Factors influencing adoption of oral health promotion by antenatal care providers in Moyo district, North-Western Uganda

**Background:** Oral health promotion (OHP) during pregnancy is a critical public health issue, yet prenatal care providers often miss opportunities to integrate it. Hormonal changes during pregnancy increase the risk of oral diseases such as gingivitis and periodontitis, which can negatively impact maternal and child health. Despite global guidelines emphasizing the need for improved oral health care for pregnant women, adoption of OHP by antenatal care (ANC) providers remains low, particularly in low- and middle-income countries. In Uganda, the prevalence of oral diseases among women is 42.4%, and 67.0% of pregnant mothers have periodontal diseases. This study assessed factors influencing the adoption of OHP by ANC providers in Moyo district, North-Western Uganda.

**Methods:** A descriptive cross-sectional study using both quantitative and qualitative methods was conducted between August and October 2017. The sample size of 152 was determined using Yamane's (1967) formula, and stratified sampling was employed. Participants included nurses, midwives, clinical officers, and medical doctors working at ANC units who had at least six months of experience. Three focus group discussions (FGDs) and six key informant (KI) interviews were conducted. Quantitative data were analyzed using SPSS version 20.0 with univariate, bivariate, and multivariate logistic regression. Qualitative data were analyzed thematically using ATLAS.ti. Adoption of OHP was measured using 24 practice items (mean score 18, SD 3.2; threshold ≥75%). Knowledge was assessed with 11 items (mean correct 7, SD 2.2), attitude with 6 items (mean 4, SD 0.98), and capacity with 16 items.

**Key Results:** Only 42 out of 152 respondents (28%) had adopted OHP. The mean age of respondents was 36 years (SD 10.49, range 37 years); 60.5% were female; 69.7% had worked 1–10 years; 53.9% worked at HC IIIs; 44.1% were nurses; and 53.9% held certificates. In multivariate analysis, factors significantly associated with adoption of OHP were: age 22–26 years (aOR = 0.066, 95%CI = 0.009–0.465, p = 0.006), level of care at HC IV (aOR = 0.050, 95%CI = 0.008–0.322, p = 0.002), good understanding between dentists and ANC providers (aOR = 0.283, 95%CI = 0.084–0.958, p = 0.042), availability of practice guidelines for OHP in ANC (aOR = 0.323, 95%CI = 0.108–0.958, p = 0.043), and working 1–10 years (aOR = 25.241, 95%CI = 2.075–307.041, p = 0.011). Factors not statistically significant included general years at work (p = 0.084), being knowledgeable (aOR = 2.143, 95%CI = 0.864–5.311, p = 0.100), having skills to advance OHP (aOR = 0.734, 95%CI = 0.272–1.984, p = 0.542), and management being good at influencing new practices (aOR = 0.477, 95%CI = 0.227–2.000, p = 0.477). Knowledge gaps were notable: 82.2% of respondents were unaware that obtaining dental radiographs is safe during pregnancy. Only 36.8% were knowledgeable about OHP in ANC. Qualitative findings emphasized the need for national and local focus on oral health, continuous staff training, and dissemination of the National Oral Health Policy (NOHP).

**Clinical Implications:** The low adoption rate (28%) indicates a substantial missed opportunity to improve maternal and child oral health through ANC. The study identifies modifiable factors—such as interprofessional collaboration, availability of practice guidelines, and staff training—that can be targeted to integrate OHP into routine antenatal care. The authors recommend reviewing the current NOHP, developing prenatal oral health care guidelines, enhancing ANC provider capacity through training, fostering collaboration with dentists, and officially adopting OHP into ANC services. Addressing knowledge gaps about the safety of dental procedures during pregnancy is also critical.