A socio-ecological study of oral health literacy in adolescent girls: a qualitative content analysis

Given the substantial impact of health literacy on health behaviors and the prevention of oral diseases, understanding the determinants of Oral Health Literacy (OHL) among female adolescents is of critical importance. Hence, this study aimed to investigate the organizational, social, and policy-related factors influencing their oral health literacy, grounded in the socio-ecological model. This qualitative study employed a directed content analysis guided by the Socio-Ecological Model. Purposive sampling with maximum variation was used to recruit 45 participants, including policymakers, organizational stakeholders, and dentists, between June 2024 and June 2025. Data were collected through in-depth, semi-structured face-to-face and telephone interviews and analyzed using the deductive approach of Elo and Kyngäs. Data collection continued until thematic saturation was achieved, defined as the absence of new concepts or categories in the final two consecutive interviews. Data analysis resulted in 15 main categories and 63 subcategories, categorized under the three levels of the Socio-Ecological Model: organizational, community, and policy. Findings highlight that female adolescents’ OHL is deeply rooted in a multi-dimensional system, encompassing the effectiveness of school-based education, media influence, insurance coverage, and intersectoral collaboration. Furthermore, participants identified the critical role of dentists as educators and the significant impact of socioeconomic, cultural, and political frameworks—specifically those mandated by the Ministries of Health and Education—on shaping OHL outcomes. The findings indicate that various organizational, social, and policy-related factors significantly influence the OHL of female adolescents. Addressing these levels simultaneously through the implementation of comprehensive strategies can enhance their OHL and ultimately contribute to a reduction in the prevalence of oral diseases.