JMIR Publications

ABSTRACT

Background:

Maternal and child oral health remains a significant public health concern in India, contributing to early childhood caries (ECC), adverse pregnancy outcomes, and long-term health complications. Anganwadi Workers (AWWs), under the Integrated Child Development Services (ICDS), are well-positioned to promote preventive oral health behaviors. However, oral health education is not part of their core training. This protocol outlines an implementation research study to develop, deliver, and evaluate a contextualized oral health education training package through AWWs for mother–child dyads in Kochi, Kerala.

Objective:

The objectives of this study are (i) to assess the current oral hygiene knowledge, attitude, behavior and identify barriers, facilitators to implement the oral health education training package among Anganwadi workers, parents, and other key stakeholders (ii) to evaluate the oral health education training package for coverage, acceptability, adoption, fidelity, and scalability and (iii) to assess the impact of an oral health education training package on the improvement of oral health knowledge, attitude and behaviour among mothers.

Methods:

A mixed-methods implementation study will be conducted across 100 Anganwadi Centres in three phases following the EPIS framework. Phase 1 will assess baseline oral hygiene practices and identify contextual barriers and facilitators using structured questionnaires and qualitative interviews. In Phase 2, Anganwadi workers will be trained using a structured oral health education package and will deliver oral health messages to mother–child dyads during routine sessions. Implementation outcomes—acceptability, coverage, adoption, fidelity, and scalability—will be evaluated using observation checklists and program tracking tools. Phase 3 will assess the impact by evaluating changes in maternal oral health knowledge, attitude, and behavior through pre- and post-intervention questionnaires administered to a subsample of mothers. Dissemination of findings and planning for long-term integration into ICDS will also be undertaken.

Results:

The study commenced in March 2024. A total of 101 Anganwadi centres have been enrolled. Permissions, stakeholder meetings, baseline data collection, preparation of teaching module and training of Anganwadi workers has been completed. Follow-up visits to assess implementation parameters are on-going. Data collection is expected to be completed in March 2026 followed by data analysis and dissemination.

Conclusions:

This study is expected to generate practical insights into the feasibility of integrating oral health education into ICDS through AWWs. The intervention will be embedded within existing ICDS touchpoints and supported by centralized training, travel allowances, and regular supervision. Findings are expected to inform a scalable, community-based model aligned with national policy priorities for oral health promotion. Clinical Trial: The study protocol has been registered with the Clinical Trial Registry of India (Ref No: CTRI/2025/07/090759)