Comparative effectiveness of culturally adapted oral health education in rural Quechua-speaking schoolchildren: a cluster quasi-experimental study.

BACKGROUND

Oral health disparities remain prevalent among Indigenous and rural populations, where linguistic barriers and limited access to culturally appropriate health education may reduce the effectiveness of conventional oral health promotion strategies. Although school-based oral health education programs have demonstrated beneficial effects, evidence on culturally adapted educational modalities for Indigenous-language-speaking communities remains limited.

OBJECTIVE

To evaluate the effectiveness of culturally adapted oral health educational interventions delivered in Quechua and Spanish through audio and video modalities on oral health knowledge, attitudes, and behaviors among rural schoolchildren from Quechua-speaking communities in the Peruvian Andes.

MATERIALS AND

METHODS

A cluster quasi-experimental study with four parallel intervention groups and repeated measures was conducted among 227 schoolchildren aged 8-12 years from two rural public schools in Puno, Peru. Classroom sections were allocated to Quechua- or Spanish-language instruction, and students within each classroom were randomly assigned to receive audio- or video-based educational materials, resulting in four intervention groups: Spanish-Audio (n = 55), Quechua-Audio (n = 58), Spanish-Video (n = 60), and Quechua-Video (n = 54). Knowledge, attitudes, and behaviors were assessed at baseline, immediately after the intervention, and at 24-hour and 7-day follow-ups using the Measurement of Knowledge, Attitudes, and Behaviors Regarding Oral Health in Schoolchildren Scale (MKAB-OH-S). Data were analyzed using Chi-square, Friedman, Wilcoxon signed-rank, Kruskal-Wallis, and Mann-Whitney U-tests.

RESULTS

All intervention modalities significantly improved oral health knowledge, attitudes, and behaviors over time (all p < 0.001). Between-group differences were observed only for knowledge immediately after the intervention (p < 0.001) and at the 24-hour follow-up (p = 0.032). The Spanish-Audio group showed lower knowledge scores than the other intervention groups during the early post-intervention assessments. The largest longitudinal effect sizes were observed for knowledge, particularly in the Quechua-language intervention groups.

CONCLUSIONS

Culturally and linguistically adapted oral health education supported by audiovisual resources improved oral health knowledge, attitudes, and behaviors among rural Quechua-speaking schoolchildren. These findings support the incorporation of culturally appropriate educational strategies into school-based oral health promotion programs to strengthen prevention and help reduce oral health inequalities in underserved Indigenous communities.