The Unequal Burden of Adaptation: Health Teachers’ Perspectives on Resources and Pathways to Sustainability of the School-Based Oral Health Promoting Program

Abstract

The school-based oral health promoting program was developed to build oral health literacy among upper primary school students with health teachers delivering the program alongside a digital platform through active learning. This activity format has a single nationwide standard, with health teachers serving as the main party responsible for its implementation in each school. This qualitative study aimed to analyze the inequality in the adaptation burden faced by health teachers in carrying out this activity, under varying levels of resource readiness across different school contexts covering readiness, obstacles, support networks, and the approaches health teachers propose for the program's sustainability. Data were collected using purposive sampling with maximum variation, drawn from 6 primary schools across 4 regions with differing levels of cooperation and resource readiness. The main informants were 14 health teachers, supplemented by data from 7 school administrators to provide context on the management environment. In-depth interviews adapted from the CIPP Model framework were used, with data analyzed through thematic analysis and credibility verified through triangulation until data saturation was reached.

The findings showed that the health teachers' adaptation burden was concentrated among health teachers in small schools and rural areas with more limited resources. This can be summarized into 5 main themes: 1) Factors that help reduce the adaptation burden; 2) Compensatory adaptation burdens falling on teachers in resource-scarce schools; 3) Reliance on external dental personnel networks, whose continuity varied unevenly across areas; 4) Teachers' perception of positive outcomes on students' oral health behavior even in resource-limited schools; and 5) Approaches proposed by teachers to reduce the inequality of the adaptation burden

The findings indicate that sustainable policy design should be flexible and allocate support according to each area's level of need, rather than leaving health teachers to face the adaptation burden alone.