Professional identity and engagement in oral health promotion activities among oral health ambassadors in China: a national cross-sectional survey

Abstract

Background: Sustained engagement of frontline health communication professionals is essential for effective public health promotion. While traditional material incentives show limited efficacy in maintaining intrinsic motivation, identity-based designation programs have emerged as a potential alternative, yet their impact in large-scale, real-world public health settings remains underexamined. Methods: A cross-sectional survey was conducted among all registered members of the China Oral Health Foundation Oral Health Promotion Ambassador program in June 2025. An anonymous online questionnaire was distributed via the program's official digital platform, yielding 1,071 valid responses from all 31 provincial-level regions of China. The questionnaire assessed sociodemographic characteristics, health communication practices, self-perceived impact of the ambassador designation, and practice-related challenges and needs. Self-reported significant enhancement of professional identity was the primary outcome. Chi-square tests were used for univariable screening, and binary logistic regression was employed to identify factors independently associated with significant self-reported identity enhancement. Results: The majority of respondents (96.4%) reported that the ambassador designation enhanced their professional identity, with 57.1% reporting significant enhancement. In multivariable analysis, nursing staff showed a significantly higher likelihood of significant identity enhancement compared to junior/attending-level dentists (OR = 1.595, 95% CI: 1.103-2.306, P = 0.013). Annual participation frequency was independently associated with significant enhancement, with both the 6-10 times/year group (OR = 1.490, 95% CI: 1.104-2.012, P = 0.008) and the >20 times/year group (OR = 1.832, 95% CI: 1.232-2.725, P = 0.003) showing significantly higher likelihood compared to the lowest-frequency group. Ambassadors in Western China showed a significantly lower likelihood of significant enhancement relative to Eastern China (OR = 0.710, 95% CI: 0.514-0.980, P = 0.037). Officially recognized certificates (83.4%) were the most preferred incentive, ranked above material rewards (41.8%). Conclusions: Following the ambassador designation, participants reported improvements in professional identity, and enhancement was significantly associated with engagement frequency and professional roles. However, the heterogeneity in responses across regions and roles suggests that uniform empowerment is insufficient. Public health managers should transition toward stratified incentive architectures and provide targeted resources that address the specific structural challenges faced by different practitioner subgroups.