Viability in delivering oral health promotion activities within the Health Promoting Schools Initiative in KwaZulu-Natal

Background: Over the years, social media (SM) has become a powerful tool for communication and health promotion, enabling health professionals to connect with wider audiences in real time. However, there is a lack of qualitative data to understand end users’ perspectives on what is effective and what may require improvement. Purpose: This study aimed to explore preferences, reactions, and perceived impacts of oral health (OH) promotion on SM among Malaysian young adults. Methods: This qualitative study involved in-depth interviews with young adults aged 20–35 years. Purposive sampling was used to ensure diverse representation across several states in Malaysia. Twenty interviews were recorded and transcribed verbatim. Data were coded and analyzed thematically using Atlas.ti software. Three main themes—preferences, reactions, and perceived impacts—and seven sub-themes emerged from the analysis. Results: The young adults expressed positive views regarding OH promotion activities on SM. Most participants preferred visually appealing OH content, such as short videos and infographics, delivered in simple terms in the national language, and presented by health professionals. Although some participants identified as silent readers who did not actively engage with OH-related content, most believed that SM interventions had positively influenced their OH knowledge, attitudes, and behaviors. Conclusion: Most participants had positive perceptions of OH promotion through SM interventions, with some expressing clear content preferences. These findings may support the development of more effective OH promotion strategies in Malaysia that better align with user expectations.

Many children in the UK still require dental treatment under general anaesthesia (DGA). Why oral health promotion and prevention, in this cohort of children, has failed is poorly understood. By questioning the parents/carers of children undergoing DGA this study aimed to establish: 1 previous exposure to oral health education and promotion activities; 2 beliefs and behaviours about dental caries and prevention; and 3 what parents perceive useful in preventing dental caries. A cross-sectional questionnaire based study. Dental general anaesthetic centres in Wales, UK. 207 consecutively attending parents of children aged < 10 years requiring a DGA. In total, 150 (76%) parents/carers claimed to have received previous oral health advice and 103 (52%) had received toothbrushing instruction from a dentist. Only 18 (9%) reported the application of topical fluoride. Sixty seven (34%) believed "tooth decay runs in families" and 53 (27%) it was simply bad luck that their child had dental decay. The majority (89%) believed that information leaflets on oral health would be useful and 133 (67%) would find information on a website helpful. This study suggests that there is a significant scope for increasing the exposure of high risk children to fluoride. A sense of fatalism and erroneous beliefs were evident amongst some parents/carers of children needing DGA. These issues need to be addressed in the future design of oral health promotion/prevention activities.

To explore and assess the effect of payment schemes on oral health promotion and prevention programmes. A scoping review was conducted using the Arksey & O'Malley framework. MEDLINE (via PubMed), Embase (via Scopus), and The Cochrane Library were searched. Unpublished literature was also collected. Searching and screening were conducted until 31 July 2025. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews. All studies comparing payment methods for oral health prevention and promotion were included. A conceptual framework linking payment mechanism to provider incentive, service delivery behaviour, and preventive care outcomes was used to guide synthesis, with findings classified across three outcome levels: utilisation (Level 1), quality of preventive care processes (Level 2), and clinical oral health outcomes (Level 3). The studies were grouped according to the payment system, their impact on the service provider and receiver, and their advantages and disadvantages. After summarising the results, the data were analysed by consulting experts and compared with existing policies. Quality assessment was carried out using Joanna Brigg's Institute's Quality appraisal tools. Out of the 30 studies included, the review found that payment systems have various forms, with four main payment systems being Pay for performance (n = 3), Fee for service (n = 15), Capitation (n = 10), and Global Budget (n = 2). Other payment systems such as salary, treatment vouchers, or direct payment by the employer were also identified, and have been shown to increase preventive dental services and oral health promotion activities. Fee-for-service payment is consistently associated with higher treatment volumes but lower rates of preventive care delivery, while capitation incentivises prevention but carries risks of patient selection and service reduction without adequate risk adjustment. Pay-for-performance and value-based payment approaches show promise for improving preventive care quality, though evidence remains limited. No single payment model reliably promotes oral health prevention across all contexts. A mixed payment model combining the activity incentives of fee-for-service, the cost-sharing principles of capitation, and the quality orientation of value-based payment offers the most promising framework for advancing oral health promotion. Policymakers should consider hybrid financing structures supported by quality monitoring, and further research is needed to evaluate their long-term effects on clinical oral health outcomes.

To explore and assess what is known about oral health promotion through health-promoting primary schools in developing countries. A scoping review was conducted using the Arksey & O'Malley framework. Web of Science, PubMed, Scopus and Cochrane Library were searched, followed by the reference lists of the resulting studies. The UN classification of developing countries was used to define the countries included and the search was between 1986 and 2021. Quality assessment was carried out using Joanna Briggs Institute's quality appraisal tools. The search resulted in 33 studies of which almost half were randomized controlled trials. The oral health promotion strategies were oral health education (n = 16) delivered by teachers, parents or peers, or multicomponent involving both toothbrushing (n = 15) and dietary components (n = 2). Most of the included studies were conducted in Asia (n = 25/33). Findings suggested that comprehensive, multicomponent theory-based oral health promotion showed improvements in oral health outcomes of schoolchildren, particularly if delivered using a whole-school approach. However, further research on feasibility and implementation of oral health promotion through health-promoting primary schools in developing countries should be considered.

There is limited literature and no reviews on oral health promotion activities in the workplace to guide planning and practice. This review summarizes evidence about oral health promotion activities in the workplace (nature and extent), its impact and the factors that facilitate or act as barriers to implementation. Using the PRISMA-ScR guidelines, scientific articles written in English and published in peer-reviewed journals up to April 2021, from six databases (Medline, PubMed, CINAHL, Scopus, EMBASE and Emcare) were screened and selected. The full texts of 95 articles were then considered; 21 articles met the inclusion criteria of using oral health status or oral health predisposing factors as primary outcome after an intervention in the workplace. Almost all included articles took a quantitative approach (n = 18), two used a qualitative design and another used a mixed-method approach. The most common activities were personalized or group oral health education interventions and oral health screenings conducted by a dental professional. Two studies reported the cost-benefit of workplace oral health promotion (WOHP). The literature indicated that WOHP interventions can be successful in achieving improvements in oral health, measured using a range of clinical (plaque accumulation, gingival inflammation, periodontal inflammation) and self-rated oral health indicators. Based on the limited literature available, WOHP may have benefits for employee oral health and employers, and the support of managers and organizations potentially improves the success of programmes. The workplace would appear to be an ideal setting to promote oral health. However, there is limited information to guide oral health promotion planning and implementation, and policy.

Background: Schools provide an important background for health promotion, as they reach around 200 million school children across India, and through them the school staff, their families, and the population as a whole. Health promotional messages can be reinforced throughout the most influential stages of children’s life, enabling them to develop lifelong sustainable attitudes and skills. Objective of the study was to identify the best suitable method of oral health promotional activity, and to identify states where there is deficiency related to oral health promotion, and to create awareness to ensure long term benefits. Methods: This current academic research reviews articles related to school based oral health programs from 2000 to 2014 which are published in English. Electronic search for literature related to school based oral health promotional activities across India using medline, pubmed, WHO, MOHFW. The articles selected were divided into five categories; divisions were based on those originating from North, South, East, West and Central India. Inclusion and Exclusion criteria - articles and reviews related to oral health promotion in children aged between 6 - 17 years were included and those adults are excluded. Fourteen articles were found to be relevant to school oral health promotion and hence were included in the present review. Data from all the fourteen articles was analyzed to determine the type of oral health promotional activity and the states in which they were organized. Results: There was paucity of oral health promotion in the eastern states of India. Oral health promotion at schools in Indian context is infrequently offered by the oral health professionals, oral health education is offered to school children as a part of dental checkup and treatment camps that are organized infrequently by the educational institutions. Conclusions: The concept of utilizing teachers for frequent oral health education and screening of any gross deposits of food debris or calculus and dental caries is practicable. Also regular oral health education by teachers was more effective than irregular oral health education by the oral health professionals.

The health promotion action means, described by the 1986 Ottawa Charter, highlights the creation of supportive environments for health(1). Following this line of reasoning, several strategies have been adopted for implementing health promotion policies, including the Health Promoting School. In 1995, the Pan American Health Organization / Regional Office for the Americas of the World Health Organization (PAHO/WHO) officially launched the Regional Health Promoting School Initiative. Since then, all the countries in Latin America and the Caribbean have strengthened school health promotion actions, rethinking school health activities(2). To become a Health Promoting School, the institution must take a comprehensive view of human beings – especially children and adolescents – in their familiar, community and social environment. It must provide a healthy environment, building constructive and harmonious relationships and hence being able to awaken skills and attitudes within participants, fostering autonomy, creativity and participation of students and also the whole school community(3). Never before has so much been said about health and health promotion as today, i.e., there is a need for promoting health at school as an element for changing reality. The school plays an important political role within this context for being a place where ideology can be constructed, destroyed or perpetuated through the transmission of values and beliefs, besides being an environment that favors the development of health education actions. Childhood is the defining moment for the construction and solidification of habits and attitudes, hence the importance of school as an environment that enhances the development of a targeted, systematized and permanent work. “Through the Health Promoting School Initiative, school health has a chance to move forward and expand its conception and practices with a comprehensive and interdisciplinary view of the human being within a broader community, environmental and political context”(4:6). The Health Promoting School seeks to develop knowledge, skills and dexterity for self care and prevention of risk behaviors. In addition, it creates education strategies to awaken – through a critical and reflexive analysis – values, behaviors, social conditions and lifestyles, and contributes to the improvement of health and human development, helping to construct citizenship and democracy, strengthening solidarity, community spirit and human rights(3). According to the Pan American Health Organization, health promotion at school has three main components: general health education, creation of a healthsupportive environment and provision of healthcare services(4). If we are to promote health, we can rely on school as a partner in this journey; and if we are to develop health education actions at school, we must rely on teachers’ support and commitment. The teacher’s role at school is complex and deserves attention because he is a (trans)formative agent(3,4). The realization of health promotion projects at school is supported by the teacher who represents an important and fundamental link, being a multiplier of ideas who should, therefore, be trained to approach the concept of health recommended in the International Conferences, the VIII National Healthcare Conference, Healthcare Public Policies and the National Curriculum Parameters (PCN) (1), not only through the handling of information but also educational strategies needed for an integrated construction of knowledge. This current issue of the Brazilian Journal in Health Promotion (Revista Brasileira em Promoção da Saúde – RBPS) features an article on the importance of the creation of a healthy environment at school, especially when it occurs in a region with low socioeconomic status. The article shows that the creation of a healthy environment since preschool years – besides being important – has an impact on children’s lives. Simple actions such as recreational activities at school, provided they are continuous, reflect on a remarkable learning. The RBPS believes that promoting the qualification of teachers and healthcare professionals, through its pages, will serve as a cornerstone of the Health Promoting School in Brazil and an example for other countries to share this idea. doi:10.5020/18061230.2013.p307

Objective. To assess the impact of oral health promotion integrated with a health promoting school (HPS) initiative on the oral health outcomes of secondary school students. Materials and method. Using an urban–rural stratified cluster randomized approach, the intervention was applied to secondary school students in Arusha, Tanzania. In the urban, three control (n = 315) and two intervention (n = 214) schools performed oral clinical examination and questionnaires at baseline. In rural the corresponding figures at baseline were two (n = 188) and three (n = 360) schools. After 2 years, 374 and 358 students remained in the intervention and control arms. Results. Mean number of decayed teeth (DT) increased in the intervention (mean score 1.0 vs 1.7, p < 0.001) and control schools (mean score 1.2 vs 1.7, p < 0.001). Mean number of teeth with plaque decreased significantly in intervention and control schools. No significant difference in caries increment and plaque decline scores was observed between groups. Mean number of teeth with bleeding decreased (0.5 vs 0.3, p < 0.05) in intervention schools, whereas no change was observed in the control schools (0.4 vs 0.5, p = 0.051). Increment in mean number of DT between baseline and follow-up was largest and smallest in students who, respectively, deteriorated and improved their plaque and bleeding scores. Conclusion. The intervention activities did not show any effect with respect to dental caries, calculus and plaque status among the students investigated. Compared with the control group, more favorable changes in the intervention group occurred with respect to bleeding on probing, suggesting a weak but positive effect on students' oral hygiene status.

According to National Oral Health Survey reports and research, Early Childhood Caries has been identified as a serious public health problem in Sri Lanka. More than 65% of preschool-aged children have dental decay and only 2% of them have had treatment. With proper interventions and commitment from public health personnel and responsible community leaders this should be a largely preventable disease. An intervention study was conducted among preschool teachers in the District of Colombo, Sri Lanka, to assess their influence on oral health promotion in the school environment. All the available 52 preschools and all 72 teachers registered under a local government authority were involved in the study. Preschools were divided into intervention group and control group based on geographically defined areas. The intervention included training preschool teachers using a manual covering health education, health promotion, incorporation of oral-health-friendly activities into the preschool curriculum, and hands-on experience of oral examination. Pre- and post- assessments were conducted with a 6 month interval. After 6 months, the median oral health knowledge score of the intervention group improved from 55 to 72 (p = 0.005) and the mean score for oral health related practices from 32 to 35 (p = 0.032). The variables: oral-health-friendly preschool environment (p = 0.02), availability of brushing facilities (p = 0.005) and availability of information, education and communication materials related to oral health (p = 0.004) were significantly different between the two groups after 6 months. Oral health promotion activities can be effectively instilled in a pre-school environment by the education of teachers.

Epidemic increase in chronic non-communicable diseases (CNCDs) is resulting in immense challenges in developing countries such as South Africa. Previously misunderstood to affect only high-income countries, 80% deaths due to CNCDs occur in developing countries. This review article traces the path of health promotion in the Eastern Cape and South Africa while considering health promotion developments globally. An example is the HealthPromoting school initiative in 180 schools in the Eastern Cape Province based on the World Health Organization’s Health-Promoting School Initiative. Alma Ata’s holistic ‘health for all’ ideals, the WHO’s ‘Right to health’ along with South Africa’s Bill of Rights have remained important paper based progress. However partial implementation of certain policies and lack of implementation of most broad based health promotion is a major challenge in South Africa which has to be addressed urgently to reverse the advancing CNCD epidemic. Keeping healthy population healthy and training them to prevent CNCDs to the maximum possible extent is feasible by strategically focusing on Health promoting schools in South Africa. Community participation, women’s organizations and youth participation are critical in implementing Health promoting schools in South Africa while being supported by the intersect oral cooperation of key stakeholders in the Department of Health, Department of Education and community engagement services of Universities.

The concepts of anticipatory guidance, dental home, and the year one dental visit in the context of oral health in children are slowing permeating the dental community. The above principles are now taught in dental schools, especially at the graduate level in specialty pediatric dentistry programs. Various dental associations, societies, and advocacy bodies have adopted those principles and advocate for them to varying degrees. While the value of oral health promotion in infants and young children is widely recognized, there is a diversity of approaches to the same. To date, a comprehensive overview of the various models, best practices, or the benchmarks for assessing their effectiveness has not been undertaken. In this special issue, dental and nondental clinicians, health promoters, and investigators have contributed to original research articles as well as proposals that document practices, experiences, and evaluation of outcomes related to oral health promotion in infants and young children from around the world. Some of the articles document the long-term effectiveness of their oral health promotion activities or models with clearly identifiable clinical outcomes. The issue highlights several facts. There is a diversity of approaches employed by a diversity of professionals. The goals, methodology, and outcome measures vary greatly. For example, the ages of the children at which these efforts ought to be directed vary. The scope of the oral health promotion activities ranges from simply providing education to parents and caregivers to provision of preventive services such as the application of fluoride varnishes. Another issue that comes to light is whether health promotion activities should primarily be aimed at caries prevention or if they should provide comprehensive anticipatory guidance which includes education on matters such as prevention of malocclusions in children due to habits, prevention of trauma, and avoidance of other risk behaviors that can predispose children to oral problems. With the advent of newer digital technologies and platforms for dissemination of information, the scope and reach of such activities are bound to evolve. Teledentistry should allow for well-established programs with documented clinical effectiveness to reach parts of the world where childhood oral disease is endemic and access to care is still an issue. There is a need for the development of oral health promotion models deliverable through modern technologies. There is great paucity of the literature documenting the effectiveness of such programs, both in the short and especially the long term. Moreover, the relationship between oral health in infancy and that in adulthood has yet to be systematically explored. While it is reasonable to conjecture that the establishment of risk factors very early in life might have long-lasting and indeed life-long effects, this has not been explored and documented. Without such evidence it would be difficult to convince governmental or non-governmental agencies to fund such programs and educational institutions to undertake training of health promoters. This special journal issue is a starting point for developing a consensus around this important pediatric health topic. Gajanan Kulkarni

One of the aims of the South African Oral Health Promotion Framework is to integrate oral health promotion activities into general health promotion using the Common Risk Factor Approach (CRFA). Though policies have directed that oral health should be integrated into general health promotion in South Africa, little is known about the implementation of the CRFA in daily oral health promotion practice. This study aimed to assess how health promoters in Gauteng integrate oral health into their general health promotion activities. The objectives were (i) to describe how health promoters undertake health promotion in Gauteng; (ii) to describe how health promoters incorporate oral health promotion into health promotion activities; and (iii) to describe the opportunities and challenges for health promoters in applying the CRFA. This was a qualitative study and data were collected using semi-structured interviews. A purposive sample of 10 formally trained health promoters agreed to be interviewed. Thematic analysis was used to analyse the data. Participants' work was centred mostly on healthy lifestyle campaigns and there was little integration of oral health into health promotion activities. While most health promoters had an understanding of the CRFA, this understanding was not common amongst other levels of management. Oral health literacy was low and health promoters perceived few opportunities for using a CRFA when weighed against other priorities such as poverty and HIV/AIDS. Currently there is little evidence of integration of oral health into general health promotion activities.

Workplaces have considerable potential for enhancing personal resources and providing a supportive working environment for staff health, including oral health and well-being. To date, assessments of workplace oral health promotion (WOHP) activities have observed benefits ranging from self-reported oral health to clinical parameters. However, previous WOHP actions were not based on a theoretical framework and did not consider the working environment as part of the planning and evaluation process. This article used evidence-based health promotion theoretical frameworks, and associated facilitators and barriers, in constructing an integrated and theoretically robust approach to planning and evaluating oral health promotion activities in the workplace. The PRECEDE-PROCEED Model for planning and evaluation, the reach effectiveness adoption implementation maintenance, and the Salutogenic Model of Health were chosen to complement each other in the planning and evaluation process, based on their different features and the applicability of those features to the workplace setting. Because of the limited literature in this area, the current article also used evidence from oral health promotion in other settings (including schools and the community) and general health promotion in the workplace to construct a theoretical framework for planning and evaluating WOHP activities. The theoretical framework developed could assist in planning or improving existing workplace health promotion programs that focus on or incorporate oral health elements. SO WHAT?: Future research on applying and adapting the proposed framework is required.

Background: This study investigated the status of oral health promotion activities for adult workers in public health centers and industrial dental offices and provided basic data for the model development of oral health promotion program for adult workers in Korea.Methods: A questionnaire was developed separately according to the person who in charge of the oral health promotion activities in public health centers nationwide and dental hygienists working in 20 industrial dental offices. This survey was conducted through postal survey and consisted of 29 items and 35 items respectively, including 19 common items for general information, oral health promotion program status and opinion. Statistical analysis was performed using the IBM SPSS ver. 23.0.Results: We analyzed the data of 147 public health centers (57.9%) and 9 industrial dental offices (45.0%). A workforce with a lack of practice was the biggest barrier to oral health promotion activities for adult workers. However, both groups showed high intention for the practice of adult worker’s oral health promotion activities. Also, they showed willingness to work together in an organic partnership to perform their roles (94.4% and 77.8%, respectively). Regarding the scope of cooperation in the implementation of the industrial oral health promotion activity linked to the public health center, dental hygienists of industrial dental offices responded that they could coordinate necessary matters and schedule management.Conclusion: The development of an oral health promotion program aided by the relationship between public health centers and industrial dental offices is essential for the oral health promotion of adult workers. The possibility of cooperation between the abovementioned centers was confirmed through this study. In a long-term perspective, it would be necessary to identify a method to institutionalize industrial dental hygienists for the provision of continuous oral health care in workplaces.

One in every two cases of caries in deciduous teeth occurs in low- and middle-income countries (LMICs). The aim of the World Health Organisation's (WHO) Healthy Schools Program is to improve the oral health of children. This study explored perceptions of implementation of the Ugandan oral health schools' program in Gulu district, northern Uganda. Semi-structured interviews were conducted with a purposive sample of 19 participants including health and education officials, community leaders, policy makers, teachers, and parents. All interviews were transcribed verbatim and analysed thematically. Our study identified three themes: (1) components of oral health promotion, (2) implementation challenges of oral health promotion, and (3) development of an oral health policy. The components of oral health promotion in schools included engagement of health workers, the community, companies, skills-based education, and oral health services. Participants were concerned about insufficient funding, unsatisfactory skills-based education, and inadequate dental screening. Participants reported that there was an urgent need to develop oral health policy to guide implementation of the program at scale. Schools provided oral health promotion that aligned with existing features of the WHO's health-promoting school framework. Implementation of this strategy could be enhanced with increased resources, adequate oral health education, and explicit development of oral health policy.