Primary schoolteachers' prospective acceptability of a multi-component school-based oral health intervention in rural Malaysia: a qualitative study.

backgroundOral health inequalities among rural primary schoolchildren remain a persistent problem, and teacher-led interventions could be a sustainable way to address them. However, their success depends on teachers' acceptance of such initiatives before they are introduced into the school system. This study explored the prospective acceptability of SPARKLE (School Program for Achieving Radiant Smiles in Kids from Rural and Low Socioeconomic Backgrounds) as a school-based oral health intervention among rural primary schoolteachers in Malaysia using the Theoretical Framework of Acceptability (TFA).

methodsIn-depth interviews were conducted with 8 teachers and 4 school administrators from four rural primary schools in Negeri Sembilan, Malaysia. Schools were selected through multistage sampling, while purposive maximum variation sampling was used to recruit participants who were likely to implement SPARKLE in the future. The interviews were analyzed using directed content analysis guided by the TFA.

resultsAcceptability varied across SPARKLE's components. Sharing oral health infographics with parents was the most acceptable activity because it aligned with routine parent-teacher communication and required minimal additional effort. Teachers valued the Oral Health Report Card for improving parental awareness but were cautious about explaining clinical findings due to limited confidence and concerns about professional boundaries. Daily supervised toothbrushing was the least acceptable component because its daily frequency increased workload and raised concerns that it was a parental responsibility. Teachers appreciated the interactive Healthy Food Project but doubted it could be effective, as unhealthy food remains widely available in and around schools.

conclusionRural Malaysian teachers broadly supported SPARKLE's aims but its acceptability was conditional and component-specific. Components were more acceptable when they aligned with existing school routines and professional roles, and less acceptable when they added substantial workload or required teachers to assume responsibilities they viewed as belonging to parents or dental personnel. Our findings highlight the importance of flexibility and contextual adaptation in the future implementation of SPARKLE.