This randomized controlled trial aims to evaluate the effectiveness and implementation of a Just-in-Time Digital Learning Platform designed to improve teachers' oral health literacy and support the delivery of oral health education in schools. Teachers play an important role in promoting healthy behaviors among children, but many have limited access to structured oral health training. Digital microlearning approaches may provide a scalable and cost-effective solution for strengthening teacher capacity in school-based oral health promotion. Teachers assigned to the intervention group will receive access to a digital learning platform that delivers short, interactive, and evidence-based oral health training modules through mobile devices. The platform will provide educational content, reminders, quizzes, feedback, and progress monitoring. Teachers in the control group will receive standard information or routine training practices. The study will assess changes in teachers' oral health literacy, knowledge, attitudes, and confidence in delivering oral health education. It will also evaluate implementation outcomes, including acceptability, feasibility, adoption, fidelity, reach, and engagement with the digital platform. In addition, the study will examine whether improvements in teacher training lead to better oral health knowledge, behaviors, and clinical oral health outcomes among students.
Oral diseases remain among the most prevalent chronic conditions affecting children worldwide and disproportionately burden populations in low- and middle-income countries. Schools are recognized as an important setting for oral health promotion because they provide sustained access to children during critical periods of behavioral development. Teachers are key agents in implementing school-based oral health interventions; however, limited training opportunities, competing responsibilities, and resource constraints often reduce their effectiveness in delivering oral health education. Digital learning technologies provide opportunities to overcome these challenges through flexible, scalable, and low-cost training approaches. Just-in-Time learning is an educational strategy that delivers concise information at the point of need, enabling users to acquire knowledge and skills in a timely and accessible manner. Despite growing interest in digital health education, evidence regarding the effectiveness and implementation of digital oral health training for teachers remains limited. This randomized controlled trial will evaluate a Just-in-Time Digital Learning Platform developed to improve teachers' oral health literacy and strengthen the delivery of school-based oral health promotion activities. The intervention consists of short digital microlearning modules, interactive quizzes, reminders, feedback mechanisms, and performance-monitoring features accessible through mobile devices. The primary objective is to determine the effect of the intervention on teachers' oral health literacy. Secondary objectives include assessing changes in teachers' oral health knowledge, attitudes, self-efficacy, and educational practices, as well as student oral health knowledge, behaviors, and clinical oral health outcomes. The study will further evaluate implementation outcomes including acceptability, feasibility, adoption, fidelity, reach, engagement, and sustainability using implementation science frameworks. Equity analyses will assess whether intervention effects differ according to school location, socioeconomic characteristics, or other contextual factors. The results will contribute to the evidence base for digital capacity-building strategies in school health programs and provide guidance for policymakers seeking scalable and sustainable approaches to improve oral health promotion through educational systems.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
TRIPLE
Enrollment
870
Teachers assigned to the intervention group will receive access to a mobile-based Just-in-Time Digital Learning Platform delivering short oral health microlearning modules, interactive quizzes, reminders, educational resources, and feedback. The intervention aims to improve teachers' oral health literacy, teaching practices, and implementation of school-based oral health promotion activities, ultimately improving student oral health outcomes.
Saleem ullah fahmi school baqai Medical complex gharo
Karachi, Sindh, Pakistan
Teacher Oral Health Literacy Score
Teacher oral health literacy will be assessed using a structured oral health literacy questionnaire completed by participating teachers at baseline and post-intervention. Each item will be scored according to the questionnaire scoring instructions, and item scores will be summed to generate a total oral health literacy score. Higher scores will indicate greater oral health literacy. The primary analysis will compare the change in mean oral health literacy score from baseline to post-intervention between the intervention and control groups.
Time frame: Baseline to post-intervention (e.g., 6 months)
Teacher oral health knowledge
Structured 20-30 item MCQ questionnaire on caries, plaque, brushing, fluoride, diet, referral, and prevention
Time frame: 6 Months
Teaching self-efficacy
8-10 Likert-scale items assessing confidence to teach oral health, demonstrate brushing, answer questions, and refer children
Time frame: 6 Months
AIM score
Acceptability of Intervention Measure, 4 items
Time frame: 6 Months
IAM score
Intervention Appropriateness Measure, 4 items
Time frame: 6 Months
FIM score
Feasibility of Intervention Measure, 4 items
Time frame: 6 Months
Training completion rate
Digital platform analytics: number of completed modules divided by total assigned modules
Time frame: 6 Months
Fidelity
Classroom observation checklist assessing whether teachers delivered key oral health messages and activities as planned
Time frame: 6 Months
Student oral health knowledge
Age-appropriate 10-20 item questionnaire on brushing, sugar intake, dental visits, and tooth protection
Time frame: 6 Months
Student oral health behaviour
Self-reported questionnaire on brushing frequency, fluoride toothpaste use, sugary snack intake, and dental care-seeking
Time frame: 6 Months
OHI-S
Clinical oral examination using Greene and Vermillion Simplified Oral Hygiene Index
Time frame: 6 Months
Plaque Index
Silness and Löe Plaque Index assessed on selected teeth/surfaces
Time frame: 6 Months
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