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Year : 2021  |  Volume : 39  |  Issue : 2  |  Page : 154-158

Oral healthcare-related perception, utilization, and barriers among schoolteachers: A qualitative study

1 Head of Department, Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India
2 Consultant, Mobile Dental Clinic Project, National Health Mission, Maulana Azad Institute of Dental Sciences, Bahadur Shah Zafar Marg, New Delhi, India

Date of Submission24-Aug-2020
Date of Decision03-Jun-2021
Date of Acceptance11-Jun-2021
Date of Web Publication29-Jul-2021

Correspondence Address:
Dr. Swati Jain
Room No. 504, Mobile Dental Clinic Project, Department of Public Health Dentistry,Maulana Azad Institute of Dental Sciences,Bahadur Shah Zafar Marg, New Delhi :110002
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JISPPD.JISPPD_368_20

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Background: Health perceptions play an important part influencing health care utilization. Oral health messages and practices advocated by teachers can ensure better compliance by the students. Aims and Objectives: The present study aimed to assess qualitative insight regarding the perception and outlook of the school teachers understanding probable barriers regarding oral health care seeking behavior. Materials and Methods: Phenomenology type of qualitative research design was used amongst 44 school teachers of a Senior Secondary Government School of Delhi selected through convenient sampling. One to one in-depth interview was taken in 03 sections: demographic details, knowledge of oral health and its significance in life along with commonly followed and recommended oral hygiene practices and their views regarding barriers to oral health. Summative content analysis was conducted. Frequency distribution of the observed keywords was analyzed using SPSS version 21. Results: The mean age of teachers was 33.7 + 7.02 years (27-41 years). Every participant in the study felt that “oral health is integral part of overall health”. On inquiring the prime reason; it was quoted 'Awareness/affects general health' (15.2%) followed by 'Bad oral health affects academic performance' (9.6%). Regarding perceived barriers for dental service delivery l; the major roadblock perceived was “lack of awareness” (47.7%) followed by “financial barrier” (29.5%).Conclusion: The responses gave an insight regarding the basic need for further subject specific oral health education programs as a key for changing the current scenario. Future seminars and workshops remain the mainstream to appraise the knowledge for school staff.

Keywords: School Health; oral health; summative content analysis, qualitative research

How to cite this article:
Mohanty V, Jain S, Grover S. Oral healthcare-related perception, utilization, and barriers among schoolteachers: A qualitative study. J Indian Soc Pedod Prev Dent 2021;39:154-8

How to cite this URL:
Mohanty V, Jain S, Grover S. Oral healthcare-related perception, utilization, and barriers among schoolteachers: A qualitative study. J Indian Soc Pedod Prev Dent [serial online] 2021 [cited 2022 Oct 5];39:154-8. Available from: http://www.jisppd.com/text.asp?2021/39/2/154/322507

   Introduction Top

Knowledge and opinions about “health concepts” influence health-seeking behavior and health-care utilization. Health-care services consist of a comprehensive health-care package including oral health care as well. Oral health is an inevitable element of general health affecting the quality of life, especially during the building years of life, i.e. school age.[1]

It affects the overall development of a child having serious consequences on their physical and psychosocial well-being. Understanding the significance of oral health and health promotional activities engaging child can help shaping positive health-related beliefs and behavior. Understanding the oral health needs and conducting oral health promotional activities as an integral component of general health promotional activities can result in positive health outcomes.[2] Empowering students and staff of schools through capacity-building activities would ensure early learning and health-seeking behavior, which may be translated to the society at a large. Hence, school-based oral health promotional activities can bring about a positive change in the oral health-care scenario as well.[3]

Oral health promotion through the health-promoting school concept has been the key focus of health planners throughout the world. Health education in schools is one of the methods to create awareness among the community. Further, behavior modification improving the understanding and knowledge concerning oral health can be a vital option to improving the felt need among the masses and would aid as an adjunct to the concept of health-promoting schools.[4],[5]

Teachers act as role models for the schoolchildren. Hence, oral health messages and practices advocated by them would ensure better compliance by the students. An insight regarding the perception and outlook of the school staff to understand the probable barriers regarding oral healthcare-seeking behavior would help in planning of tailor-made health promotional activities at the school level. Qualitative exploration method would be ideal for in-depth analysis.

Limited literature exists regarding the perception and significance of oral health care among teachers and school staff in India. The current study was conducted to assess the awareness level of schoolteachers regarding the significance of health and to understand the probable roadblocks behind restricted oral health-care utilization. The results obtained will be useful in planning further capacity-building activities with a targeted approach for schoolteachers and students, suggesting a way for including oral health promotional and preventive activities in their curriculum.

   Methods Top

Phenomenology type of qualitative research design was used to understand and analyze the perception and roadblocks regarding oral health among the schoolteachers of a Senior Secondary Government School of Delhi selected through purposive sampling. Ethical approval from the institutional review board was obtained, and prior permission from the school authorities was sought. The study design was in accordance with Consolidated criteria for reporting qualitative research (COREQ) Checklist.[6]

One to one in-depth interview was taken for individual participants in a separate room in school premises maximum for a period of 30 min each by a single investigator using a pilot-tested interview guide. The interview consisted of three sections: (1) respondents' demographic details, (2) knowledge and oral hygiene practices, and (3) views/opinions regarding barriers to oral health and ways to overcome them and feasibility of integration of oral health into the school curriculum.

Audio recording done and field notes were prepared by a recording clerk for all the interviews. All the teachers present on the day of study interviewed till response saturation was encountered, and a total of 44 (n = 44) study participants were included in the study.

Data analysis

Summative content analysis was conducted of all the responses obtained by a data coder who was blinded to the identity of the respondent. The coding tree was prepared for individual key words derived for each question. The responses were then categorized and put into specific themes all exclusive of each other. The key words were so selected/derived to highlight the understanding of each section. To check the consistency of the keywords, repeat coding and matching was done for every fifth respondent by an independent coder. All the key words were then entered in Microsoft Excel Sheet for respective question in each section. Frequency trend of the observed keywords was then analyzed using IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.

   Results Top

The present study provided a qualitative insight to the perceived barriers pertaining to oral health-care delivery of schoolteachers. A total of 44 teachers available on the day of study (data collection) were included. The reason for a single sitting evaluation was to prevent the dilution of information among other teachers possible in a subsequent visit.

[Figure 1] shows the distribution of study population as per educational status. The mean age of teachers was 33.7 ± 7.02 years, with a range of 27–41 years. Only three male teachers (6.8%) were present on the day of study, the rest being females. Nearly 30% (n = 13) of the subjects were graduates, and 66% were postgraduates by education, and two subjects (4%) were qualified to doctoral level.
Figure 1: Sociodemographic profile of study participants

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Every participant in the study emphasized the role of oral health on the overall wellbeing of an individual. On inquiring the prime reason for importance of oral health [Table 1], the primary reason quoted was “Awareness/affects general health” (15.2%) and “Bad oral health affect academic performance” (9.6%), and the least quoted reason was “affects quality of life” (<1%).
Table 1: Oral health is important because

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Upon inquiring the common oral hygiene practices they follow and recommend [Table 2], a major proportion of teachers primarily admitted to brushing twice daily (93%), followed by avoiding sweet and sticky food (47.7%) and avoiding tobacco (20.5%). Interestingly, the least quoted practice was using fluoride toothpastes, drinking water after having milk at night, and avoiding citric drinks (<5%).
Table 2: What oral hygiene practices do you follow and recommend?

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A variety of answers were received in the next question [how do you think that information regarding oral health can be included in the school curriculum/activities; [Figure 2]], actually depicting the ways wherein teachers are interested to participate and disseminate their knowledge on oral hygiene to students. Many respondents gave multiple responses. However, these thirty answers were clubbed to five major responses, as they had a similar intention.
Figure 2: How do you think that information regarding oral health can be included in school curriculum/activities?

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Regarding responses pertaining to perceived barriers for dental service delivery both at school and community level [Table 3], 91% of the respondents provided various responses which were clubbed in 6 major themes. The major roadblock perceived was “lack of awareness” (47.7%) followed by “financial barrier” (29.5%).
Table 3: According to you what are the primary barriers for providing oral health care?

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Further, the probable solution to these barriers were enquired [Figure 3], wherein majority of the respondents suggested to improve the basic awareness level of students, teachers, and parents (38.6%), followed by organizing school-based activities (36.3%).
Figure 3: How can we overcome the barriers for oral health care?

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Nearly 100% of the respondents rated the workshop as “excellent” or “fruitful” and suggested. Further, almost 25% of the teachers felt that frequent workshops are required on the topics covering various dental diseases [Table 4].
Table 4: What future topics need to be covered?

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   Discussion Top

The present study provided a unique qualitative insight on the teachers' perception about oral health-care needs and utilization. The study findings provided laden, exhaustive information, which could help to create a road map for oral health promotive activities at school level. Improving the oral health of students and school personnel is a priority of both state and union health departments. The nation's upcoming national oral health policy launched national oral health-care program in five states of India, with special focus on information, education, and communication materials to schoolteachers and students.[1],[2] This reflects the inevitability of this sector of the population and its possible oral health impact on the schoolchildren.

Bringing about a positive behavior change among schoolchildren is the responsibility of the peer and staff. The “burden of oral disease” of schoolchildren in turn depends on the oral health attitudes of their “teacher” role models. Although the outcome cannot be generalized as it reflects personal choices and decisions of every respondent, it showcases qualitative insight on the schoolteachers' apprehension and motivation toward maintaining oral health and hygiene. The focus of this study being to identify the level of oral health awareness among the students' role models, their teachers. The qualitative methodological approach employed in this study offered an in-depth view of the schoolteachers as end users of oral health promotion services in school settings. Our results indicated that the comprehension regarding oral health significance among the participants was reasonable. All of the participants ascertained the fact that “oral health is vital component of general health” and is important. Similar results were observed by Blaganna et al.[7] and Wahengbam et al.[8] This highlights the knowledge acquired either from television or through peers, which indicates a positive baseline behavior toward oral health.[7] This could be further attributed to the special study group “teachers” who are usually considered to be well appraised about the health facts.[9] This finding can prove quite useful in further dissemination of oral health facts and practices to school students.

Oral health significance

Majority of the study participants (15.2%, question no. 2) believed that oral health is important as it affects general health. The responses such as ”Yes, it (oral health) is important not only for school children but also for every individual to keep them healthy. As mouth is one of the opening that allows the entry of many bacteria along with food.” In another response, a participant said ”Oral health is important as it is directly related to general health.” This highlights that the participants appreciated the link between oral and general health and hence were motivated to pay heed to it.[10]

The next most common response indicated that oral health is important as it affects studies “ I feel oral health is important for school children because of teeth problem, school children suffer and often do not go to school and concentrate in studies.” A few participants considered that oral health is important as it helps in the prevention of diseases of mouth (4.8%). Few of the responses were “Yes; because it can prevent many ailments like tooth decaying, systematic diseases etc.” In another response,; the respondent said “Oral health prevents gums diseases.”

The above responses highlighted that the participants logically specified the significance of oral health. Similar results were observed by Maida et al.(2015).[11] Oral diseases have negative affect not only oral health but also overall well-being. They also highlighted the consequence of functional and esthetic aspects of an individual on overall socialization and quality of life. This basic understanding can influence the acceptance of health-care treatment modalities promoting intersectoral coordination to serve the needy.[12]

Oral hygiene practices: Perception and implementation

Understanding of oral health-related practices and regimes followed by the individuals for a healthy mouth is usually based on patient's discernment regarding oral health care. Having an insight regarding this would aptly describe the current practices and would also help in addressing the knowledge gap.[12] In the current study, the most common oral hygiene practices followed were “ ”Brushing teeth twice daily (93.2%),” ”Avoid sweet and sticky food (47.7%),” “Avoid gutkha, supari (arecanut) and tobacco (20.5%).” It was interesting to note that few respondents were able to appreciate the relationship between carbonated drinks and high carbohydrate diet with poor oral health by advocating “Avoid citric drinks and junk foods.” Similar results were observed by Oberoi et al.[13] In another study done by Elsabagh et al., almost 50% of the study participants considered eating sweet food as the main reason behind poor oral health.[14] Brushing teeth twice daily remains the foundation principle of oral hygiene practices worldwide. Our study highlighted majority of the participants advocating and practicing brushing twice daily which is contrary to the findings of Thapa et al.[15] and Amin and Al-Abad[16] who have reported once daily toothbrushing as the key oral hygiene aid. Again, the target group in our study, i.e., teaching professionals who have high awareness level can be the major reason for the study findings.[17]

Oral health promotion

It was interesting to observe that almost 68.2% of the respondents advocated “school-based activities” for oral health promotion. Further, we obtained responses such as ”celebrating special days,” ”organizing dental and science fair in schools” and ”Involve parents in dental activities also.” Almost 36.4% told ”include dental information in school curriculum.” This complies with the findings of previous researches which advocated the concept of “health-promoting school” through active participation of school authorities and health-care providers.[18]

Barriers for oral health-care delivery and probable solutions

Health-seeking behavior influences the health-care utilization to a greater extent. This becomes further important when dealing with pediatric age group due to the inherent fear and anxiety toward dental treatment. Lack of awareness continues to be another major barrier greatly influencing the care-seeking behaviors in a negative manner. Many participants responded by.

Children are afraid of dental treatment, hence do not come for treatment” It could be comprehended from these observations that oral health-care services are elective unless there is dental emergency.[18] Many also indicated “lack of money “as the primary reason behind dental treatment noncompliance. Surprisingly, three of the respondents mentioned “the lack of school based Mobile Dental services” as the reason behind low utilization.

Regarding the probable solutions, mostly, the respondents provided duplicate responses and confirmed “oral health promotion through school-based activities” as the streamline system for improving dental care utilization.[19]

   Conclusion Top

The responses further highlighted the basic need for further subject-specific oral health education programs as a key for changing the current scenario. Future seminars and workshops remain the mainstream to appraise the knowledge regarding oral health care for the school staff who acts as role models for the children.

Study findings revealed the perceptions regarding various aspects of dental care and offer direction for actions to be taken at school level; in particular, the balance between various health and oral health promotional activities. Also illustrated are the perceived roadblocks in accessibility for oral health-care services, as well as the impact of dental fear and protective retort when seeking oral health care. Furthermore, these findings can serve to be reminiscent to education department, health-care providers, and policymakers of the existent knowledge gap, especially at school level. Further longitudinal in-depth analysis of various target groups is recommended for planning of state-based and nation-based oral health-related programs.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Srinivasan R. Health Care in India – Vision; 2020. Available from: https://planningcommission.nic.in/reports.Page. [Last accessed on 2019 Jul 18].  Back to cited text no. 1
Parkash H, Shah N. National Oral Health Care Programme Implementation Strategies. New Delhi: AIIMS, Ansari Nagar; 2002.  Back to cited text no. 2
Available from: https://www.who.int/school_youth_health/gshi/hps/en/HealthPromotingSchools; Page. [Last accessed on 2019 Jul 18].  Back to cited text no. 3
Karkada S, Pai MS. Concept of health promoting school. Manipal J Nurs Health Sci 2016;2:65-8.  Back to cited text no. 4
Nanda Kishor KM. Public health implications of oral health-inequity in India. J Adv Dent Res 2010;1:1-9.  Back to cited text no. 5
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007;19:349-57.  Back to cited text no. 6
Blaganna A, Grover V, Anjali A, Kapoor A, Blaganna V, Tanwar R, et al. Oral health knowledge, attitudes and practice behaviour among secondary school children in Chandigarh. J Clin Diag Res 2016;10:ZC01-6.  Back to cited text no. 7
Wahengbam PP, Kshetrimayum N, Wahengbam BL, Tanya Nandkeoliar T, Lyngdoh D. Assessment of oral health knowledge, attitude and self-care practice among adolescents – A state wise cross- sectional study in Manipur, North Eastern India. J Clin Diag Res 2016;10:ZC65-70.  Back to cited text no. 8
Available from: https://www.rwjf.org/en/library/research/2016/07/teacher-stress-andhealth.html. [Last accessed on 2019 Jul 18].  Back to cited text no. 9
Jackson SL, Vann WF Jr., Kotch JB, Pahel BT, Lee JY. Impact of poor oral health on children's school attendance and performance. Am J Public Health 2011;101:1900-6.  Back to cited text no. 10
Maida CA, Marcus M, Hays RD, Coulter ID, Ramos-Gomez F, Lee SY, et al. Child and adolescent perceptions of oral health over the life course. Qual Life Res 2015;24:2739-51.  Back to cited text no. 11
Lasser KE, Himmelstein DU, Woolhandler S. Access to care, health status, and health disparities in the United States and Canada: Results of a cross-national population-based survey. Am J Public Health 2006;96:1300-7.  Back to cited text no. 12
Oberoi SS, Mohanty V, Mahajan A, Oberoi A. Evaluating awareness regarding oral hygiene practices and exploring gender differences among patients attending for oral prophylaxis. J Indian Soc Periodontol 2014;18:369-74.  Back to cited text no. 13
[PUBMED]  [Full text]  
Elsabagh HM, Abd EM, Abd Elkader EN. Oral hygiene knowledge, attitude, practice and self-perception of personal dental appearance among majmaah university female student, KSA. Intl J Adv Comm Med 2018;1:14-8.  Back to cited text no. 14
Thapa P, Aryal KK, Mehata S, Vaidya A, Jha BK, Dhimal M, et al. Oral hygiene practices and their socio-demographic correlates among Nepalese adult: Evidence from non communicable diseases risk factors STEPS survey Nepal 2013. BMC Oral Health 2016;16:105.  Back to cited text no. 15
Amin TT, Al-Abad BM. Oral hygiene practices, dental knowledge, dietary habits and their relation to caries among male primary school children in Al Hassa, Saudi Arabia. Int J Dent Hyg 2008;6:361-70.  Back to cited text no. 16
Au KH. Helping high schools meet higher standards. J Adolesc Adult Lit 2013;56:535-9.  Back to cited text no. 17
Kwan SY, Petersen PE, Pine CM, Borutta A. Health-promoting schools: An opportunity for oral health promotion. Bull World Health Organ 2005;83:677-83:  Back to cited text no. 18
Mofidi M, Rozier RG, King RS. Problems with access to dental care for Medicaid-insured children: What caregivers think. Am J Public Health 2002;92:53-8.  Back to cited text no. 19


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3], [Table 4]


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