Long-term Implementation and Clinical Outcomes: Nutrition Literacy Program for Oral Health Promotion

Introduction: Nutrition literacy represents a critical determinant of oral health outcomes. Guided by Social Cognitive Theory and the Nutrition Literacy Skills Framework, this study evaluated the implementation and effectiveness of a nutrition literacy programme for oral health promotion among village health volunteers (VHVs), key implementers in Thailand's healthcare system, during January to December 2024. Methods: A convergent parallel mixed-methods design was employed to address existing methodological gaps in nutrition literacy research. The quantitative component comprised a cross-sectional survey (N=60 VHVs trained in January 2024) and clinical outcome monitoring via electronic health records. The qualitative strand involved a multi-case study approach with purposive sampling (n=20) through in-depth interviews. Data collection occurred at 6-month post-implementation (July 2024), with clinical monitoring through December 2024. Analysis integrated descriptive and inferential statistics with thematic analysis. Results: Post-implementation analysis revealed significantly enhanced nutrition literacy skills (M=4.14, SD=0.414), with notable improvements in communication (M=4.74, SD=0.511) and implementation (M=4.21, SD=0.440). All six nutrition literacy domains showed strong correlations (r=0.712-0.868, p<.01), supporting the framework's interconnected nature. Clinical outcomes improved significantly: oral health check-up rates increased from 1.41% to 2.61% (p<.05), and functional teeth retention rose from 87.36% to 92.72% (p<.01). Qualitative findings revealed adaptive knowledge transfer methods and context-specific implementation strategies influenced by community readiness. Conclusion: Through comprehensive mixed-methods evaluation, the 12-month implementation data demonstrated significant improvements in both VHVs' nutrition literacy skills and clinical oral health outcomes. Success factors included theoretically-grounded implementation strategies and stakeholder engagement in resource-limited settings.