Content Analysis of School Textbooks for Oral Health Promotion Information, among Six States/Union Territories of North India: A Mixed-method Study
Dimple Atodaria, Arpit Gupta, Diptajit Das, Neha Patyal, Ashima GoyalAbstract
Background:
Textbooks are key tool for promoting oral health education, yet their inclusion in Indian school textbooks remains underexplored. Despite schools being key platforms for healthy behaviors, few studies have evaluated oral health information in textbooks. This study aimed to evaluate adequacy, accuracy, and acceptability of oral health information in school textbooks from six northern Indian states and union territories, identifying gaps for improvement.
Methods:
A mixed-method study was conducted including textbooks from Punjab, Haryana, Himachal Pradesh, Jammu and Kashmir, Ladakh, and Chandigarh. Textbooks were assessed using oral health education curriculum analysis tool (O-HECAT), developed and validated through expert consultation for this study. Evaluation was performed by public health professionals, oral health experts, teachers, and parents. The tool’s content validity was confirmed through both qualitative and quantitative expert consultations and assessments across three levels: (i) Oral health module analysis, (ii) Textbook accuracy and acceptability, and (iii) Curriculum comparison.
Results:
A total of 123 textbooks were reviewed, ICSE board had the most comprehensive oral health content, while state boards like Haryana and Jammu and Kashmir had minimal coverage. Accuracy analysis revealed minor errors included terms like “teeth cancer” and unrealistic statements (e.g., sparkling white teeth). The content validation of O-HECAT tool revealed scale-level content validity index (CVI) universal agreement = 0.70 and scale-level CVI average = 0.89. Multiple curriculum analysis showed ICSE board score of 8 and Punjab board score of 7.
Conclusion:
Significant gaps exist in textbook oral health content, particularly in state boards, and even the ICSE board, although performing best, contained inaccuracies. Standardized, evidence-based curriculum updates and teacher training are needed to strengthen oral health education nationwide.