{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:53:10Z","timestamp":1785405190869,"version":"3.56.0"},"reference-count":55,"publisher":"AOSIS","issue":"1","license":[{"start":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T00:00:00Z","timestamp":1769817600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0In South Africa, oral diseases are a significant public health concern. The Western Cape has a high prevalence of dental caries, with rates increasing from 82% to 84% in 6-year-olds over a 13-year period. This study explored the experiences of oral hygienists, children and their parents to generate insights that can inform the design of a new approach to oral health promotion (OHP).\nAim:\u00a0This exploratory descriptive qualitative study was conducted within an interpretivist paradigm using semi-structured individual interviews with three groups of participants: oral hygienists, children aged 8\u201312 years and their parents.\nSetting:\u00a0The study was conducted at the dental public health facilities in the Western Cape Metropole.\nMethods:\u00a0The transcripts were thematically analysed using ATLAS.ti software and guided by the Ritchie and Spencer framework approach to thematic analysis.\nResults:\u00a0Seven main themes were identified: oral health promotion approaches and effectiveness, professional development, barriers and challenges, children and parents\u2019 oral health knowledge, attitudes and practices, parental influence and family dynamics, cultural and socio-economic considerations and engagement between oral hygienists, parents and children. Resource limitations within the public dental healthcare system had a negative effect on the hygienists\u2019 ability to deliver effective OHP services.\nConclusion:\u00a0Although oral hygienists employ diverse methods, including practical demonstrations and interactive techniques, current OHP strategies remain inadequate to address the high burden of dental caries. These findings support the development of an alternative approach to OHP in this setting.\nContribution:\u00a0The study contributes to understanding the role of family dynamics in reducing the burden of oral diseases among children in the Western Cape.<\/jats:p>","DOI":"10.4102\/phcfm.v18i1.5231","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T13:18:51Z","timestamp":1769779131000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The experiences and practices of oral health promotion for children in Cape Town: An exploratory descriptive qualitative study"],"prefix":"10.4102","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2079-7929","authenticated-orcid":false,"given":"Fathima","family":"Peerbhay","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/00h2vm590","id-type":"ROR","asserted-by":"publisher"}],"name":"University of the Western Cape"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7373-0774","authenticated-orcid":false,"given":"Robert","family":"Mash","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05bk57929","id-type":"ROR","asserted-by":"publisher"}],"name":"Stellenbosch University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,1,31]]},"reference":[{"key":"ref0","unstructured":"United Nations. Oral health and the UN political declaration on NCDs [homepage on the Internet]. FDI World Dental Federation; 2012 [cited 2019 Feb 22]. Available from: https:\/\/www.fdiworlddental.org\/oral-health-and-united-nations-political-declaration-ncds"},{"key":"ref1","unstructured":"World Health Organization. Bangkok declaration. World Health Organization: Report of the global oral health meeting, Bangkok, Thailand [homepage on the Internet]. 2024 [cited 2025 Aug 19]; p. 1\u20136. Available from: https:\/\/cdn.who.int\/media\/docs\/default-source\/ncds\/mnd\/oral-health\/bangkok-declaration-oral-health.pdf"},{"key":"ref2","unstructured":"World Health Organization (WHO). Global strategy and action plan oral health 2023\u20132030 [homepage on the Internet]. Geneva: 2024 [cited 2025 Sep 07]. Available from: https:\/\/iris.who.int\/bitstream\/handle\/10665\/376623\/9789240090538-eng.pdf"},{"key":"ref3","unstructured":"World Health Organization. Global oral health status report: Towards universal health coverage for oral health by 2030 [homepage on the Internet]. 2022 [cited 2025 Sep 03]. Available from: http:\/\/apps.who.int\/bookorders"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Peres MA, Macpherson LMD, Weyant RJ, et al. Oral diseases: A global public health challenge. Lancet. 2019;394(7):249\u2013260. https:\/\/doi.org\/10.1016\/S0140-6736(19)31146-8","DOI":"10.1016\/S0140-6736(19)31146-8"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Bernabe E, Marcenes W, Hernandez CR, et al. 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. J Dent Res. 2020;99:362\u2013373.","DOI":"10.1177\/0022034520908533"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Blomma C, Davidson T, Gerdin EW, B\u00e5gesund M, Lyth J. Persistent oral health inequality in children \u2013 Repeated cross-sectional studies in 2010 and 2019. BMC Public Health. 2024;24(1): 3528. https:\/\/doi.org\/10.1186\/s12889-024-20905-y","DOI":"10.1186\/s12889-024-20905-y"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Watt RG, Heilmann A, Listl S, Peres MA. London charter on oral health inequalities. J Dent Res. 2016;95(3):245\u2013247. https:\/\/doi.org\/10.1177\/0022034515622198","DOI":"10.1177\/0022034515622198"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Abid A, Maatouk F, Berrezouga L, et al. Prevalence and severity of oral diseases in the Africa and Middle East Region. Adv Dent Res. 2015;27(1):10\u201317. https:\/\/doi.org\/10.1177\/0022034515582062","DOI":"10.1177\/0022034515582062"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Thema LK, Singh S. Epidemiological profile of patients utilising public oral health services in Limpopo province, South Africa. Afr J Prim Health Care Fam Med. 2017;9(1):a1206. https:\/\/doi.org\/10.4102\/phcfm.v9i1.1206","DOI":"10.4102\/phcfm.v9i1.1206"},{"key":"ref10","unstructured":"Van Wyk C, Van Wyk PJ. Trends in dental caries prevalence, severity and unmet treatment need levels in South Africa between 1983 and 2002. S Afr Dent J. 2010;65(7):310\u2013314."},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Smit D, Barrie RB, Louw AJ. The burden of dental caries in the Western Cape and a recommended turn-around strategy. S Afr Dent J. 2017;72(8):360\u2013365. https:\/\/doi.org\/10.17159\/2519-0105\/2017\/v72no8a3","DOI":"10.17159\/2519-0105\/2017\/v72no8a3"},{"key":"ref12","unstructured":"Department of Health R of SA. National oral health policy and strategy. Pretoria: National Department of Health."},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Smit D, Osman Y. The availability of the basic oral health care package in the Western Cape. S Afr Dent J. 2017;72(6):258\u2013261. https:\/\/doi.org\/10.17159\/2519-0105\/2017\/v72no6a2","DOI":"10.17159\/2519-0105\/2017\/v72no6a2"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Thema KL, Singh S. Oral health service delivery in Limpopo Province. S Afr Dent J. 2017;72(7):310\u2013314. https:\/\/doi.org\/10.17159\/2519-0105\/2017\/v72no7a3","DOI":"10.17159\/2519-0105\/2017\/v72no7a3"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Johnson PM. International profiles of dental hygiene 1987 to 2001: A 19-nation comparative study. Int Dent J. 2003;53(5):299\u2013313. https:\/\/doi.org\/10.1111\/j.1875-595X.2003.tb00763.x","DOI":"10.1111\/j.1875-595X.2003.tb00763.x"},{"key":"ref16","unstructured":"South African Department of Health. South African government gazette [homepage on the Internet]. Pretoria: National Department of Health; 2017. Available from: https:\/\/www.gov.za\/sites\/default\/files\/gcis_document\/201705\/40847gen439.pdf"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Hooley M, Skouteris H, Boganin C, Satur J, Kilpatrick N. Parental influence and the development of dental caries in children aged 0\u20136 years: A systematic review of the literature. J Dent. 2012;40:873\u2013885. https:\/\/doi.org\/10.1016\/j.jdent.2012.07.013","DOI":"10.1016\/j.jdent.2012.07.013"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Kaushik M, Sood S. A systematic review of parents\u2019 knowledge of children\u2019s oral health. Cureus. 2023;15(7):e41485. https:\/\/doi.org\/10.7759\/cureus.41485","DOI":"10.7759\/cureus.41485"},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Sa\u011flam C, Mojarrab N, Ahlat EM, et al. Evaluation of the effectiveness of parental oral health education. J Pediatr Res. 2025;12(1):7\u201313. https:\/\/doi.org\/10.4274\/jpr.galenos.2025.54765","DOI":"10.4274\/jpr.galenos.2025.54765"},{"key":"ref20","unstructured":"Department of cooperative governance and traditional affairs. City of Cape Town metropolitan municipality profile: City of Cape Town metro. Pretoria: Department of Cooperative Governance and Traditional Affairs."},{"key":"ref21","unstructured":"Western Cape Government Health. Healthcare 2030: The road to wellness [homepage on the Internet]. 2014 [cited 2019 Sep 03]. Available from: https:\/\/www.westerncape.gov.za\/assets\/departments\/health\/healthcare2030.pdf"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Bica I, Cunha M, Reis M, Costa P, Costa J, Albuquerque C. Educational intervention for oral health. Procedia Soc Behav Sci. 2015;171:613\u2013619. https:\/\/doi.org\/10.1016\/j.sbspro.2015.01.168","DOI":"10.1016\/j.sbspro.2015.01.168"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Nepaul P, Mahomed O. Influence of parents\u2019 oral health knowledge and attitudes on oral health practices of children (5\u201312 years) in a rural school in KwaZulu-Natal, South Africa. J Int Soc Prev Community Dent. 2020;10(5):605\u2013612. https:\/\/doi.org\/10.4103\/jispcd.JISPCD_273_20","DOI":"10.4103\/jispcd.JISPCD_273_20"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Pawar P, Kashyap N, Anand R. Knowledge, attitude, and practices of mothers related to their oral health status of 6\u201312 years old children in Bhilai City, Chhattisgarh, India. Eur Sci J. 2018;14(21):248. https:\/\/doi.org\/10.19044\/esj.2018.v14n21p248","DOI":"10.19044\/esj.2018.v14n21p248"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13(1):1. https:\/\/doi.org\/10.1186\/1471-2288-13-117","DOI":"10.1186\/1471-2288-13-117"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In: Bryman A, Burgess R, editors. Qualitative data analysis. London: Routledge, 1994; p. 173\u2013194.","DOI":"10.4324\/9780203413081_chapter_9"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Sari SE, Farhan H, Gyamera E, Paghubasan MD. The influence of education using animated videos on dental and oral health behavior in elementary school children. J Educ Technol Learn Creat. 2025;3(1):1\u201311. https:\/\/doi.org\/10.37251\/jetlc.v3i1.1608","DOI":"10.37251\/jetlc.v3i1.1608"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Angelopoulou M, Kavvadia K. Experiential learning in oral health education. J Educ Health Promot. 2018;7(70):1\u20136. https:\/\/doi.org\/10.4103\/jehp.jehp_180_17","DOI":"10.4103\/jehp.jehp_180_17"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Pang L, Zhou Y, Tao Y, et al. An experiential service-learning project on oral health examination and education. BMC Med Educ. 2024;24(34). https:\/\/doi.org\/10.1186\/s12909-023-05020-7","DOI":"10.1186\/s12909-023-05020-7"},{"key":"ref30","unstructured":"Brukiene V, Aleksejuniene J. Theory-based oral health education in adolescents. Stomatologija. 2010;12(1):3\u20139."},{"key":"ref31","doi-asserted-by":"crossref","unstructured":"Kay E, Vascott D, Hocking A, Nield H, Dorr C, Barrett H. A review of approaches for dental practice teams for promoting oral health. Community Dent Oral Epidemiol. 2016;44(4):313\u2013330. https:\/\/doi.org\/10.1111\/cdoe.12220","DOI":"10.1111\/cdoe.12220"},{"key":"ref32","doi-asserted-by":"crossref","unstructured":"Peerbhay F, Mash R, Khan S. Effectiveness of oral health promotion in children and adolescents through behaviour change interventions: A scoping review. PLoS One. 2025;20(1):e316702. https:\/\/doi.org\/10.1371\/journal.pone.0316702","DOI":"10.1371\/journal.pone.0316702"},{"key":"ref33","unstructured":"Mishra P. Social determinants of oral health: A comprehensive review of socioeconomic and environmental factors. J Dent Care. 2024;1:1\u201310."},{"key":"ref34","doi-asserted-by":"crossref","unstructured":"Ortiz AS, Tomazoni F, Knorst JK, Ardenghi TM. Influence of socioeconomic inequalities on levels of dental caries in adolescents: A cohort study. Int J Paediatr Dent. 2020;30(1):42\u201349. https:\/\/doi.org\/10.1111\/ipd.12572","DOI":"10.1111\/ipd.12572"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Tiwari T, Palatta A, Stewart J. What is the value of social determinants of health in dental education? NAM Perspect. 2020;2020:1\u20134. https:\/\/doi.org\/10.31478\/202004a","DOI":"10.31478\/202004a"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Watt RG, Sheiham A. Integrating the common risk factor approach into a social determinants framework. Community Dent Oral Epidemiol. 2012;40(4):289\u2013296. https:\/\/doi.org\/10.1111\/j.1600-0528.2012.00680.x","DOI":"10.1111\/j.1600-0528.2012.00680.x"},{"key":"ref37","doi-asserted-by":"crossref","unstructured":"Verdugo-Paiva F, Urquhart O, Matanhire-Zihanzu CN, et al. Barriers to and facilitators for creating, disseminating, implementing, monitoring and evaluating oral health policies in the WHO African region: A scoping review. Community Dent Oral Epidemiol. 2024;52:775\u2013785. https:\/\/doi.org\/10.1111\/cdoe.12984","DOI":"10.1111\/cdoe.12984"},{"key":"ref38","doi-asserted-by":"crossref","unstructured":"Fol\u00e1yan MO, Ishola AG, Bhayat A, El Tantawi M, Ndembi N. Strengthening health systems to tackle oral diseases in Africa: Africa centers for disease control and prevention\u2019s role. Front Public Health. 2025;13:1539805. https:\/\/doi.org\/10.3389\/fpubh.2025.1539805","DOI":"10.3389\/fpubh.2025.1539805"},{"key":"ref39","doi-asserted-by":"crossref","unstructured":"Petersen PE, Baez RJ, Ogawa H. Global application of oral disease prevention and health promotion as measured 10 years after the 2007 World Health Assembly statement on oral health. Community Dent Oral Epidemiol. 2020;48(4):338\u2013348. https:\/\/doi.org\/10.1111\/cdoe.12538","DOI":"10.1111\/cdoe.12538"},{"key":"ref40","doi-asserted-by":"crossref","unstructured":"Quadri MFA, Jaafari FRM, Mathmi NAA, et al. Impact of the poor oral health status of children on their families: An analytical cross-sectional study. Children. 2021;8(7):586. https:\/\/doi.org\/10.3390\/children8070586","DOI":"10.3390\/children8070586"},{"key":"ref41","doi-asserted-by":"crossref","unstructured":"Abed R, Bernabe E, Sabbah W. Family impacts of severe dental caries among children in the United Kingdom. Int J Environ Res Public Health. 2020;17(1):109. https:\/\/doi.org\/10.3390\/ijerph17010109","DOI":"10.3390\/ijerph17010109"},{"key":"ref42","doi-asserted-by":"crossref","unstructured":"Marshman Z, Ahern SM, McEachan RRC, Rogers HJ, Gray-Burrows KA, Day PF. Parents\u2019 experiences of toothbrushing with children: A qualitative study. JDR Clin Trans Res. 2016;1(2):122\u2013130. https:\/\/doi.org\/10.1177\/2380084416647727","DOI":"10.1177\/2380084416647727"},{"key":"ref43","doi-asserted-by":"crossref","unstructured":"Hajizamani A, Bozorgmehr E, Mohammadi T. Improving oral health status of preschool children using motivational interviewing method. Dent Res J (Isfahan). 2015;12(5):476. https:\/\/doi.org\/10.4103\/1735-3327.166231","DOI":"10.4103\/1735-3327.166231"},{"key":"ref44","doi-asserted-by":"crossref","unstructured":"Alamoudi RM, Showlag RA, Almujil NJ, et al. The impact of parental oral health behaviors on the oral health of children. Int J Community Med Public Health. 2023;10(11):4451\u20134456. https:\/\/doi.org\/10.18203\/2394-6040.ijcmph20233149","DOI":"10.18203\/2394-6040.ijcmph20233149"},{"key":"ref45","unstructured":"Statistics South Africa. Child series volume IV children living with grandparents in South Africa, 2023 Statistics South Africa Risenga Maluleke Statistician-General [homepage on the Internet]. Pretoria: Statistics South Africa; 2023 [cited 2025 Jul 13]; vol. IV. Available from: www.statssa.gov.za"},{"key":"ref46","doi-asserted-by":"crossref","unstructured":"Balasooriyan A, Van der Veen MH, Bonif\u00e1cio CC, Dedding C. Understanding parental perspectives on young children\u2019s oral health (\u2264 4 years) growing up in a disadvantaged neighbourhood of Amsterdam, the Netherlands: An exploratory study. BMC Public Health. 2024;24(1):627. https:\/\/doi.org\/10.1186\/s12889-024-18073-0","DOI":"10.1186\/s12889-024-18073-0"},{"key":"ref47","unstructured":"Cohn LD, Villar ED, Armando O. Fatalism and health behavior: A meta-analytic review [homepage on the Internet]. 2015 [cited 2019 Aug 13]. Available from: https:\/\/www.researchgate.net\/publication\/313838796"},{"key":"ref48","unstructured":"Hammersmith KJ, Stephenson KG, Peng J. Associations between oral health fatalism and demographic factors, dental practices, fatalism, and oral health self-efficacy. Pediatr Dent [serial online]. 2023 [cited 2019 Sep 13];25(6):497\u2013503. Available from: https:\/\/www.researchgate.net\/publication\/377119553"},{"key":"ref49","doi-asserted-by":"crossref","unstructured":"Ramakrishnan M, Banu S, Ningthoujam S, Samuel V. Evaluation of knowledge and attitude of parents about the importance of maintaining primary dentition \u2013 A cross-sectional study. J Family Med Prim Care. 2019;8(2):414\u2013418. https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_371_18","DOI":"10.4103\/jfmpc.jfmpc_371_18"},{"key":"ref50","doi-asserted-by":"crossref","unstructured":"Rojas-Brice\u00f1o NB, Oc Carrasco OJ, Silva D\u00edaz YA, et al. Knowledge and attitudes of parents about oral health in the primary dentition stage in a Peruvian High Andean City. Int J Environ Res Public Health. 2024;21(2):154. https:\/\/doi.org\/10.3390\/ijerph21020154","DOI":"10.3390\/ijerph21020154"},{"key":"ref51","doi-asserted-by":"crossref","unstructured":"Garcia RI, Cadoret C, Henshaw M. Multicultural issues in oral health. Dent Clinics of North America. 2008;52(2):319\u2013332. https:\/\/doi.org\/10.1016\/j.cden.2007.12.006","DOI":"10.1016\/j.cden.2007.12.006"},{"key":"ref52","doi-asserted-by":"crossref","unstructured":"Waylen A. The importance of communication in dentistry. Dent Update. 2017;44(8):774\u2013780. https:\/\/doi.org\/10.12968\/denu.2017.44.8.774","DOI":"10.12968\/denu.2017.44.8.774"},{"key":"ref53","doi-asserted-by":"crossref","unstructured":"Almajed OS, Aljouie AA, Alharbi MS, Alsulaimi LM. The impact of socioeconomic factors on pediatric oral health: A review. Cureus. 2024;16(2):e53567. https:\/\/doi.org\/10.7759\/cureus.53567","DOI":"10.7759\/cureus.53567"},{"key":"ref54","doi-asserted-by":"crossref","unstructured":"Mthethwa S, Gugushe T, Nyalunga P. Throughputs of oral hygiene programmes offered at Sefako Makgatho health sciences: A retrospective comparison. S Afr Dent J. 2022;76(10):596\u2013601. https:\/\/doi.org\/10.17159\/2519-0105\/2021\/v76no10a2","DOI":"10.17159\/2519-0105\/2021\/v76no10a2"}],"container-title":["African Journal of Primary Health Care &amp; Family Medicine"],"original-title":[],"link":[{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/view\/5231\/9044","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T13:19:00Z","timestamp":1769779140000},"score":1,"resource":{"primary":{"URL":"https:\/\/phcfm.org\/index.php\/phcfm\/article\/view\/5231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,31]]},"references-count":55,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/phcfm.v18i1.5231","relation":{},"ISSN":["2071-2928","2071-2936"],"issn-type":[{"value":"2071-2928","type":"print"},{"value":"2071-2936","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,31]]},"article-number":"a5231"}}