A Just-in-Time Digital Learning Platform for Teacher Oral Health Training

A Just-in-Time Digital Learning Platform for Teacher Oral Health Training: Effects on Oral Health Literacy, Implementation, and Student Oral Health Outcomes in a Randomized Controlled Trial

This randomized controlled trial aims to evaluate the effectiveness and implementation of a Just-in-Time Digital Learning Platform designed to improve teachers' oral health literacy and support the delivery of oral health education in schools. Teachers play an important role in promoting healthy behaviors among children, but many have limited access to structured oral health training. Digital microlearning approaches may provide a scalable and cost-effective solution for strengthening teacher capacity in school-based oral health promotion.

Teachers assigned to the intervention group will receive access to a digital learning platform that delivers short, interactive, and evidence-based oral health training modules through mobile devices. The platform will provide educational content, reminders, quizzes, feedback, and progress monitoring. Teachers in the control group will receive standard information or routine training practices.

The study will assess changes in teachers' oral health literacy, knowledge, attitudes, and confidence in delivering oral health education. It will also evaluate implementation outcomes, including acceptability, feasibility, adoption, fidelity, reach, and engagement with the digital platform. In addition, the study will examine whether improvements in teacher training lead to better oral health knowledge, behaviors, and clinical oral health outcomes among students.

Study Overview

• Status: Not yet recruiting
• Conditions: Oral Health Behavior Change; Oral Hygiene, Oral Health; Digital Literacy
• Intervention / Treatment: Behavioral: Just-in-Time Digital Learning Platform for Teacher Oral Health Training

Detailed Description

Oral diseases remain among the most prevalent chronic conditions affecting children worldwide and disproportionately burden populations in low- and middle-income countries. Schools are recognized as an important setting for oral health promotion because they provide sustained access to children during critical periods of behavioral development. Teachers are key agents in implementing school-based oral health interventions; however, limited training opportunities, competing responsibilities, and resource constraints often reduce their effectiveness in delivering oral health education.

Digital learning technologies provide opportunities to overcome these challenges through flexible, scalable, and low-cost training approaches. Just-in-Time learning is an educational strategy that delivers concise information at the point of need, enabling users to acquire knowledge and skills in a timely and accessible manner. Despite growing interest in digital health education, evidence regarding the effectiveness and implementation of digital oral health training for teachers remains limited.

This randomized controlled trial will evaluate a Just-in-Time Digital Learning Platform developed to improve teachers' oral health literacy and strengthen the delivery of school-based oral health promotion activities. The intervention consists of short digital microlearning modules, interactive quizzes, reminders, feedback mechanisms, and performance-monitoring features accessible through mobile devices.

The primary objective is to determine the effect of the intervention on teachers' oral health literacy. Secondary objectives include assessing changes in teachers' oral health knowledge, attitudes, self-efficacy, and educational practices, as well as student oral health knowledge, behaviors, and clinical oral health outcomes. The study will further evaluate implementation outcomes including acceptability, feasibility, adoption, fidelity, reach, engagement, and sustainability using implementation science frameworks. Equity analyses will assess whether intervention effects differ according to school location, socioeconomic characteristics, or other contextual factors.

The results will contribute to the evidence base for digital capacity-building strategies in school health programs and provide guidance for policymakers seeking scalable and sustainable approaches to improve oral health promotion through educational systems.

• Study Type: Interventional
• Enrollment (Estimated): 870
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Muhammad Arshed, Ph.D.; Phone Number: +923337474464; Email: drarshedchaudhary@gmail.com

Study Locations

• Pakistan
  • Sindh
    • Karachi, Sindh, Pakistan, 74600
      • Saleem ullah fahmi school baqai Medical complex gharo
      • Contact: Muhammad Arshed; Phone Number: 03337474464; Email: drarshedchaudhary@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria: Teachers aged ≥18 years. Currently employed in participating schools. Access to a smartphone, tablet, or computer with internet connectivity. Able to understand the intervention language. Willing to provide informed consent and participate in study activities. -

Exclusion Criteria: Currently participating in another oral health training program or research study.

Planning to leave employment at the participating school during the study period.

Unable to access or use the digital learning platform. Refusal or withdrawal of informed consent.

-

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Just-in-Time Digital Learning Platform for Teacher Oral Health Training; Participants in this arm will receive access to a Just-in-Time Digital Learning Platform designed to improve teachers' oral health literacy and capacity to deliver school-based oral health education. The intervention includes short mobile-based microlearning modules, educational videos, interactive quizzes, reminders, feedback, digital learning resources, and progress tracking. Content covers oral health knowledge, preventive practices, oral hygiene promotion, and classroom implementation strategies. Teachers will engage with the platform throughout the intervention period and apply learned concepts in routine school activities. The intervention is designed to improve teacher oral health literacy, implementation outcomes, and student oral health outcomes.	Behavioral: Just-in-Time Digital Learning Platform for Teacher Oral Health Training; Teachers assigned to the intervention group will receive access to a mobile-based Just-in-Time Digital Learning Platform delivering short oral health microlearning modules, interactive quizzes, reminders, educational resources, and feedback. The intervention aims to improve teachers' oral health literacy, teaching practices, and implementation of school-based oral health promotion activities, ultimately improving student oral health outcomes.
No Intervention: Standard Teacher Training or Routine Practice; Participants in this arm will continue routine educational practices and receive standard training or information available through existing school systems. They will not receive access to the Just-in-Time Digital Learning Platform during the study period. Outcomes will be assessed at the same time points as the intervention group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Teacher Oral Health Literacy Score	Teacher oral health literacy will be assessed using a structured oral health literacy questionnaire completed by participating teachers at baseline and post-intervention. Each item will be scored according to the questionnaire scoring instructions, and item scores will be summed to generate a total oral health literacy score. Higher scores will indicate greater oral health literacy. The primary analysis will compare the change in mean oral health literacy score from baseline to post-intervention between the intervention and control groups.	Baseline to post-intervention (e.g., 6 months)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Teacher oral health knowledge	Structured 20-30 item MCQ questionnaire on caries, plaque, brushing, fluoride, diet, referral, and prevention	6 Months
Teaching self-efficacy	8-10 Likert-scale items assessing confidence to teach oral health, demonstrate brushing, answer questions, and refer children	6 Months
AIM score	Acceptability of Intervention Measure, 4 items	6 Months
IAM score	Intervention Appropriateness Measure, 4 items	6 Months
FIM score	Feasibility of Intervention Measure, 4 items	6 Months
Training completion rate	Digital platform analytics: number of completed modules divided by total assigned modules	6 Months
Fidelity	Classroom observation checklist assessing whether teachers delivered key oral health messages and activities as planned	6 Months
Student oral health knowledge	Age-appropriate 10-20 item questionnaire on brushing, sugar intake, dental visits, and tooth protection	6 Months
Student oral health behaviour	Self-reported questionnaire on brushing frequency, fluoride toothpaste use, sugary snack intake, and dental care-seeking	6 Months
OHI-S	Clinical oral examination using Greene and Vermillion Simplified Oral Hygiene Index	6 Months
Plaque Index	Silness and Löe Plaque Index assessed on selected teeth/surfaces	6 Months

Collaborators and Investigators

• Sponsor: Universiti Putra Malaysia
• Investigators: Principal Investigator: Muhammad Arshed, PhD, Baqai Medical University

Publications and helpful links

General Publications

• Weiner BJ, Lewis CC, Stanick C, Powell BJ, Dorsey CN, Clary AS, Boynton MH, Halko H. Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017 Aug 29;12(1):108. doi: 10.1186/s13012-017-0635-3.
• Kameg BN, Constantino RE. #MeToo and "Time's Up": Implications for Psychiatric and Mental Health Nurses. J Am Psychiatr Nurses Assoc. 2018 May/Jun;24(3):188-189. doi: 10.1177/1078390318763267. No abstract available.
• Maus T, Carter R, El-Yahchouchi C, Geske J, Diehn F. Letter to the editor. Pain Med. 2014 May;15(5):879-81. doi: 10.1111/pme.12425. Epub 2014 Mar 21. No abstract available.
• De Gagne JC, Park HK, Hall K, Woodward A, Yamane S, Kim SS. Microlearning in Health Professions Education: Scoping Review. JMIR Med Educ. 2019 Jul 23;5(2):e13997. doi: 10.2196/13997.

Study record dates

Study Major Dates

• Study Start (Estimated): June 15, 2026
• Primary Completion (Estimated): October 24, 2026
• Study Completion (Estimated): October 30, 2026

Study Registration Dates

• First Submitted: June 8, 2026
• First Submitted That Met QC Criteria: June 8, 2026
• First Posted (Actual): June 12, 2026

Study Record Updates

• Last Update Posted (Actual): June 12, 2026
• Last Update Submitted That Met QC Criteria: June 8, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Oral Health Literacy; Digital Learning; Teacher Training; Implementation Outcomes; Health Equity
• Other Study ID Numbers: BMUU

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The study protocol, statistical plan, and results will be disseminated through publications in peer-reviewed Journals.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No