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Pictorial art in Sierra Leone

King’s Dental Institute worked with an illustrator and graphic designer to obtain informed consent from participants in a country-wide dental health survey in Sierra Leone.

Pictorial-Pictorial Art in Sierra Leone  trialled an image-led information sheet and consent form to explain the value of participating in a country-wide oral health survey to both adults and children aged 6, 12 and 15 years old across the country. Over a six-month period, the team collected data from 1,650 individuals using the pictorial information sheets. The King’s team worked with Sierra Leonean partners to design, seek feedback on and use a pictorial information sheet. The paperwork met King’s research ethics requirements and was well received by Sierra Leoneans, both children and adults. The evaluation showed strong support for this distinctive approach that enhanced their understanding of the survey.

Sugar consumption is rapidly increasingly in Sierra Leone and tooth decay is a growing issue, while dental services are limited. As a result, dental help is sought too late and extractions are often the only option remaining. King’s Sierra Leone Partnership is working to better understand the country’s dental health needs, the challenges its health professionals face and the training needs of its dental workers. To underpin this work, a country-wide oral health survey was required. However, low levels of literacy combined with limited contact with dentistry proved to be major stumbling blocks to obtaining informed consent from individuals to participate in the survey. In response, the partnership developed a way of using the universal language of art to convey information and obtain consent.

The information gained through the survey found that most children and all adults examined have tooth decay and need dental care, many urgently. The team is now using the data gathered to work with government and health leaders in Sierra Leone on the planning and delivery of a scaled-up dental workforce for the future.


Pictorial art in Sierra Leone is a collaboration between King's College London's Division of Population & Patient Health, King’s Dental Institute, Connaught Hospital, Sierra Leone, and Clarice Holt, supported by the university's Culture team.

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