Implementation of School-based Oral Health Activities in Special Schools in the Kingdom of Saudi Arabia

Abstract

Background: Oral diseases are prominent among socially marginalised populations, including children with disabilities. Such children often experience high levels of oral diseases and unmet dental needs and are at a greater risk of poorer oral health. The WHO recognises schools as a key platform for promoting oral health. Understanding the barriers and facilitators for school-based oral health activities (OHAs) is crucial for their successful implementation, however, no existing studies have explored the implementation of OHAs in the Kingdom of Saudi Arabia (KSA) special schools. This research aims to fill this gap by exploring the current provision of OHAs in the KSA’s special schools and identifying the barriers and facilitators to their implementation using the Consolidated Framework for Implementation Research (CFIR). Methods: Two studies were conducted to address the research aims. Study One: To map the literature on OHAs in special schools, identify research gaps, and provide guidance for Study Two, a scoping review employing the Levac et al. (2010) framework was performed. This review outlined the OHAs used, examined their outcomes, and identified the factors affecting their application. Eleven studies were included in the review. The results indicate that very few studies have examined school-based OHAs for children with disabilities, and that school-based OHAs help to improve oral hygiene and oral health-related knowledge in the short term. It highlights a lack of understanding of the contextual factors impacting OHAs in special schools. Study Two: Qualitative semi-structured interviews with a sample of staff and children’s parents/carers at the KSA’s special schools were conducted (n=30). Subsequently, framework analysis was conducted using the CFIR to analyse the facilitators and barriers to school-based OHAs at these schools. Although some oral health education (OHE) activities were implemented, adequate planning, adaptation to children’s needs, evaluation, and reinforcement were lacking. Furthermore, staff members in the KSA special schools need to improve their knowledge, attitudes, and self-efficacy towards OHAs. As an inner setting, the KSA special schools experience barriers to implementing OHAs, including low relative priority, inadequate financial and human resources, and lack of tailored educational resources and toolkits. Moreover, the lack of external policies and incentives could hinder the implementation. Accordingly, this study recommends key concepts underpinning an oral health promotion (OHP) implementation toolkit. Conclusion: Research examining the implementation of OHAs in special schools is lacking. Overall, research indicates that providing school-based OHAs benefits children with disabilities, with a short-term positive impact on children’s oral hygiene level and oral health-related knowledge and behaviours. It also suggests involving parents and teachers in the activities and follow-up for longer periods. Furthermore, it reveals that, although OHE had been implemented in some of the KSA special schools, none of the activities fulfilled the definition of OHP. This study has found that several factors hinder the implementation of OHAs, including poor adaptability, lack of financial and human resources, and poor stakeholder engagement. Moreover, a need to develop an OHP implementation toolkit to guide the implementation of OHAs in the KSA special schools has been highlighted. Based on the identified barriers, research recommends four concepts to underpin the toolkit development: embracing OHP principles, developing adaptable oral health resources, using a collaborative approach and evaluation. These findings can significantly impact the work of researchers, policymakers, educators, and healthcare professionals aiming to promote oral health in the KSA’s special schools.