Integrating Oral Health into Primary Healthcare: Lessons from Project OHE-NCHeW (Oral Health Education for Nurses and Community Health Workers) in Nigeria

Abimbola M. Oladayo^1*Folake Lawal²Oyinkan Sofola³Omolara Uti³Afolabi Oyapero⁴Adetayo Aborisade⁵Mojisola Olujitan⁶Omotayo Francis Fagbule⁷Adeola Temitope Williams²Aderonke DEDEKE²Ejiro Idiga²Abdul-kabir Adegoke Yahya-Imam³Ilori Oluwagbenga Adeniji³Aishatu Baba Mele⁵Amina Baffa⁵Ifeoluwa Adetula⁵Khadija Saad Musa⁵Bernal Stewart⁸Carlo Daep⁸Deon Hines⁸Jacinto Beard⁹Taiwo Lawal²Azeez Butali⁶

• ¹A.T. Still University, Kirksville, Missouri, United States
• ²University of Ibadan, Ibadan, Oyo, Nigeria
• ³Lagos University Teaching Hospital, Lagos, Nigeria
• ⁴Lagos State University, Ojo, Lagos, Nigeria
• ⁵Bayero University Kano, Kano, Kano, Nigeria
• ⁶The University of Iowa, Iowa City, Iowa, United States
• ⁷University of Nevada, Reno, Reno, Nevada, United States
• ⁸Colgate Palmolive (United States), New York, New York, United States
• ⁹National Dental Association Foundation (United States), Washington DC, Washington, United States

IntroductionOral health disparities in Nigeria highlight the need to integrate basic oral health into Primary Health Care (PHC). Project OHE-NCHeW (Oral Health Education for Nurses and Community Health Workers) was developed to train PHC workers in providing basic oral health care, education, and referrals in underserved communities. This study explored the impact of the training program on participants' knowledge, referral practices, and patient outcomes, and gathered feedback to optimize the program for future implementation.MethodsUsing a qualitative phenomenological approach, five focus group discussions (FGDs) were conducted with participants to gather insights on knowledge acquisition, changes in referral practices, and barriers or facilitators to implementation. Audio recordings were transcribed verbatim and analyzed thematically using the CREATIVE framework. Additional feedback from trainers and observed patient impact were also considered. ResultsThe trained PHC workers reported enhanced knowledge and confidence, resulting in improved patient education and referrals. Patients also noted better oral health literacy and increased trust in dental referrals. Facilitators viewed the program as valuable and feasible, emphasizing the importance of ongoing training, resource allocation, and policy integration to maintain the program's impact. Key barriers included insufficient resources, lack of supervision, and cultural beliefs.DiscussionThe pilot training enhanced PHC worker capacity and was positively perceived by trainers. Patients reportedly responded favorably, indicating potential impact. However, addressing identified systemic and resource barriers is crucial for sustainable integration. This study offers multi-perspective insights for optimizing oral health integration within PHC in similar settings.Keywords: Primary Healthcare (PHC), Oral health Disparities, CREATIVE framework, Nurses, Community Health Worker (CHW), Oral health education/promotion