Impact of an education training package to Anganwadi workers for improving oral health knowledge among mother-child dyads in Kerala, India – An interim analysis
1
Public Health Dentistry, Amrita School of Dentistry, Kochi, India
2
Community Medicine, Amrita School of Medicine, Kochi, India
Popul. Med. 2026;8(Supplement Supplement 1):A2872
ABSTRACT
INTRODUCTION:
Maternal and child oral health remains a neglected public health priority in India, contributing to early childhood caries and long-term adverse outcomes. Anganwadi Workers (AWWs), a grassroot-level healthworkers are well positioned to deliver preventive oral health education; however, oral health is not routinely included in their training. This implementation research aims to develop, implement, and evaluate a contextualised oral health education training package delivered through AWWs to improve oral health knowledge, attitudes, and behaviours among mother–child dyads in Kerala, India.
METHODS:
A mixed-methods study, guided by the EPIS (Exploration, Preparation, Implementation, Sustainment) framework, is being conducted across 101 Anganwadi Centres. Phase 1 comprised baseline assessments using questionnaires, focus group discussions, and in-depth interviews with AWWs, mothers and officials to identify needs, facilitators, barriers, and training priorities. In Phase 2, dental professionals trained AWWs using customized modules to integrate oral health education into routine Anganwadi activities. Outcomes evaluated include acceptability, coverage, adoption and fidelity. Phase 3 involves post-intervention assessment of mothers’ oral health knowledge, attitudes, and behaviours.
RESULTS:
After completion of activities and baseline assessment in Phase 1; a total of 101 AWWs were enrolled. Among them 97 attended the training (Phase 2) and expressed willingness to implement oral health sessions (acceptability = 96.03%). About 75% of AWW delivered at least one session (coverage) and 54.63% delivered multiple sessions (adoption). Observation of 16 sessions showed >75% fidelity adherence. Qualitative findings highlighted institutional support, integration into routine activities, interactive teaching, and AWWs’ trusted role, while time constraints and competing duties were key barriers. Phase 2 is ongoing and this will be followed by post-intervention assessment (Phase 3).
CONCLUSIONS:
Interim results indicate integrating oral health education into routine Anganwadi services through trained AWWs is feasible, acceptable, and scalable, demonstrating strong coverage, adoption, and fidelity for community-based maternal and child oral health.
Maternal and child oral health remains a neglected public health priority in India, contributing to early childhood caries and long-term adverse outcomes. Anganwadi Workers (AWWs), a grassroot-level healthworkers are well positioned to deliver preventive oral health education; however, oral health is not routinely included in their training. This implementation research aims to develop, implement, and evaluate a contextualised oral health education training package delivered through AWWs to improve oral health knowledge, attitudes, and behaviours among mother–child dyads in Kerala, India.
METHODS:
A mixed-methods study, guided by the EPIS (Exploration, Preparation, Implementation, Sustainment) framework, is being conducted across 101 Anganwadi Centres. Phase 1 comprised baseline assessments using questionnaires, focus group discussions, and in-depth interviews with AWWs, mothers and officials to identify needs, facilitators, barriers, and training priorities. In Phase 2, dental professionals trained AWWs using customized modules to integrate oral health education into routine Anganwadi activities. Outcomes evaluated include acceptability, coverage, adoption and fidelity. Phase 3 involves post-intervention assessment of mothers’ oral health knowledge, attitudes, and behaviours.
RESULTS:
After completion of activities and baseline assessment in Phase 1; a total of 101 AWWs were enrolled. Among them 97 attended the training (Phase 2) and expressed willingness to implement oral health sessions (acceptability = 96.03%). About 75% of AWW delivered at least one session (coverage) and 54.63% delivered multiple sessions (adoption). Observation of 16 sessions showed >75% fidelity adherence. Qualitative findings highlighted institutional support, integration into routine activities, interactive teaching, and AWWs’ trusted role, while time constraints and competing duties were key barriers. Phase 2 is ongoing and this will be followed by post-intervention assessment (Phase 3).
CONCLUSIONS:
Interim results indicate integrating oral health education into routine Anganwadi services through trained AWWs is feasible, acceptable, and scalable, demonstrating strong coverage, adoption, and fidelity for community-based maternal and child oral health.
| eISSN: | 2654-1459 |
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