Behavioral change and oral health literacy among elementary students after a school-based oral health education program

Abstract

BACKGROUND: Oral health knowledge and behavior are essential in preventing dental caries among school-aged children, particularly in low- and middle-income countries where access to preventive education is limited. This study aimed to evaluate changes in oral health literacy, behavior, and clinical oral health status among Indonesian elementary students following a school-based oral health education intervention. MATERIALS AND METHODS: This study employed a cluster-randomized longitudinal intervention design with pre- and post-test assessments. A total of 582 students aged 8-12 years from public elementary schools in Makassar, Indonesia, were recruited using cluster random sampling and allocated into three groups: Multimedia-based education, conventional education, and a control group. Oral health literacy was assessed using a validated knowledge, attitude, and practice (KAP) questionnaire with confirmed internal reliability (Cronbach's α >0.80). Clinical outcomes were evaluated using the Oral Hygiene Index-Simplified (OHI-S) and the Decayed, Missing, and Filled Teeth (DMFT) index based on the World Health Organization criteria. Data were analyzed statistically to assess associations between literacy and clinical outcomes. RESULTS: < 0.001). Higher oral health literacy was significantly associated with better oral hygiene and lower caries experience. Qualitative findings indicated increased awareness, improved habits, and peer support after the intervention. CONCLUSION: Multimedia-based school oral health education effectively enhances literacy, behaviors, and clinical oral health outcomes. Integrating interactive multimedia into the school curriculum may support sustainable preventive oral health strategies for children.

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