowledge about the importance of maintaining oral health became a major factor incidence of oral health problems among students in boarding schools. Evidenced by the results of a preliminary survey of the boarding school Alyasini Pasuruan, 18 of the 21 students have cavities and only two of which are performing maintenance to the dentist. Religious education which has been in the boarding school curriculum has not been able to establish a healthy lifestyle, so that the necessary learning material integrated between religion and science of dental oral health in general. Dental Santri School Program (DENTSPRO) is a method of learning to learn the lessons that integrate oral health with religious lessons in the boarding school. Integrated system developed in this DENTSPRO learning format that will enhance the cognitive, psychomotor, and affective learning system using student centered learning (SCL). Dental Santri School Program (DENTSPRO) as an integrated learning of oral health in boarding school is done by develop the concept of education that integrates oral health education with an understanding of health in everyday activities at boarding school. Unified or integrated learning is believed to be a practice-oriented approach to learning that suits needs. Effectively integrated learning opportunity that will help create evaluated to see and build concepts that are interrelated. Thus, providing an opportunity to understand the complex issues that exist in the surrounding environment with a view of the whole.3 Integrated model is the integration of a number of topics of different subjects, but essentially the same in a particular topic.4 This model is an integrated learning approach that uses between subjects. This model is attempted by combining subjects by means of setting curricular priorities and determine the skills, concepts, and attitudes that overlap each other in some subjects.

According to Prabowo, integrated learning is a teaching approach that involves several fields of study. Teaching and learning approaches such as these are expected to provide a meaningful experience to the students. Meaningful here because the meaning of integrated learning is expected child will gain an understanding of the concepts they are learning through direct experience and connect with other concepts they already understand. An integrated learning approach to teaching and learning to pay attention and adjust the level of development of the students (Developmentally Appropriate Practical). One example of a correlation between religious knowledge and oral dental health, among others, are using the Siwak. Including the sunnah of the most frequent and most pleased by Rosululloh sallallaahu 'alaihi wasallam. Siwak is the work of a lightweight but has good benefits, namely to maintain oral hygiene, healthy and white teeth, and eliminate bad breath. Material and Method This study is the experimental pseudo / quasi with a sample of 22 students and 44 younger cadres. There is only one group treated with the design of the Pretest-Postest only one group design. In the implementation there is a training procedure for 1 (one) day at boarding school Miftahul Alyasini Ulum. First of all cadres DENTSPRO collected in one class and is given by the tutor module and an explanation of the process of learning to use the module. Then the speaker gives a refresher course materials include oral dental health knowledge that is integrated with religious materials. Each module is delivered by a tutor, then cadres were given the opportunity to discuss with friends in the group (11 people per group), perform simulations, practice, and utilize the knowledge available media, it is an exercise in using the module. Simulations performed by dividing the participants into two roles, one role as a cadre DENTSPRO and other roles as ordinary people. For example how to practice good brushing and correct. Once completed, for each topic, are discussed along with dental health experts. Participants sought to identify and analyze your own shortcomings is happening and look for alternative answers. Tutor only directs, if there is congestion in the discussion, the tutor gave out road signs. After completion of the training cadre post held immediately DENTSPRO knowledge test. After that they followed the training of trainers training to prepare them to communicate better to transfer the knowledge that 2

they gained in the training material. Then tutorial counseling practice performed on the second day at boarding school hall which has been established with the guidance of a tutor. Process tutorial implemented by way of cadre which gives counseling to santri Tsanawiyah. Things that are delivered include oral dental materials in general, how to brush teeth properly in accordance with the method taught by a tutor as discussion groups. Supporting the learning process, in addition to modules provided a model and toothbrush, is a process of learning activities to enhance knowledge. Evaluation and monitoring targets torches are also taken at this session to find out how much success in the transfer of knowledge that can improve knowledge and behaviors of the target younger cadres. Result The results of training in boarding school DENTSPRO Miftahul Ulum Al Yasini who performed 22 students gained level data or knowledge is tested through cognitive pretest and post test. In the table below can be seen the average value of the variable test subjects before and after.
Table 1. Cognitive Data Analysis Results Variable Data DENTSPRO Training Research Pre Post Mean 7.2727 13.9545 St. Deviation 3.16501 1.61768 Asymp. Sig 0.880 0.496 Distribution of data Normal Normal

fairly. From these data it was found that the distribution of education should be comprehensive and it provides a direct implementatif in reality on the ground.

Figure 2. Distribution Category Graphic of Cognitive Score (pre-test)

While for the distribution of the boarding school students knowledge level after the treatment of Al Yasini DENTSPRO method is divided into two sections in figure 3, found 18 students (82%) for the category of fairly, and 4 students (18%) for good categories.

Based on table 1 can know the value of the average level of knowledge / cognitive DENTSPRO before and after training. Results of analysis of test data for normality with significance level = 0.05 throughout the variable results obtained, the significance of> (0.05) so that the data confirmed the results of research using the normal distribution and parametric analysis of the calculation of paired t-test. DENTSPRO cadre cognitive scores are categorized as follows, under the 55 percent correct answers including lack of knowledge, 5675 percent of sufficient knowledge and good knowledge of over 75.7 The results of the distribution of the category scores of cognitive / knowledge at pretest are listed in table 1. Distribution of the boarding school students knowledge level prior to the treatment of Al Yasini DENTSPRO method is divided into two sections, obtained 18 students (82%) for the category of less, and 4 students (18%) category

Figure 3. Distribution Category Graphic of Cognitive Score (post-test)

Then the difference between the results of data before and after DENTSPRO method (in the figure 4), which is 36.30% in the pre-test and increased to 69.70% at post-test. Ho result is rejected, because the p-value < (0.05). from the results we can conclude that the training DENTSPRO effective in raising the level of knowledge in Al Yasini boarding school.

Figure 4. Cognitive Test Results Graphic

The results of awareness and skill level of brushing teeth / psychomotor examined by dental hygiene through the data in the index PHP (Personal Hygiene Performance Index). In table.2 can be seen below the average index value of PHP subjects before and after DENTSPRO training.
Tabel 2. Cognitive Data Analysis Results Variable Data DENTSPRO Training Research Pre Post Mean 0.538 0.325 St. Deviation 0.2513 0.1500 Asymp. Sig 0.331 0.117 Distribution of data Normal Normal

students at a value of 3 (18.2%), 1 student at a value of 4 (4.5%), 0 student at a value of 5 (0%), and 0 students at a the value of 6 (0%). From these data it was found that the distribution of education should be comprehensive and it provides a direct implementation in reality on the ground so that students can keep and care for the teeth and mouth clean and well organized.

Based on Table 2, it can be seen that the average value of plaque index before and after brushing teeth with a DENTSPRO training. Results from analysis of test data for normality with significance level = 0.05 obtained results, the significance> (0.05) so that the normal distribution of data and research results using parametric analysis calculations paired t-test. Distribution values are examined through data psychomotor dental hygiene in the index PHP (Personal Hygiene Performance Index) from Al Yasini boarding school students prior to the treatment method of distribution of value DENTSPRO contained 7 sections, students on the value of 0 (0%), 3 students in value of 1 (13.4%), 6 students at a value of 2 (27.4%), 2 students at a value of 3 (9.1%), 6 students at value of 4 (27.4%), 4 students at value of 5 (18.2%), and 1 students at a value of 6 (4.5%). The distribution of the data obtained PHP impairment score.

Figure 6. Distribution Value of Psychomotor Score (post test)

Then the difference between the results of data before and after DENTSPRO method, which is 53.80% in the prior to training and decreased to 32.60% in after doing the training. These data show a decrease of plaque index.

Figure 7. Psychomotoric Test Results Graphic

Figure 5. Distribution Value of Psychomotor Score (pre test)

Distribution value of are examined through data psychomotor dental hygiene in the index PHP (Personal Hygiene Performance Index) from Al Yasini boarding school students conducted after treatment there were distribution of value DENTSPRO contained 7 sections , 1 student at a value of 0 (4.5%), 5 students the value of 1 (22.8%), 11 students at a value of 2 (50%), 4

To find out difference between the circumstances before and after training, performed statistical tests using data with a significant level: (0.05). Ho result is rejected, because the p-value < (0.05). from the results we can conclude that the training is effective in improving DENTSPRO level of skill / psychomotor boarding school in Al Yasini. The study measured attitudes through training Presence parameter extension, the activity and communication in the Forum Group Discussion and simulation of counseling, outreach presentations to younger cadres, cadre and guidance to younger monitors through the calendar with a toothbrush in the morning and evening for two weeks (fourteen days full). Checklist from some criteria of affective behavior obtained during this training takes place. Then 4

also a checklist of learning the method of brushing teeth good and regularly in accordance with the existing references, including methods of scrub, roll method, method of Stillman, and methods of fones. Result This study sample form 22 cadres from Al Yasini senior high school. From 22 cadres drawn at random who meet the criteria of the study subjects. The situation has not previously done training of cadres of oral health so that need special intervention and conducive to coaching and mentoring cadres. Appropriate intervention is the training by using the method of DENTSPRO.

Figure 8. Group Discussion Forum Module Case

From the research training DENTSPRO between before and after training, there is an increased level of knowledge / cognitive decline in the average index of PHP, and monitoring and evaluation of behavior. These three aspects are an indicator of the success from this training, because the three aspects are related to each other in their development.5 According to Green, the characteristic is one of the predisposing factors that influence knowledge, attitudes and actions. World Health Organization (WHO) said by Notoatmodjo states that a person gains knowledge from his own experience or the experience of others. This is in accordance with the principle of learning is an experience that occurs within oneself.6 At pretest, the amount of cadre DENTSPRO who have lack knowledge there is 82% and then to have a good knowledge of 18%. After a cadre of trained, knowledgeable cadre of good number increased to 18% and knowledgeable fairly to 82%. It shows that the knowledge of most of the cadres increased after training. The results of the mean level of knowledge / cognitive tests examined through a questionnaire (pre and post test) there is an increasing level of knowledge, and cognitive scores were categorized as follows

DENTSPRO cadres, below 55 percent correct answers including lack of knowledge, 56-75 percent of sufficient knowledge and over 75 is well knowledgeable.7 The average value of 36.30 pre tests are included in the category of lack of knowledge, then increased to 69.70 on the post test is included in the category of fairly in the average value. Based on statistical analysis of its conclusions have significant differences between the situation before and after training DENTSPRO. With these results DENTSPRO stated that training can increase the level of knowledge / cognitive knowledge from a variety of oral health. Despite increases in the level of knowledge / cognitive, there are some things to keep in mind during the last DENTSPRO training, there are some students who lack health information, lack conditioning in the boarding school environment, and levels of questions that came from level 1 (know) up to level 4 (analysis). Advantages from DENTSPRO training as an integrated learning of oral health in boarding school is apart from the concept of religious-based learning, learning is also applied to student centered learning (SCL) through Focus Group Discussion discusses the realities of oral health in accordance with the conditions on the ground. Participant-centered learning is essentially learning that focuses on the needs of the participants so the impact on curriculum design, learning content and learning activities of the participants.9 Estes (2004) in his research was to prove that learning to student-centered learning was better than the teacher-centered learning, because learning to student-centered learning participants are required to learn actively. The results of the mean level of skill / psychomotor tested through the index (Personal Hygiene Personal) there is a decrease in the average index PHP. There is a distribution from scores PHP value of from each students describe different patterns of oral health care from individual students. The results of the average index value of PHP prior to training that is equal to 0.538, then after the training there is a decrease of 0.326. there are significant changes between before and after training, but the level of oral hygiene was categorized as moderate. This can occur because students still do not understand way of brushing the teeth is good and right, students are still accustomed to the habit of brushing your teeth before treatment, so that effort in brushing your teeth properly is not maximized, the 5

motivation of students in terms of tooth brushing is still lacking. Based on statistical analysis of its conclusions have significant differences (p-value <0.05) between prior to the training and after training. With these results that can be used as a training DENTSPRO study of oral health, especially the teaching of brushing your teeth.

Figure 9. Learning brushing method of in accordance with existing methods

On the affective aspects of statistical calculation is not performed because the parameters are the needs from reality in the field or in other words the adjustment of the development from the concept of monitoring and evaluation of the planned follow-up post in the arrangement of the cadre, which include training of teaching Presence is an important point in smooth delivery of information to the general public about the material on oral health, brushing checklist with a variety of method of, and training in education are also aspects of the assessment of activity and communication in group discussion forum in the form of certain criteria, among others: a) Dared to express opinions b) Appreciate other people's opinions c) Asked / answered in a logical and easy to understand d) Can interact in a group both stage of assessment before the assessment of cadre development or preparation prior to deployed to communities around the boarding school, while the next stage is the presentation of activities Educate the public about (in this case Al Yasini junior high students), and also conducted follow-up activities to the younger cadres scout guidance with the help of a toothbrush with a calendar day and night to fill the full time span of 14 days (there are 28 boxes when fully charged). Calendar aims to measure the extent of the influence patterns of cadres to invite communities to continue to maintain healthy teeth and mouth properly and regularly. Limitations of existing research can not be controlled study of the influence from external research such as the mass media and information from other sources, which can affect the knowledge and skills of the respondents, Assessor for the knowledge and skills test observers PHP cadres in the index by a team of tutors so that possible subjectivity in assessments. To overcome the subjectivity can actually be done by assessors appointed instead from tutor team and conducted double-blind manner, then the parameters are lack affective portrait of the real state from development of the behavior of these cadres. References
1. 2. Haedari, Amin. 2007. Transformasi Pesantren. Jakarta: Media Nusantara. hal.3 Mastuki, El-sha, M. Ishom. 2006. Intelektualisme Pesantren. Jakarta: Diva Pustaka. hal.1

In observing motor skills students study the subject, keep in mind the child's motor development elements in it is the pattern of motor and motor skills, ie understanding when brushing your teeth is a motor skills, but using it as a skill from the activity of cleaning the teeth and mouth is a pattern of motor .10 The point is to build the motor development of children in oral hygiene, tooth brushing skills is an attempt for a healthy lifestyle to improve hygiene behavior in the oral cavity. In the measurement of the average post test score of skill / psychomotor from pretest to post test, the cadres became increasingly more significant, as shown in figure 7. To keep the retention of knowledge and skills as well as preventing a decrease retention of the cadres, it can be done by assigning tasks and follow-up counseling and teaching for the younger classes at boarding school with the material presented in the form of the sciences that have been taught before.

Figure 10. Presentation of teaching the younger cadre

3.

Resmini, N dkk. 1996. Penentuan Unit Tema dalam Pembelajaran Terpadu. Malang: IKIP Malang. Fogarty, Robin. 1991. How to Integrated the Curricula. Palatine, Ilinois: IRI/ Skylight Publishing, Inc. Green, LW. and Kreuter, MW. 1991. Health Promotion Planning, An Educational and Environmental Approach. 2nd ed. Mayfield Publishing Company, Mountain View. Notoatmodjo, S. 1995. Studi Sistem Penghargaan Kader Sebagai Upaya Melestarikan Posyandu di Jawa Barat dan Jawa Timur. Majalah KesehatanMasyarakat Indonesia, Tahun XXIII Nomor 10 Halaman 647-650. Arikunto, S. 2002. Prosedur Penelitian Suatu Pendekatan Praktis. Penerbit Rineka Cipta, Jakarta, hal 43 45. Forrester, DJ, and Fleming, J. Pediatric dental medicine. Philadelphia: Lea & febiger. 1981: 377387. Pedersen, Susan and Williams,Doug. 2004. A Comparison of Assessment Practices and Their Effects on Learning and Motivation in a StudentCentered Learning Environment. Journal of Educational Multimedia and Hypermedia, 13 (3), pp.283-307 Perseptual untuk Anak Usia Dini. http://salamahazhar.wordpress.com/2010.01/26/pe rkembangan-motorik-dan-perseptual-untuk-anakusia-dini akses 18 Desember 2010

4.

5.

6.

7.

8.

9.

10. Azhar, S. 2010. Perkembangan Motorik dan