Barriers, Facilitators, Scope, And Feasibility of Integrating Oral Health into School Health Programs: A Qualitative Study in Bengaluru, India
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https://doi.org/10.14419/zwedkg50
Received date: July 22, 2025
Accepted date: August 30, 2025
Published date: October 5, 2025
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School Oral Health Integration; Oral Health Promotion; Barriers and Facilitators; Qualitative Study; School-Based Oral Health Initiatives; Health Educa-tion Frameworks. -
Abstract
This qualitative research study explored the barriers and facilitators, scope, and feasibility of integrating oral health into school health programs in Bengaluru, India. Findings indicate that barriers such as resource constraints, curriculum gaps, awareness and engagement deficits, environmental, structural, geographic , and socioeconomic barriers, poor resources, inadequate curriculum, and limited awareness among key stakeholders contribute to the significant hurdles in incorporating oral health into such programs. On the other hand, facilitators emerged, such as administrative commitment, community collaboration, school children-centric engagement, support from strong administrators, coordination with the community, and active involvement of school children, all of which can increase the feasibility of such initiatives. It further emphasizes the role of innovative teaching methods and comprehensive health curricula in fostering sustainable oral health practices. The study provided recommendations to design effective oral health programs, which can be adapted for use in other urban contexts to promote lifelong health benefits and reduce future healthcare costs.
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References
- World Health Organization: WHO. (2019, November 14). Oral health. https://www.who.int/health-topics/oral-health.
- Sheiham, A. (2005, September 30). Oral health, general health, and quality of life. https://pmc.ncbi.nlm.nih.gov/articles/PMC2626333/.
- Petersen PE, Kwan S. Evaluation of community-based oral health promotion and oral disease prevention – WHO recommendations. Community Dent Health. 2004;21(4):319-29. https://pubmed.ncbi.nlm.nih.gov/15617418/.
- Dangi, S., Chhabra, K. G., Naganandini, S., Chaudhary, P., Singh, A., & Srivastava, H. (2025). To contemplate the role of school teachers on oral health promotion – A qualitative study. Journal of Education and Health Promotion, 14(1). https://doi.org/10.4103/jehp.jehp_921_24.
- Jawdekar, A. M. (2013). A proposed model for infant and child oral health promotion in India. International Journal of Dentistry, 2013, 1–6. https://doi.org/10.1155/2013/685049.
- Anopa, Y., & Conway, D. I. (2020). Exploring the cost-effectiveness of child dental caries prevention programmes. Are we comparing apples and oranges? Evidence-Based Dentistry, 21(1), 5–7. https://doi.org/10.1038/s41432-020-0085-7.
- American Dental Association. Oral health and well-being in children. ADA. Available from: https://www.ada.org/resources/research/science-and-research/oral-health.
- Chakraborty, T., Munigala, A., Kala, T., Yedla, R., Shankar, K. S., Bennadi, D., Tiwari, H. D., & Patel, P. (2024). Assessment of Oral Health Pro-motion Programs in Schools and their Long-Term Effects. Journal of Pharmacy and Bioallied Sciences, 16(Suppl 3), S2543–S2545. https://doi.org/10.4103/jpbs.jpbs_287_24.
- P. Akera, S. Kennedy, R. Lingam et al., "Effectiveness of primary school-based interventions in improving oral health of children in low- and mid-dle-income countries: a systematic review and meta-analysis," BMC Oral Health, 2022. https://doi.org/10.1186/s12903-022-02291-2.
- Y. E. Elsadek and S. R. Baker, "Oral health promotion through health-promoting schools in developing countries: A scoping review," Community Dentistry and Oral Epidemiology, 2023. https://doi.org/10.1111/cdoe.12864.
- Lee, A. (2009b). Health-promoting schools: evidence for a holistic approach to promoting health and improving health literacy. PubMed, 7(1), 11–17. https://doi.org/10.1007/BF03256138.
- M. H. Khoshnevisan, M. Pakkhesal, M.-P. Jadidfard and G. G. Nejad, "School-Based Oral Health Promotion: A Thorough Review," Shahid Be-heshti University Dental Journal, 2017.
- R. S. Gambhir, R. K. Sohi, T. Nanda et al., "Impact of School Based Oral Health Education Programmes in India: A Systematic Review," Journal of Clinical and Diagnostic Research : JCDR, 2013. https://doi.org/10.7860/JCDR/2013/6212.3718.
- V. V. Narayan, S. Thomas, M. S. S. Gomez et al., "Auxiliary delivered school based oral health promotion among 12-14-year-old children from a low resource setting-A cluster randomized trial," Journal of Public Health Dentistry, 2023. https://doi.org/10.1111/jphd.12565.
- B. R. Chandrashekar, S. Suma, K. Sukhabogi et al., "Oral health promotion among rural school children through teachers: an interventional study," Indian Journal of Public Health, 2014. https://doi.org/10.4103/0019-557X.146278.
- D. Sharma, M. B. C., N. Vyas, B. Sabbarwal, S. Yadav, and J. Kayasth, "Effectiveness of School Dental Health Programs: A Review with Insights from India," National Board of Examinations Journal of Medical Sciences, 2025. https://doi.org/10.61770/NBEJMS.2025.v03.i01.011.
- Purohit et al., "Effectiveness of an oral health promotion training program among school nurses in India," Nurse Education Today, 2024. https://doi.org/10.1016/j.nedt.2023.105989.
- Oral health among primary school children in rural and urban areas in Gulu district, northern Uganda, UNSW thesis reposito-ry, https://unsworks.unsw.edu.au/bitstreams/8dd08ab3-feda-400a-a1ea-f50fd8f326ba/download.
- Shailee et al., "Oral health status and treatment needs among 12- and 15-year-old government and private school children in Shimla city, Himachal Pradesh, India," Journal of International Society of Preventive & Community Dentistry, 2013. https://doi.org/10.4103/2231-0762.115715.
- Guskuma et al., "FACTORS ASSOCIATED WITH THE PREVALENCE AND INTENSITY OF DENTAL PAIN IN CHILDREN IN THE MUNICIPALITIES OF THE CAMPINAS REGION, SÃO PAULO," Revista Paulista de Pediatria, 2017. https://pubmed.ncbi.nlm.nih.gov/28977286. https://doi.org/10.1590/1984-0462/;2017;35;3;00001.
- P. Kahar, "Comparison of Oral Hygiene Behaviors and Caries Experience between Rural Populations of the Dominican Republic and India," TAMU OakTrust repository, https://oaktrust.library.tamu.edu/bitstreams/083f84e9-a1fb-4254-b479-a9f4d318b93f/download.
- Chandrashekar et al., "Oral health promotion among rural school children through teachers: an interventional study," Indian Journal of Public Health, 2014. https://doi.org/10.4103/0019-557X.146278.
- Comparison of oral health status in Asia: results for eight emerging and five high income countries or regions and implications, CJDR, 2016. http://www.cjdrcsa.com/uploads/media/170207/CJDR-2016-04-2.pdf.
- Shailee; Sogi; Sharma; Nidhi, "Dental caries prevalence and treatment needs among 12- and 15-Year old schoolchildren in Shimla city, Himachal Pradesh, India," Indian Journal of Dental Research, 2012. https://doi.org/10.4103/0970-9290.107330.
- Saccomanno, S., De Luca, M., Saran, S., Petricca, M. T., Caramaschi, E., Mastrapasqua, R. F., Messina, G., & Gallusi, G. (2023). The importance of promoting oral health in schools: a pilot study. European Journal of Translational Myology, 33(1). https://doi.org/10.4081/ejtm.2023.11158.
- Lawal and Taiwo, "An audit of school oral health education program in a developing country," Journal of International Society of Preventive & Community Dentistry, 2014. https://doi.org/10.4103/2231-0762.144600.
- Vonk, L., Eekhout, I., Huijts, T., Levels, M., & Jansen, M. W. (2024). School health promotion and fruit and vegetable consumption in secondary schools: a repeated cross-sectional multilevel study. BMC Public Health, 24(1). https://doi.org/10.1186/s12889-024-18546-2.
- Pulimeno, M., Piscitelli, P., Colazzo, S., Colao, A., & Miani, A. (2020). School is as ideal setting to promote health and wellbeing among young people. Health Promotion Perspectives, 10(4), 316–324. https://doi.org/10.34172/hpp.2020.50.
- Barton, G. H. (2020). Designing and Conducting Mixed Methods Research (3rd Edition; International School childrenEdition) by John W. Cre-swell & Vicki L. Plano Clark. The Cognitive Psychology Bulletin, 1(5), 88–89. https://doi.org/10.53841/bpscog.2020.1.5.88.
- Corbin, J., & Strauss, A. (2008). Basics of Qualitative Research (3rd ed.): Techniques and Procedures for Developing Grounded Theory. https://doi.org/10.4135/9781452230153.
- Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19(6), 349–357. https://doi.org/10.1093/intqhc/mzm042.
- Admin. (2021, March 5). Focus groups: A Practical Guide for Applied Research (5th edition) – Digital Fieldwork. https://digitalfieldwork.iu.edu/bib-entry/focus-groups-a-practical-guide-for-applied-research-5th-edition/.
- Hennink, M., & Moore, A. C. (2024). Understanding communication between patients and healthcare professionals regarding comprehensive bi-omarker testing in precision oncology: A scoping review. Cancer Medicine, 13(3). https://doi.org/10.1002/cam4.6913.
- Smith, S., & El-Gamal, D. (2024). The novel anti-cancer agent, SpiD3, is cytotoxic in CLL cells resistant to ibrutinib or venetoclax. Hemato, 5(3), 321–339. https://doi.org/10.3390/hemato5030024.
- Silverman, D. (2024). CYP2D6 activity in patients with metastatic breast cancer treated with single-agent tamoxifen: Results from ECOG-ACRIN E3108. Breast Cancer Research and Treatment. Advanced online publication.
- Guest, G., MacQueen, K., & Namey, E. (2012). Applied Thematic Analysis. https://doi.org/10.4135/9781483384436.
- Forero, R., Nahidi, S., De Costa, J., Mohsin, M., Fitzgerald, G., Gibson, N., et al. (2018). Application of four-dimension criteria to assess rigor of qualitative research in emergency medicine. BMC Health Services Research, 18(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816375/. https://doi.org/10.1186/s12913-018-2915-2.
- Forero R, Nahidi S, De Costa J, Mohsin M, Fitzgerald G, Gibson N, et al. Application of four-dimension criteria to assess rigor of qualitative re-search in emergency medicine. BMC Health Services Research [Internet]. 2018 Feb 17;18(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5816375/. https://doi.org/10.1186/s12913-018-2915-2.
- Gargano, L., Mason, M. K., & Northridge, M. E. (2019). Advancing Oral Health Equity Through School-Based Oral Health Programs: An Ecologi-cal Model and Review. Frontiers in Public Health, 7. https://doi.org/10.3389/fpubh.2019.00359.
- Narain, J. P. (2016b). Public health challenges in India: Seizing the opportunities. Indian Journal of Community Medicine, 41(2), 85. https://doi.org/10.4103/0970-0218.177507.
- Implementation of Health Promotion Programmes in Schools: An Approach to Understand Knowledge, Perceptions and Barriers. (2022). Journal of Community Medicine & Public Health, 6(1). https://doi.org/10.29011/2577-2228.100233.
- Rajan, S., Roberts, K. J., Guerra, L., Pirsch, M., & Morrell, E. (2017). Integrating Health Education in Core Curriculum Classrooms: Successes, Challenges, and Implications for Urban Middle Schools. Journal of School Health, 87(12), 949–957. https://doi.org/10.1111/josh.12563.
- Jacobsen, K. H., & Waggett, C. E. (2022). Global health education for the post-pandemic years: parity, people, planet, priorities, and practices. Global Health Research and Policy, 7(1). https://doi.org/10.1186/s41256-021-00234-y.
- Morel, M. M., Chuang, E., & Laniado, N. (2022). Bridging gaps in oral health education in a medical school in the United States: a pilot study. BMC Medical Education, 22(1). https://doi.org/10.1186/s12909-022-03648-5.
- Carman, K. L., Dardess, P., Maurer, M., Sofaer, S., Adams, K., Bechtel, C., & Sweeney, J. (2013). Patient And Family Engagement: A Framework for Understanding the Elements and Developing Interventions and Policies. Health Affairs, 32(2), 223–231. https://doi.org/10.1377/hlthaff.2012.1133.
- Jackson, S. L., Vann, W. F., Kotch, J. B., Pahel, B. T., & Lee, J. Y. (2011). Impact of poor oral health on children’s school attendance and perfor-mance. American Journal of Public Health, 101(10), 1900–1906. https://doi.org/10.2105/AJPH.2010.200915.
- Guarnizo-Herreño, C. C., & Wehby, G. L. (2012b). Children’s Dental Health, School Performance, and Psychosocial Well-Being. The Journal of Pediatrics, 161(6), 1153-1159.e2. https://doi.org/10.1016/j.jpeds.2012.05.025.
- Guarnizo-Herreño, C. C., & Wehby, G. L. (2012). Children’s Dental Health, School Performance, and Psychosocial Well-Being. The Journal of Pe-diatrics, 161(6), 1153-1159.e2. https://doi.org/10.1016/j.jpeds.2012.05.025.
- O’Connell, T., Ramanathan, K., & Chopra, M. (2013). What does universal health coverage mean? The Lancet, 383(9913), 277–279. https://doi.org/10.1016/S0140-6736(13)60955-1.
- Social Determinants of Health for Rural People Overview - Rural Health Information Hub. (n.d.). https://www.ruralhealthinfo.org/topics/social-determinants-of-health.
- National Academies Press (US). (2018, March 1). Factors That Affect Health-Care Utilization. Health-Care Utilization as a Proxy in Disability De-termination - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK500097/.
- Diao, H., Pu, Y., Yang, L., Li, T., Jin, F., & Wang, H. (2019). The impacts of peer education based on adolescent health education on the quality of life in adolescents: a randomized controlled trial. Quality of Life Research, 29(1), 153–161. https://doi.org/10.1007/s11136-019-02309-3.
- Laursen, B., & Veenstra, R. (2021). Toward understanding the functions of peer influence: A summary and synthesis of recent empirical research. Journal of Research on Adolescence, 31(4), 889–907. https://doi.org/10.1111/jora.12606.
- Blank, M. J. (2015). Building Sustainable Health and Education Partnerships: Stories from Local Communities. Journal of School Health, 85(11), 810–816. https://doi.org/10.1111/josh.12311.
- Devraj, R., Butler, L. M., Gupchup, G. V., & Poirier, T. I. (2010). Active-Learning Strategies to Develop Health Literacy Knowledge and Skills. American Journal of Pharmaceutical Education, 74(8), 137. https://doi.org/10.5688/aj7408137.
- Williams, M. V. (1995). Inadequate Functional Health Literacy Among Patients at Two Public Hospitals. JAMA, 274(21), 1677. https://doi.org/10.1001/jama.1995.03530210031026.
- Hopper, M. K., & Brake, D. A. (2018). School childrenengagement and higher order skill proficiency: a comparison of traditional didactic and re-newed integrated active learning curricula. AJP Advances in Physiology Education, 42(4), 685–692. https://doi.org/10.1152/advan.00149.2018.
- Robertson, D., Carins, J., Rundle‐Thiele, S., & Harris, J. (2022). Evaluation of Social Impact Within Primary School Health Promotion: A Systemat-ic Review. Journal of School Health, 92(8), 739–764. https://doi.org/10.1111/josh.13160.
- Fernandez, M. E., Hoor, G. a. T., Van Lieshout, S., Rodriguez, S. A., Beidas, R. S., Parcel, G., Ruiter, R. a. C., Markham, C. M., & Kok, G. (2019). Implementation Mapping: Using Intervention Mapping to Develop Implementation Strategies. Frontiers in Public Health, 7. https://doi.org/10.3389/fpubh.2019.00158.
- Spencer, G. (2013). Empowerment, Health Promotion and Young People. In Routledge eBooks. https://doi.org/10.4324/9780203071038.
- N, J., & Pe, P. (2011). Oral health behaviour of urban and semi-urban schoolchildren in the Lao PDR. PubMed, 28(4), 280–285. https://pubmed.ncbi.nlm.nih.gov/22320066.
- Seirawan, H., Faust, S., & Mulligan, R. (2012b). The Impact of Oral Health on the Academic Performance of Disadvantaged Children. American Journal of Public Health, 102(9), 1729–1734. https://doi.org/10.2105/AJPH.2011.300478.
- Jackson, S. L., Vann, W. F., Kotch, J. B., Pahel, B. T., & Lee, J. Y. (2011). Impact of Poor Oral Health on Children’s School Attendance and Per-formance. American Journal of Public Health, 101(10), 1900–1906. https://doi.org/10.2105/AJPH.2010.200915.
- Haleem, A., Siddiqui, M. I., & Khan, A. A. (2012). School-based strategies for oral health education of adolescents- a cluster randomized con-trolled trial. BMC Oral Health, 12(1). https://doi.org/10.1186/1472-6831-12-54.
- Ghasemi, H., Alautry, H. F., Khoshnevisan, M. H., & Namdari, M. (2024). Effectiveness of a School-Based Oral Health Promotion Program on Dental Caries Among Iraqi School children: A Cluster Randomised Controlled Trial. International Dental Journal. https://doi.org/10.1016/j.identj.2024.07.1214.
- Ghasemi, H., Alautry, H. F., Khoshnevisan, M. H., & Namdari, M. (2024). Effectiveness of a School-Based Oral Health Promotion Program on Dental Caries Among Iraqi School children: A Cluster Randomised Controlled Trial. International Dental Journal. https://doi.org/10.1016/j.identj.2024.07.1214.
- Allensworth, D., Lawson, E., Nicholson, L., & Wyche, J. (1997). Guidelines for comprehensive school health Programs. Schools & Health - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK232686/.
- Lelyana, N., Sarjito, A., & Sutawidjaya, A. H. (2024). The Effectiveness of Dental Health Education Programs in Reducing Dental Caries Preva-lence among Indonesian Adolescents. Journal of Ecohumanism, 3(7), 2140–2152. https://doi.org/10.62754/joe.v3i7.4368.
- Van Baal, P., Morton, A., & Severens, J. L. (2018). Health care input constraints and cost-effectiveness analysis decision rules. Social Science & Medicine, 200, 59–64. https://doi.org/10.1016/j.socscimed.2018.01.026.
- Joshi, A., Bhatt, A., Gupta, M., Grover, A., Saggu, S. R., & Malik, I. V. (2022). The current state of public health education in India: A scoping review. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.970617.
- Allensworth, D., Lawson, E., Nicholson, L., & Wyche, J. (1997). Guidelines for comprehensive school health Programs. Schools & Health - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK232686/.
- Van Baal, P., Morton, A., & Severens, J. L. (2018). Health care input constraints and cost effectiveness analysis decision rules. Social Science & Medicine, 200, 59–64. https://doi.org/10.1016/j.socscimed.2018.01.026.
- Ho, Y. L., Mahirah, D., Ho, C. Z., & Thumboo, J. (2022). The role of the family in health promotion: a scoping review of models and mechanisms. Health Promotion International, 37(6). https://doi.org/10.1093/heapro/daac119.
- McIsaac, J. D., Penney, T. L., Ata, N., Munro-Sigfridson, L., Cunningham, J., Veugelers, P. J., Storey, K., Ohinmaa, A., Kirk, S. F., & Kuhle, S. (2017). Evaluation of a health promoting schools program in a school board in Nova Scotia, Canada. Preventive Medicine Reports, 5, 279–284. https://doi.org/10.1016/j.pmedr.2017.01.008.
- Dudovitz, R. N., Wong, M. D., Perez-Aguilar, G., Kim, G., & Chung, P. J. (2018). Update on How School Environments, Social Networks, and Self-Concept Impact Risky Health Behaviors. Academic Pediatrics, 19(2), 133–134. https://doi.org/10.1016/j.acap.2018.09.014.
- Pai, L. P., Bhat, S. S., Sheikh, A., Ballal, K. R., K, S. H., & Shabbir, A. (2024). Oral Health Related Quality of Life in Malnutrition. RGUHS Jour-nal of Dental Sciences, 16(2). https://doi.org/10.26463/rjds.16_2_11.
- Renugalakshmi, A., Vinothkumar, T. S., Hakami, F. B., Salem, R. M., Qadri, A. A., Harbosh, Z. M., & Hakami, Z. (2021). Impact of Silver Dia-mine Fluoride Therapy on Oral Health-related Quality of Life of Uncooperative Preschool children: A Prospective Study. Oral Health & Preventive Dentistry, 19, 93–99.
- Maghsoudi, T., Cascón-Pereira, R., & Lara, A. B. H. (2020). The Role of Collaborative Healthcare in Improving Social Sustainability: A Conceptual Framework. Sustainability, 12(8), 3195. https://doi.org/10.3390/su12083195.
- Elsadek, Y. E., Edwebi, S., Turner, A., Vinall-Collier, K., Csikar, J., & Pavitt, S. (2023). A systematic review of school-based school childrenpeer-led oral health interventions to promote the oral health of school children. BMC Oral Health, 23(1). https://doi.org/10.1186/s12903-023-03482-1.
- Haraldsson, K. S., Lindgren, E. M., Fridlund, B. G., Baigi, A. M., Lydell, M. C., & Marklund, B. R. (2007). Evaluation of a school-based health promotion programme for adolescents aged 12–15 years with focus on well-being related to stress. Public Health, 122(1), 25–33. https://doi.org/10.1016/j.puhe.2007.04.016.
- Chew, C., Rosen, D., Watson, K., D’Alesio, A., Ellerbee, D., Gloster, J., Tharp-Gilliam, S., Beasley, T., & Burgette, J. M. (2024). Implementing a Community Engagement Model to Develop a Community-Driven Oral Health Intervention. Progress in Community Health Partnerships, 18(1), 67–77. https://doi.org/10.1353/cpr.2024.a922331.
- Langford, R., Bonell, C., Jones, H., Pouliou, T., Murphy, S., Waters, E., Komro, K., Gibbs, L., Magnus, D., & Campbell, R. (2014). The World Health Organization’s Health Promoting Schools Framework: A Cochrane Systematic Review and Meta Analysis. European Journal of Public Health, 24(suppl_2). https://doi.org/10.1093/eurpub/cku163.051.
- Abdul, N. S., Adeghe, N. E. P., Adegoke, N. B. O., Adegoke, N. a. A., & Udedeh, N. E. H. (2024). Leveraging data analytics and IoT technolo-gies for enhancing oral health programs in schools. International Journal of Applied Research in Social Sciences, 6(5), 1005–1036. https://doi.org/10.51594/ijarss.v6i5.1149.
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R. Sagarkar, D. A. M. (PhD) ., K, D. P. ., Gadicherla , D. S. ., & Krishnappa, D. L. . (2025). Barriers, Facilitators, Scope, And Feasibility of Integrating Oral Health into School Health Programs: A Qualitative Study in Bengaluru, India. International Journal of Basic and Applied Sciences, 14(6), 71-79. https://doi.org/10.14419/zwedkg50
