Staff and students at Dundee School of Dentistry have started a new initiative in collaboration with a local English language teaching organisation, using comics and storytelling to provide health education.

Promotion of oral health equity and student direction of their education are core tenets of Dundee Dental Connect, a co-creation group here at the Dundee Dental Hospital and Research school. It is crucial that principles of Global Citizenship, patient and public engagement are instilled within undergraduate students to provide insight into the impact that they can have as oral health professionals. Although only established for one year, the enthusiasm of the staff and students involved have made a number of projects addressing inequality a success and these have been previously reported on.1,2 This latest endeavour involved collaborating with Dundee's ‘Conversation Café', utilising storytelling and comics to simultaneously deliver oral health education and teach the English language.

What is the Conversation Café?

The Conversation Café is an initiative funded by Dundee City Council and provides refugees and anyone else who has settled in Dundee with the opportunity to learn and refine their English language.3 Diare Drammeh, alongside volunteers, runs the Conversation Café in the Victoria and Albert (V&A) museum on a weekly basis, which serves to not only enhance participants' English speaking, but provide a social bubble and sense of community for those who attend. The class is tailored to adults, but children are welcome when childcare is unavailable. Beginner to advanced levels of English speaking are catered for, and refreshments are provided throughout the class. The relaxed, informal, ‘café-like' setting allows learners to chat amongst themselves and with volunteers, to enhance their English, meet new people and find out about opportunities within the local area. Approximately 20 to 30 learners attend each week and are divided into smaller groups depending upon their abilities.

Dundee Dental Connect saw this collaboration as a fantastic opportunity to integrate oral health promotion into the English language teaching.

How were the sessions organised?

Dundee Dental Connect had become aware of the Conversation Café through a previous event for Ukrainian refugees. The group contacted the Café to gauge interest in a dental student visit to the venue, and the response was extremely receptive. An initial scoping visit was undertaken, and a lesson plan was devised based on this.

It was determined that a short presentation on oral health practice would be ideal, followed by a workshop where a comic developed for younger children was employed. This comic was an existing resource and was structured with appropriate English to be suitable for a number of levels of fluency. The resources were quality assured by dental professionals for content and by experienced English teachers for suitability.

Dundee Dental Connect saw this collaboration as a fantastic opportunity to integrate oral health promotion into the English language teaching.

The students delivering the intervention were calibrated to ensure appropriate delivery was assured.

Similar to other events, those in attendance would be offered oral health aids generously donated from ChildSmile4 and the opportunity to be seen on the Undergraduate Dental Clinics, provided they were not currently under the care of any other dental service. Forms were provided, along with translations or help understanding the questions where necessary.

A date was finalised for the dental student visit and a poster created for the Café to display and email to those who attend.

The pilot event

A presentation entitled ‘Why oral health matters and how to keep your mouth healthy' was delivered by undergraduate students using simplified language, visual aids, ensuring comprehension and pausing to address questions regarding the language used or the advice being given. Mouth models were used in small group settings to visually illustrate optimal toothbrushing techniques and oral hygiene instruction. The team used a comic ‘Toothy Tiger's Pearls of Wisdom' (Fig. 1) to help improve the learners' reading skills. This gave learners the opportunity to practise reading and speaking aloud, while reinforcing the principles of maintaining good oral health. Learners were encouraged to read to each other and following the session, to read the comic to their friends, children, and grandchildren.

Fig. 1
figure 1

Excerpts from the oral health promotion comic ‘Toothy Tiger's Pearls of Wisdom'

Full size image

The outcome

Staff, students, volunteers and those who attended all engaged well and found the event to be useful. The session lasted three hours and all remained until the end. Most of the participants availed themselves of the oral health aids, taking age-appropriate toothbrushes and toothpastes for themselves and their families. Furthermore, the majority of those in attendance were unaware that they could be seen at the Dundee Dental Hospital on the Undergraduate clinics through a self-referral pathway. Fifteen registration forms were completed, ranging from children to adults. Some of the volunteers at the café had connections with the medical school and expressed an interest in expanding the remit of these visits.

The students also responded positively. Student reflections showed these visits served not only as an education adjunct which helped to develop their communication and listening skills, but also posed as a truly enjoyable and rewarding experience. Student perspectives included the following:

‘I really enjoyed teaching everyone about the importance of brushing and flossing. It will not only enable them to improve their own oral hygiene, but also to pass on such information and skills to their children, families, and friends. I also really enjoyed chatting to and getting to know the folk that came along'.

‘I really enjoyed being part of this amazing visit. It was fantastic to see how engaged the learners were. Their enthusiasm towards learning about oral health, and their eagerness to learn how to look after their teeth optimally was a delight to see. A personal highlight for me was reading the comic alongside one of the learners and her son. It allowed them to learn new English phrases and words together and provided the mother with an opportunity to emphasise the importance of oral health and how to brush your teeth optimally to her son. It was a joy to watch and emphasised the vast effect which these sessions can not only have on the learners, but also upon their families and communities.'

Student reflections showed these visits served not only as an education adjunct but posed as a truly enjoyable and rewarding experience.

‘I found our first visit to the Conversation Café to be extremely rewarding. The class members showed great engagement and were inquisitive regarding language used and OHI given from the slideshow. A lot of the OHI we gave through the slideshow and toothbrushing demonstrations appeared to be new to most of the members and we received a substantial number of sign-ups for attendees and family members for student treatment at Dundee Dental Hospital. The success of this dental student visit has highlighted the power these events can hold in optimising oral health and caries prevention amongst the refugee community within Dundee.'

The way forward

Following on from this successful initial visit, there are plans being confirmed to undertake these visits not only again within the Conversation Café held within the V&A, but also within other Conversation Cafés, social groups and ESOL classes within Dundee. Initial preliminary discussions have also been initiated with stakeholders from the Dundee School of Medicine to explore how collaborations may give way to multi-disciplinary interventions, demonstrating the relationship between specialties in holistic patient care. Moving forward this intervention needs to be evaluated.5 There is substantial evidence of the power of comics6,7for healthcare intervention, along with co-creation as part of clinical training,8,9,10 and it is hoped that we can further contribute to this.

We are also very happy to collaborate with other institutions to develop these initiatives.

All images produced by the University of Dundee for the Dundee School of Dentistry. Artwork by Robbie MaCoy, Medical Artist.