Strengthening Oral Health and Oral Hygiene Behaviour among School-Aged Children through the Healthier Smiles Phase 7 Programme
Results of an End-line Assessment in North Luwu and East Luwu Regencies, South Sulawesi, Indonesia
DOI:
https://doi.org/10.59585/ijhs.v4i3.1407Keywords:
oral health, oral hygiene, health behaviour, school-aged children, Healthier Smiles, healthy schools, mixed methods, health promotionAbstract
Oral health problems among school-aged children remain a major public health challenge in Indonesia, particularly in rural areas where access to dental care services is limited. This study aimed to evaluate the achievements of the Healthier Smiles Phase 7 Programme through an end-line assessment, focusing on changes in oral health knowledge, attitudes, and practices, the strengthening of the school environment, and programme sustainability. A mixed-methods approach with a non-experimental repeated cross-sectional design was employed, integrating quantitative surveys, school observations, Key Informant Interviews (KIIs), and Focus Group Discussions (FGDs). A total of 544 respondents, comprising 250 students, 250 parents or caregivers, and 44 teachers from 12 schools, participated in the study. The findings demonstrated that students' knowledge increased from 64.4% to 84.0%, while positive attitudes reached 98.4%. The programme also strengthened supervised toothbrushing activities, school-based health education, collaboration with community health centres (Puskesmas), and the implementation of the School Health Programme (Usaha Kesehatan Sekolah—UKS). However, healthy behavioural practices did not fully correspond with the improvement in knowledge, indicating the need for sustained reinforcement through support from families, schools, and local government. It is concluded that the Healthier Smiles Phase 7 Programme has contributed to improving oral health and oral hygiene behaviours while strengthening the school health system. Nevertheless, sustaining these achievements requires stronger policy support and continued cross-sectoral collaboration.
Downloads
References
Ajzen, I. (1991). The Theory of Planned Behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211.
Bandura, A. (1986). Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ.
Bloom, B. S., Engelhart, M. D., Furst, E. J., Hill, W. H., & Krathwohl, D. R. (1956). Taxonomy of Educational Objectives: The Classification of Educational Goals. Handbook 1: Cognitive Domain. Longman New York.
Braun, V., & Clarke, V. (2006). Using Thematic Analysis in Psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa
Bronfenbrenner, U. (1979). The Ecology of Human Development: Experiments by Nature and Design. Harvard University Press.
Creswell, J. W., & Clark, V. L. P. (2007). Designing and Conducting Mixed Methods Research. Sage.
Creswell, J. W., & Creswell, J. D. (2017). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches (5th ed.). SAGE Publications.
Denzin, N. K. (2017). The Research Act: A Theoretical Introduction to Sociological Methods. Routledge.
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of Convenience Sampling and Purposive Sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–4.
Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013). Achieving Integration in Mixed Methods Designs—Principles and Practices. Health Services Research, 48(6pt2), 2134–2156.
Fullan, M. (2025). The New Meaning of Educational Change. Teachers College Press.
Green, L. W., & Kreuter, M. W. (2005). Health Program Planning: An Educational and Ecological Approach (4th ed.). McGraw Hill.
Kemenkes RI. (2023). Survei Kesehatan Indonesia (SKI) 2023 Dalam Angka.
Krueger, R. A., & Casey, M. A. (2009). Focus Groups: A Practical Guide for Applied Research. Sage.
Langford, R., Bonell, C. P., Jones, H. E., Pouliou, T., Murphy, S. M., Waters, E., Komro, K. A., Gibbs, L. F., Magnus, D., & Campbell, R. (2014). The WHO Health Promoting School Framework for Improving the Health and Well‐Being of Students and Their Academic Achievement. Cochrane Database of Systematic Reviews, 4.
Launiala, A. (2009). How Much Can a KAP Survey tell us About People’s Knowledge, Attitudes and Practices? Some Observations from Medical Anthropology Research on Malaria in Pregnancy in Malawi. Anthropology Matters, 11(1).
Levy, P. S., & Lemeshow, S. (2009). Sampling of Populations: Methods and Applications, Solutions Manual. John Wiley & Sons.
Lohr, S. L. (2023). Sampling: Design and Analysis. Duxbury Press Pacific Grove, California.
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An Ecological Perspective on Health Promotion Programs. Health Education Quarterly, 15(4), 351–377.
Miles, M. B., Huberman, A. M., & Saldaña, J. (2013). Qualitative Data Analysis: A Methods Sourcebook. Sage Publications.
Nutbeam, D. (2000). Health Literacy as A Public Health Goal: A Challenge for Contemporary Health Education and Communication Strategies Into the 21st Century. Health Promotion International, 15(3), 259–267.
OCDE. (2021). Applying Evaluation Criteria Thoughtfully. OECD Publishing.
Patton, M. Q. (2014). Qualitative Research & Evaluation Methods: Integrating Theory and Practice. Sage Publications.
Petersen, P. E. (2003). The World Oral Health Report 2003: Continuous Improvement of Oral Health in the 21st Century–the Approach of the WHO Global Oral Health Programme. Community Dentistry and Oral Epidemiology, 31, 3–24.
Rogers, E. M. (2003). Diffusion of Innovations. The Free Press.
Rosenstock, I. M. (1974). Historical Origins of the Health Belief Model. Health Education & Monographs, 2(4), 328–335.
Save the Children Indonesia. (2026). End-line Assessment for Oral Health and Hygiene Behaviour among School-Aged Children in North Luwu and East Luwu – South Sulawesi Province.
Save the Children International. (2021). Monitoring, Evaluation, Accountability and Learning Framework.
UNICEF. (2021). Child Safeguarding Toolkit. United Nations Children’s Fund. https://www.unicef.org/childrightsandbusiness/child-safeguarding-toolkit-business
WHO. (2020). Water, Sanitation, Hygiene and Health: Policy Brief. World Health Organization. Regional Office for Europe.
WHO. (2021). Making Every School A Health-Promoting School: Implementation Guidance. World Health Organization.
WHO. (2022). Global Oral Health Status Report: Towards Universal Health Coverage for Oral Health by 2030. World Health Organization.
World Medical Association. (2013). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. Jama, 310(20), 2191–2194.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Andi Alim, Arlin Adam, Roberth Edison Nufninu, Zamli, Syamsul Bahri
This work is licensed under a Creative Commons Attribution 4.0 International License.
International Journal of Health Sciences is licensed under a Creative Commons Attribution 4.0 International License
