A framework for oral health community engagement: a case study of the Vhembe district in Limpopo province, South Africa

Abstract

Introduction: Oral health remains a significant global public health concern. Despite advances in oral healthcare, considerable challenges persist worldwide, especially in socioeconomically disadvantaged areas within both high- and low-income countries. South Africa has exhibited a slow response to oral health challenges, particularly in rural communities, where the prevalence of oral diseases is markedly high and the costs of treatment and management are substantial, primarily because they are frequently excluded from universal health coverage. Oral health services often fail to correspond with the specific needs of the population and are not effectively integrated into the primary healthcare system. A major issue is that out-of-pocket expenses continue to be the principal means of funding for these services, leading to serious economic implications for access, availability, and affordability. In contrast to most developed countries, where they exist, oral health community engagements remain poorly executed in achieving positive health outcomes due to inconsistent financial support and insufficient government resources allocated to the promotion of oral health. Aim: The aim of this study was to develop a framework to guide oral health community engagement for oral health promotion for rural communities in the Vhembe district of Limpopo province. Methods: This study was conducted in six distinct phases to streamline the data collection process and achieve the research aim. In Phase 1, oral health community engagement programmes informing rural oral healthcare were identified and synthesised. A cross-sectional, exploratory, and descriptive design with a mixed-methods approach was adopted. In Phases 2–4, purposive sampling was employed, and structured self-administered questionnaires adapted from previously validated oral health systems and health services research instruments and contextualised for rural primary health care were used to collect data from healthcare facility managers (Phase 2), dental educators (Phase 3), and oral health professionals (Phase 4). The instruments were refined to reflect the local rural context and included both Likert-scale and open-ended questions. Quantitative data were analysed using descriptive statistics, while qualitative responses were analysed thematically using ATLAS.ti software. Focus group discussions were conducted with rural community members (Phase 5). The findings were synthesised through document analysis to develop the framework (Phase 6).