Social Story for Promoting Healthy Diet: Development and Validation

Abstract

Objectives: To develop and validate a social story for promoting healthy diet among children with special needs. Methods: The social story entitled “What do I eat every day” briefly introduced the importance of healthy diet, major food categories, and tooth-friendly snacking habits. The text of the story had been edited and revised by a panel of five registered dental surgeons; the illustrations were designed by three investigators using the Proceate software. Face and content validity were assessed by a panel of specialists in Paediatric Dentistry, and parents and teachers from special child care centres (SCCCs). Booklets presenting this social story were sent to 150 children in SCCCs. Caries status of these children was determined following the ICDAS criteria. Questionnaires regarding children’s oral-health related eating habits (OHREH) were completed by their parents. A higher OHREH score indicates better eating habits. The internal reliability of OHREH was analysed by Cronbach’s alpha. Construct validity of the story was assessed by correlating children’s caries status with their eating habits. Empirical validity was assessed by comparing children’s between-meal snacking frequencies before issuing the booklets and at the 6-month follow-up. Results: The panel agreed that the social story was easy to be understood and could be used to promote healthy diet among children with special needs. The internal reliability of the OHREH was 0.97. Children with inappropriate snacking habits had a higher number of carious surfaces than their counterparts did (p < 0.001). The numbers of extensive carious surfaces were negatively correlated to the OHREH scores (Pearson Correlation = -0.16, p = 0.05). Fewer children had between-meal snacks at the 6-month follow-up (p = 0.005). Conclusions: The main findings indicate that the social story is valid to promote healthy diet among children with special needs.