A framework for integrated oral health promotion within the Health Promoting Schools Initiative in KwaZulu-Natal

Objectives: To establish the appropriateness of using a framework to critically assess the viability of including oral health promotion elements within the Health Promoting Schools Initiative for school-based oral health service delivery.
Methods: This study was explorative using a mixed methods approach. Twenty-three schools of a total sample of 154 were selected from the eleven districts of KwaZulu-Natal using multistage cluster sampling. Data collection comprised policy reviews, a self administered questionnaire, data capture sheets, interviews and focus group discussions.
Results: The results of the study indicated that policy statements on oral health promotion were not translated into practice at school level. The study findings indicated an absence of oral health promotion initiatives in the curriculum. Barriers and challenges identified included lack of funds, human resources, knowledge and ownership; high workloads and time constraints. Benefits identified by the educators included the importance of the inclusion of oral health promotion into the curriculum, the reinforcement of oral health education in the curriculum by the introduction of examples and activities as well as the creation of awareness to oral health for the educators. The framework used to guide this study provided a systematic and negotiated approach to the planning, implementation and review of the oral health promotion intervention.
Conclusions: Strategies for oral health promotion have not been translated into practice indicating that oral health services are currently not properly aligned. There is a lack of coordination between the Health Promoting Schools Initiative and School Health Services in terms of policy and guidelines with education policies and guidelines. There is a need for multiple stakeholder involvement in policy implementation, monitoring and evaluation of oral health promotion activities. More research needs to be done to explore the mechanism to support and address inequity in oral health promotion related service delivery at schools.