A total of 1650 children were contacted from 22 randomly selected schools (both primary and secondary) spread across urban, semi-urban and rural settings in every region of SL. A random subsample (30%, n=500) including children, their parents and other adults were approached for feedback on the pictorial information sheet and a response rate of 79% (n=394) was received.
The findings from the questionnaire survey interview suggested that pictorials used in the information sheet helped the participants’ in understanding the overall process of the project. This was reflected in their responses as 93% (n=354) reported that the pictures on the information sheet helped them ‘very much’ to understand about the oral health survey with only 2% (n=6) suggesting otherwise, and 2.5% (n=10) remaining neutral. Similarly, 96% (n=369) of the sample reported that they liked the pictures.
The findings from this study suggest that pictorials, relaying messages about the research study, were welcomed and perceived to help with gaining informed consent from participant; however, the views of the 21% who did not participate in the nested evaluation remain unknown. These findings will be published in due course and contribute to wider academic knowledge.
In the future, the project team are planning to use this approach again in a low income country with low levels of literacy, and possibly in the UK with internationals who may not have written English.
Pictures can convey so much more than words. I was very impressed by Clarice’s ability to tell a story using cartoon sketches; it was a delight to collaborate with her on this innovative project. Her art enabled us to gain informed consent for dental research using pictures in Sierra Leone, a country where many adults have limited literacy and will never have encountered a dentist.
Professor Jenny Gallagher, academic lead
The illustrations’ main function was to inform, so I had to think very carefully about clarity of image, text and symbols within the cultural background of the target audience. These discoveries about how to convey complex ideas have clearly been invaluable.
Clarice Holt, artistic lead
The use of pictures was very important in the Sierra Leone setting. The information and consent form sheet used in this survey was very helpful in making parents and children understand the oral health survey. The pictures gave them a sense of why we were approaching them and how the survey would be conducted. As a result we have been able to approach and treat patients, especially children, in rural school settings.
Dr Patric Don Davis, project collaborator
On behalf of parents, children and staff we are so pleased to have received King’s and the Sierra Leone government’s support for the good oral check-up and treatment they gave to us. We appreciate the pictures used in this survey. They made teaching about the survey easy to understand for all. We say thank you for coming to our aid.
Teethsavers team, project participants
Professor Jennifer Gallagher is Head of Population and Patient Health in the Dental Institute at King's. The overall aim of Professor Gallagher's research is to provide a strategic public health perspective on the dental workforce in support of health and oral healthcare, and thus, inform future decisions at population (governments, educational providers), practice and individual level. Her research interests focus on shaping the healthcare workforce to meet the needs of the population, with a strong emphasis on promoting oral health and preventing disease, particularly amongst vulnerable groups.
Dr Patric Don Davis is the Principal Dental Surgeon at Connaught Hospital, Sierra Leone.
Clarice Holt is an illustrator, graphic facilitator and graphic designer living and working in San Francisco, CA. She creates visuals that help people understand and engage with complex information. With a strong background in the business, academic and charity sectors, she has a wide breadth of experience helping clients solve their visual communication problems.
Professor Stephen Challacombe, an expert in oral medicine, and Swapnil Ghotane, a doctorate student at King's in the division of Population and Patient health, are additional partners involved in the project.