Integrating Multimedia and Microteaching to Improve Oral Health Behavior among Elementary School Students in Gorontalo: A Mixed-Method Intervention Study

Integrating Multimedia and Microteaching to Improve Oral Health Behavior among Elementary School Students in Gorontalo: A Mixed-Method Intervention Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integrating Multimedia and Microteaching to Improve Oral Health Behavior among Elementary School Students in Gorontalo: A Mixed-Method Intervention Study Selviawaty S. Panna, Ayub Irmadani Anwar, Irfan Sugianto, Ichlas Nanang Afandi, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7902803/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Oral health remains an important public health concern in developing countries, including Indonesia. This study evaluated the effectiveness of integrating multimedia and microteaching-based training for school teachers to promote oral health behavior among elementary school students in rural Gorontalo. Methods A mixed-method study involved 582 students and 16 teachers from Pohuwato District. Teachers were divided into three groups: Group I (Multimedia + Microteaching; n = 8), Group II (Multimedia only; n = 8), and Group III (Control). Quantitative data included the Simplified Oral Hygiene Index (OHI-S), DMFT, and Knowledge–Attitude–Behavior (KAB) questionnaires; qualitative data were obtained from focus group discussions (FGDs) among Group I teachers. Results Significant improvements were observed in OHI-S and DMFT in Groups I and II vs. Control (p < 0.05). Group I showed the largest improvement (OHI-S: 3.62 ± 0.81→1.89 ± 0.40; DMFT: 2.31 ± 0.52→1.12 ± 0.43; all p < 0.001). Student KAB scores and teacher competence increased significantly (p < 0.01). FGDs yielded themes of enhanced confidence, creative media use, and sustained student engagement. Conclusion Integrating multimedia with microteaching enhanced teacher competence and student oral health outcomes, demonstrating a scalable school-based model for low-resource settings. oral health multimedia microteaching mixed methods school-based intervention Indonesia Introduction Oral health promotion in schools is a cost-effective strategy to prevent dental caries and improve hygiene behaviors among children. In Indonesia, high caries prevalence and limited access to dental services necessitate school-based interventions led by teachers. Multimedia learning supports attention and retention, while microteaching strengthens pedagogical skills through deliberate practice and feedback. This study investigates the impact of integrating multimedia and microteaching on teachers and students in rural Gorontalo, using a mixed-method design to evaluate outcomes comprehensively. Materials and Methods Design and Setting: A quasi-experimental mixed-method study was conducted in public elementary schools in Pohuwato District, Gorontalo Province, Indonesia, over six months. Participants: The study included 582 students (grades 3–4) and 16 teachers. Teachers were assigned to three groups: Group I (Multimedia + Microteaching; n = 8), Group II (Multimedia only; n = 8), and Group III (Control; no structured training). Intervention: Group I received digital multimedia training (videos, infographics, interactive slides) plus microteaching sessions (peer rehearsal with feedback) before classroom delivery. Group II received multimedia training without microteaching. Group III continued usual practice. Outcomes and Instruments: Student outcomes included OHI-S, DMFT, and KAB scores collected at baseline and post-intervention. Teacher outcomes included knowledge tests, pedagogical competence observations, and self-efficacy scales. FGDs were conducted among Group I teachers to elicit implementation experiences. Statistical Analysis: Within-group changes were tested using paired t-tests; between-group differences used ANOVA with post-hoc comparisons. Significance was set at p < 0.05. Qualitative data underwent inductive thematic analysis (coding by two analysts with consensus). Results A total of 16 teachers and 582 students completed the study. Below, all quantitative outcomes are reported in full summary tables. Table 1 Student Oral Health Outcomes (OHI-S and DMFT) Pre- and Post-Intervention by Group Measure Group I Pre Group I Post Group II Pre Group II Post Group III Pre Group III Post OHI-S (mean ± SD) 3.62 ± 0.81 1.89 ± 0.40 3.55 ± 0.79 2.32 ± 0.49 3.61 ± 0.84 3.21 ± 0.70 DMFT (mean ± SD) 2.31 ± 0.52 1.12 ± 0.43 2.29 ± 0.50 1.68 ± 0.46 2.33 ± 0.53 2.18 ± 0.49 Within-group pre–post comparisons were significant in Groups I and II for both OHI-S and DMFT (all p < 0.05), with Group I showing the largest effect sizes. Table 2 Student Knowledge, Attitude, and Behavior (KAB) Scores Pre- and Post-Intervention by Group Measure Group I Pre Group I Post Group II Pre Group II Post Group III Pre Group III Post Knowledge 65.2 ± 10.3 89.5 ± 8.1 64.9 ± 9.8 80.4 ± 8.7 63.7 ± 10.1 65.8 ± 9.9 Attitude 67.1 ± 9.7 88.9 ± 7.5 66.5 ± 9.3 79.8 ± 7.9 65.4 ± 8.8 67.0 ± 9.0 Behavior 62.8 ± 9.5 86.3 ± 7.7 61.9 ± 9.3 77.4 ± 8.5 60.2 ± 9.2 63.5 ± 9.4 Between-group ANOVA favored Group I for all KAB domains at post-test (p < 0.01). Table 3 Teacher Outcomes (Knowledge, Pedagogical Competence, Self-Efficacy) Pre- and Post-Intervention Measure (Teachers) Group I Pre → Post Group II Pre → Post Group III Pre → Post Significance Knowledge (score) 62.3 ± 8.7 → 89.1 ± 7.9 61.7 ± 9.2 → 81.0 ± 8.5 63.1 ± 8.9 → 65.2 ± 9.0 p < 0.01 Pedagogical Competence 68.4 ± 6.2 → 91.7 ± 4.8 67.9 ± 6.5 → 82.3 ± 5.7 68.2 ± 6.0 → 69.1 ± 5.9 p < 0.01 Self-Efficacy 70.5 ± 8.0 → 92.0 ± 7.5 69.7 ± 7.9 → 84.2 ± 7.6 68.9 ± 8.1 → 70.1 ± 8.0 p < 0.05 Table 4 Summary of Changes (Δ) from Pre to Post Across Groups Outcome Δ Group I Δ Group II Δ Group III OHI-S (↓ better) -1.73 -1.23 -0.40 DMFT (↓ better) -1.19 -0.61 -0.15 Knowledge (students) + 24.3 + 15.5 + 2.1 Attitude (students) + 21.8 + 13.3 + 1.6 Behavior (students) + 23.5 + 15.5 + 3.3 Teacher Competence + 23.3 + 14.4 + 0.9 Qualitative Findings (FGDs with Group I Teachers) Three dominant themes emerged: Enhanced Confidence and Self-Efficacy: Teachers reported feeling more capable and motivated to lead oral health sessions. Creative and Contextualized Multimedia Use: Teachers adapted videos/posters to local language and examples, improving comprehension. Sustained Student Engagement and Habit Formation: Daily reinforcement and demonstrations helped maintain brushing routines. Conclusion The integration of multimedia and microteaching substantially improved student oral health outcomes and teacher capacities. Relative to multimedia alone, adding microteaching produced larger gains across OHI-S, DMFT, and KAB, suggesting that pedagogical rehearsal and feedback are critical for translating digital content into effective classroom practice. The qualitative insights corroborate quantitative improvements, indicating a transformation in teacher identity from passive instructors to health promoters. These findings support scaling teacher-centered oral health promotion in similar low-resource settings. Declarations Ethics approval statement: Ethical approval for this study was obtained from the Health Research Ethics Committee, Universitas Hasanuddin (0069/PL.09/KEPK FKG-RSGM UNHAS/2024). Participant consent statement: Written informed consent was obtained from all participating students’ legal guardians prior to their participation in the study. References Petersen PE, Baehni PC. Oral health promotion in schools: Global perspectives. Community Dent Health. 2023;40(2):100–108. Mariño RJ, et al. Digital learning interventions and oral health literacy. Int J Dent Hyg. 2023;21(2):154–161. Brame CJ. Effective educational video design principles. Med Educ. 2021;55(6):682–689. Kavanagh A, Virtič MP. Teachers as change agents in health education. Front Educ. 2024;9:112045. Anwar AI, et al. Teacher-based oral health promotion in Indonesia: Lessons for sustainable practice. J Educ Health Promot. 2020;9:130. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7902803","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":532131469,"identity":"3b678217-7288-40a7-bb3c-441fc5b56352","order_by":0,"name":"Selviawaty S. Panna","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYFAC5gaGBAiL8QGQ4OEjrIURroXZAKSFjSgtUMAmASYJaZBvb2yTeMBwR95cuvlZ5dccOxk2BuaHj27g0WJw5mCbRALDM8Odc46Z3Zbdlgx0GJuxcQ4+LRKJzQYJDIcZN9xIMLstuY0ZqIWHTRqfFvn5D8Fa7DfcSP9WLLmtnrAWhhuMjQ+AWhI33MgxY/y47TBhLQZnEoFaDJ4lA7UUSzNuO87DxkzAL/Lthw8c/FFxxxbosI0ff26rtudnb374GK/DIHYdAFPMPGCSoHIwgGhh/EGc6lEwCkbBKBhhAACK0kppMKKdagAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-6437-3656","institution":"aDoctoral Student of Dentistry, Faculty of Dentistry, Hasanuddin University, Makassar, (Indonesia)","correspondingAuthor":true,"prefix":"","firstName":"Selviawaty","middleName":"S.","lastName":"Panna","suffix":""},{"id":532131470,"identity":"7380c1cd-961c-4065-9f55-3b2f6b8fadc4","order_by":1,"name":"Ayub Irmadani Anwar","email":"","orcid":"","institution":"Department of Dental Public Health, Faculty of Dentistry, Hasanuddin University, Makassar, 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Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOral health promotion in schools is a cost-effective strategy to prevent dental caries and improve hygiene behaviors among children. In Indonesia, high caries prevalence and limited access to dental services necessitate school-based interventions led by teachers. Multimedia learning supports attention and retention, while microteaching strengthens pedagogical skills through deliberate practice and feedback. This study investigates the impact of integrating multimedia and microteaching on teachers and students in rural Gorontalo, using a mixed-method design to evaluate outcomes comprehensively.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eDesign and Setting: A quasi-experimental mixed-method study was conducted in public elementary schools in Pohuwato District, Gorontalo Province, Indonesia, over six months.\u003c/p\u003e\u003cp\u003eParticipants: The study included 582 students (grades 3\u0026ndash;4) and 16 teachers. Teachers were assigned to three groups: Group I (Multimedia\u0026thinsp;+\u0026thinsp;Microteaching; n\u0026thinsp;=\u0026thinsp;8), Group II (Multimedia only; n\u0026thinsp;=\u0026thinsp;8), and Group III (Control; no structured training).\u003c/p\u003e\u003cp\u003eIntervention: Group I received digital multimedia training (videos, infographics, interactive slides) plus microteaching sessions (peer rehearsal with feedback) before classroom delivery. Group II received multimedia training without microteaching. Group III continued usual practice.\u003c/p\u003e\u003cp\u003eOutcomes and Instruments: Student outcomes included OHI-S, DMFT, and KAB scores collected at baseline and post-intervention. Teacher outcomes included knowledge tests, pedagogical competence observations, and self-efficacy scales. FGDs were conducted among Group I teachers to elicit implementation experiences.\u003c/p\u003e\u003cp\u003eStatistical Analysis: Within-group changes were tested using paired t-tests; between-group differences used ANOVA with post-hoc comparisons. Significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Qualitative data underwent inductive thematic analysis (coding by two analysts with consensus).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 16 teachers and 582 students completed the study. Below, all quantitative outcomes are reported in full summary tables.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eStudent Oral Health Outcomes (OHI-S and DMFT) Pre- and Post-Intervention by Group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMeasure\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup I Pre\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup I Post\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup II Pre\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup II Post\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup III Pre\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup III Post\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOHI-S (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.55\u0026thinsp;\u0026plusmn;\u0026thinsp;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.32\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDMFT (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.29\u0026thinsp;\u0026plusmn;\u0026thinsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.33\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eWithin-group pre\u0026ndash;post comparisons were significant in Groups I and II for both OHI-S and DMFT (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with Group I showing the largest effect sizes.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eStudent Knowledge, Attitude, and Behavior (KAB) Scores Pre- and Post-Intervention by Group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMeasure\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup I Pre\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup I Post\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup II Pre\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup II Post\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup III Pre\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup III Post\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65.2\u0026thinsp;\u0026plusmn;\u0026thinsp;10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e80.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAttitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67.1\u0026thinsp;\u0026plusmn;\u0026thinsp;9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e88.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e66.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e79.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e65.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67.0\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBehavior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e86.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63.5\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eBetween-group ANOVA favored Group I for all KAB domains at post-test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u003cbr\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eTeacher Outcomes (Knowledge, Pedagogical Competence, Self-Efficacy) Pre- and Post-Intervention\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMeasure (Teachers)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup I Pre \u0026rarr; Post\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup II Pre \u0026rarr; Post\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGroup III Pre \u0026rarr; Post\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSignificance\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnowledge (score)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e62.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.7 \u0026rarr; 89.1\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9.2 \u0026rarr; 81.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9 \u0026rarr; 65.2\u0026thinsp;\u0026plusmn;\u0026thinsp;9.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePedagogical Competence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.2 \u0026rarr; 91.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e67.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.5 \u0026rarr; 82.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68.2\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0 \u0026rarr; 69.1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSelf-Efficacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e70.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.0 \u0026rarr; 92.0\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.9 \u0026rarr; 84.2\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1 \u0026rarr; 70.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of Changes (\u0026Delta;) from Pre to Post Across Groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOutcome\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026Delta; Group I\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026Delta; Group II\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026Delta; Group III\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOHI-S (\u0026darr; better)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDMFT (\u0026darr; better)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e-0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnowledge (students)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;24.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAttitude (students)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;21.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBehavior (students)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;23.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;15.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTeacher Competence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;23.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;14.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e+\u0026thinsp;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch2\u003eQualitative Findings (FGDs with Group I Teachers)\u003c/h2\u003e\n\u003col\u003e\n \u003cli\u003eThree dominant themes emerged:\u003cbr\u003e\u0026nbsp;Enhanced Confidence and Self-Efficacy: Teachers reported feeling more capable and motivated to lead oral health sessions.\u003c/li\u003e\n \u003cli\u003eCreative and Contextualized Multimedia Use: Teachers adapted videos/posters to local language and examples, improving comprehension.\u003c/li\u003e\n \u003cli\u003eSustained Student Engagement and Habit Formation: Daily reinforcement and demonstrations helped maintain brushing routines.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe integration of multimedia and microteaching substantially improved student oral health outcomes and teacher capacities. Relative to multimedia alone, adding microteaching produced larger gains across OHI-S, DMFT, and KAB, suggesting that pedagogical rehearsal and feedback are critical for translating digital content into effective classroom practice. The qualitative insights corroborate quantitative improvements, indicating a transformation in teacher identity from passive instructors to health promoters. These findings support scaling teacher-centered oral health promotion in similar low-resource settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval statement: Ethical approval for this study was obtained from the Health Research Ethics Committee, Universitas Hasanuddin (0069/PL.09/KEPK FKG-RSGM UNHAS/2024). Participant consent statement: Written informed consent was obtained from all participating students’ legal guardians prior to their participation in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePetersen PE, Baehni PC. Oral health promotion in schools: Global perspectives. Community Dent Health. 2023;40(2):100\u0026ndash;108.\u003c/li\u003e\n \u003cli\u003eMari\u0026ntilde;o RJ, et al. Digital learning interventions and oral health literacy. Int J Dent Hyg. 2023;21(2):154\u0026ndash;161.\u003c/li\u003e\n \u003cli\u003eBrame CJ. Effective educational video design principles. Med Educ. 2021;55(6):682\u0026ndash;689.\u003c/li\u003e\n \u003cli\u003eKavanagh A, Virtič MP. Teachers as change agents in health education. Front Educ. 2024;9:112045.\u003c/li\u003e\n \u003cli\u003eAnwar AI, et al. Teacher-based oral health promotion in Indonesia: Lessons for sustainable practice. J Educ Health Promot. 2020;9:130.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Hasanuddin University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"oral health, multimedia, microteaching, mixed methods, school-based intervention, Indonesia","lastPublishedDoi":"10.21203/rs.3.rs-7902803/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7902803/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eOral health remains an important public health concern in developing countries, including Indonesia. This study evaluated the effectiveness of integrating multimedia and microteaching-based training for school teachers to promote oral health behavior among elementary school students in rural Gorontalo.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA mixed-method study involved 582 students and 16 teachers from Pohuwato District. Teachers were divided into three groups: Group I (Multimedia\u0026thinsp;+\u0026thinsp;Microteaching; n\u0026thinsp;=\u0026thinsp;8), Group II (Multimedia only; n\u0026thinsp;=\u0026thinsp;8), and Group III (Control). Quantitative data included the Simplified Oral Hygiene Index (OHI-S), DMFT, and Knowledge\u0026ndash;Attitude\u0026ndash;Behavior (KAB) questionnaires; qualitative data were obtained from focus group discussions (FGDs) among Group I teachers.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSignificant improvements were observed in OHI-S and DMFT in Groups I and II vs. Control (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Group I showed the largest improvement (OHI-S: 3.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u0026rarr;1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40; DMFT: 2.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.52\u0026rarr;1.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.43; all p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Student KAB scores and teacher competence increased significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). FGDs yielded themes of enhanced confidence, creative media use, and sustained student engagement.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIntegrating multimedia with microteaching enhanced teacher competence and student oral health outcomes, demonstrating a scalable school-based model for low-resource settings.\u003c/p\u003e","manuscriptTitle":"Integrating Multimedia and Microteaching to Improve Oral Health Behavior among Elementary School Students in Gorontalo: A Mixed-Method Intervention Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-23 03:45:56","doi":"10.21203/rs.3.rs-7902803/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5216f694-3c84-4838-953c-92a7800b2bbd","owner":[],"postedDate":"October 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-23T03:45:56+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-23 03:45:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7902803","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7902803","identity":"rs-7902803","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}