Poster Guided Reinforcement Learning technique on sugar intake and oral hygiene knowledge, attitude and practices among adolescents: A cluster randomized controlled trial

Excessive consumption of sugar-sweetened beverages (SSBs) and sugary snacks during adolescence is a major risk factor for dental caries and other non-communicable diseases. Conventional school-based oral health education often improves knowledge but fails to achieve sustained behavioural change. To evaluate and compare the effectiveness of a Novel Poster Guided Reinforcement Learning (PGRL) technique with conventional oral health education (OHE) on sugar intake and oral hygiene knowledge, attitudes, practices (KAP)among adolescents aged 12–15 years. A double-blinded, parallel-arm cluster randomized controlled trial was conducted among 400 school children from two private schools in Belagavi, Karnataka. Participants within each school were randomly selected to the intervention group (PGRL; n = 200) or control group (conventional OHE; n = 200) however, randomization was performed at the cluster level. A validated, self-designed questionnaire assessed sugar intake frequency and KAP at baseline and after three months. The PGRL intervention included a colour-coded Sugar Education Board and daily visual reinforcement through diary-based stickers, while the control group received conventional oral health education. Data were analysed using Wilcoxon signed-rank and Mann–Whitney U tests. At three months, the intervention group demonstrated significantly higher overall KAP scores compared to the control group (22.55 ± 2.96 vs. 20.96 ± 5.34; p = 0.004). A substantial reduction in sugary drink and snack consumption was observed in the PGRL group (mean score reduced from 22.20 ± 9.98 to 9.95 ± 3.70), compared to a smaller reduction in the control group (23.27 ± 9.25 to 16.20 ± 7.00; p < 0.001). The Poster Guided Reinforcement Learning technique was significantly more effective than conventional education in improving sugar-related knowledge, attitudes, practices, and reducing sugary food and beverage intake among adolescents.