{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T22:57:18Z","timestamp":1790117838841,"version":"4.0.1"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T00:00:00Z","timestamp":1698883200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>One in every two cases of caries in deciduous teeth occurs in low- and middle-income countries (LMICs). The aim of the World Health Organisation\u2019s (WHO) Healthy Schools Program is to improve the oral health of children. This study explored perceptions of implementation of the Ugandan oral health schools\u2019 program in Gulu district, northern Uganda.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Semi-structured interviews were conducted with a purposive sample of 19 participants including health and education officials, community leaders, policy makers, teachers, and parents. All interviews were transcribed verbatim and analysed thematically.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Our study identified three themes: (1) components of oral health promotion, (2) implementation challenges of oral health promotion, and (3) development of an oral health policy. The components of oral health promotion in schools included engagement of health workers, the community, companies, skills-based education, and oral health services. Participants were concerned about insufficient funding, unsatisfactory skills-based education, and inadequate dental screening. Participants reported that there was an urgent need to develop oral health policy to guide implementation of the program at scale.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Schools provided oral health promotion that aligned with existing features of the WHO\u2019s health-promoting school framework. Implementation of this strategy could be enhanced with increased resources, adequate oral health education, and explicit development of oral health policy.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0293761","type":"journal-article","created":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T17:52:20Z","timestamp":1698947540000},"page":"e0293761","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["Perceptions of oral health promotion in primary schools among health and education officials, community leaders, policy makers, teachers, and parents in Gulu district, northern Uganda: A qualitative study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1034-7465","authenticated-orcid":true,"given":"Peter","family":"Akera","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean E.","family":"Kennedy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9217-4937","authenticated-orcid":true,"given":"Aletta E.","family":"Schutte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2897-4109","authenticated-orcid":true,"given":"Robyn","family":"Richmond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hodgins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raghu","family":"Lingam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,11,2]]},"reference":[{"issue":"4","key":"pone.0293761.ref001","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1177\/0022034520908533","article-title":"Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study","volume":"99","author":"E Bernabe","year":"2020","journal-title":"Journal of Dental Research"},{"issue":"73","key":"pone.0293761.ref002","article-title":"Dental pain, oral impacts and perceived need for dental treatment in Tanzanian school students: a cross-sectional study. Health and Quality of Life Outcomes","volume":"7","author":"KO Mashoto","year":"2009","journal-title":"BMC Central"},{"issue":"29","key":"pone.0293761.ref003","article-title":"Oral health and the impact of socio behavioural factors in a cross-sectional survey of 12-year-old school children in Laos","volume":"9","author":"N Jurgensen","year":"2009","journal-title":"BMC Oral Health"},{"key":"pone.0293761.ref004","volume-title":"Promoting oral health in Africa: prevention and control of oral diseases and noma as part of essential noncommunicable disease intervention.","author":"World Health Organization","year":"2016"},{"key":"pone.0293761.ref005","volume-title":"Oral Health Promotion: An Essential Element of a Health-Promoting","author":"World Health Organization","year":"2003"},{"key":"pone.0293761.ref006","volume-title":"Health Promoting Schools: An effective approach to early action on Non-Communicable Disease risk factors","author":"World Health Organization","year":"2017"},{"key":"pone.0293761.ref007","volume-title":"Local Action Creating Health Promoting Schools","author":"World Health Organization","year":"2000"},{"issue":"4","key":"pone.0293761.ref008","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.4314\/ahs.v15i4.33","article-title":"Prevalence and factors associated with dental caries among children and adults in selected districts in Uganda","volume":"15","author":"A Kutesa","year":"2015","journal-title":"African Health Sciences"},{"issue":"3","key":"pone.0293761.ref009","first-page":"227","article-title":"Prevalence of oral diseases\/conditions in Uganda","volume":"5","author":"LM Muwazi","year":"2005","journal-title":"African Health Sciences"},{"key":"pone.0293761.ref010","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s00784-009-0363-4","article-title":"Assessment of factors associated with dental caries in rural communities in Rakai District, Uganda","volume":"15","author":"L. 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Rwenyonyi CMM","year":"2011","journal-title":"Clinical Oral Investigations"},{"issue":"4","key":"pone.0293761.ref011","first-page":"232","article-title":"Oral health status of school children in Mbarara, Uganda","volume":"7","author":"V Batwala","year":"2007","journal-title":"African Health Sciences"},{"issue":"1","key":"pone.0293761.ref012","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1093\/heapro\/dar039","article-title":"Many voices, one song\u2019: a model for an oral health programme as a first step in establishing a health promoting school","volume":"27","author":"A Macnab","year":"2012","journal-title":"Health Promotion International"},{"key":"pone.0293761.ref013","volume-title":"The SAGE Handbook of Qualitative Research in Psychology","author":"G Terry","year":"2017"},{"key":"pone.0293761.ref014","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"E Proctor","year":"2011","journal-title":"Administration and Policy in Mental Health"},{"issue":"1","key":"pone.0293761.ref015","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.1875-595X.2004.tb00250.x","article-title":"Effect of a school-based oral health education programme in Wuhan City, Peoples Republic of China.","volume":"54","author":"PE Petersen","year":"2004","journal-title":"International Dental Journal"},{"issue":"6","key":"pone.0293761.ref016","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1080\/00016350410010036","article-title":"Can school\u2010based oral health education and a sugar\u2010free chewing gum program improve oral health? Results from a two\u2010year study in PR China","volume":"62","author":"B Peng","year":"2004","journal-title":"Acta Odontologica Scandinavica"},{"issue":"5","key":"pone.0293761.ref017","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1111\/j.1600-0528.2009.00484.x","article-title":"Assessing the effectiveness of a school-based oral health promotion programme in Yichang City, China.","volume":"37","author":"BJ Tai","year":"2009","journal-title":"Community Dentistry and Oral Epidemiology"},{"key":"pone.0293761.ref018","first-page":"204","article-title":"Promoting oral health of children through schools-Results from a WHO global survey 2012","volume":"30","author":"N J\u00fcrgensen","year":"2013","journal-title":"Community Dental Health"},{"issue":"1","key":"pone.0293761.ref019","doi-asserted-by":"crossref","first-page":"16","DOI":"10.7196\/SAJCH.2017.v11i1.1132","article-title":"The promotion of oral health in health-promoting schools in KwaZulu-Natal Province, South Africa","volume":"11","author":"M Reddy","year":"2017","journal-title":"South African Journal of Child Health"},{"issue":"1","key":"pone.0293761.ref020","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1186\/s12903-022-02291-2","article-title":"Effectiveness of primary school-based interventions in improving oral health of children in low- and middle-income countries: a systematic review and meta-analysis","volume":"22","author":"P Akera","year":"2022","journal-title":"BMC Oral Health"},{"issue":"1","key":"pone.0293761.ref021","doi-asserted-by":"crossref","first-page":"17","DOI":"10.2105\/AJPH.2013.301608","article-title":"Six components necessary for effective public health program implementation","volume":"104","author":"TR Frieden","year":"2014","journal-title":"American Journal of Public Health"},{"key":"pone.0293761.ref022","unstructured":"Republic of Uganda. Ministry of Health. National Oral Health Policy In: Ministry of Health, editor. Kampala 2007."},{"key":"pone.0293761.ref023","unstructured":"Republic of Uganda. Ministry of Health. Health Sector Strategic Plan II 2005\/6\u20132009\/10. In: Ministry of Health, editor. Kampala, Uganda. Ministry of Health. 2005."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0293761","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,2]],"date-time":"2023-11-02T17:52:40Z","timestamp":1698947560000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0293761"}},"subtitle":[],"editor":[{"given":"Phyllis","family":"Lau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,11,2]]},"references-count":23,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0293761","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,2]]}}}