Knowledge, Attitudes, and Practices Among School Health Staff in Xi’an: A Path Analysis-Based Study

Background Oral diseases severely affect children’s health. School health professionals (SHPs, including those from primary and secondary schools and kindergartens) are pivotal in promoting oral health within school settings. However, the interrelationships among oral healthcare personnel’s knowledge, attitudes, and practices, as well as how training participation is associated with their implementation of oral health practices for students, require more detailed examination. Objective This study investigated the oral health knowledge, attitudes, and practices status of SHPs in Xi’an and examined the relationships among training participation, objective knowledge, perceived oral health knowledge, personal oral-care practice, educational attitude, and educational practice for students (specifically, delivering health education, supervising toothbrushing, and conducting oral screenings). Methods A cross-sectional survey was conducted in December 2025 among 79 SHPs in Xi’an. Objective knowledge, perceived oral health knowledge, personal oral-care practice, educational attitude, educational practice, and training participation were assessed using a self-administered questionnaire. Data were analysed using descriptive statistics, supplementary Spearman correlation analysis, Pearson correlation analysis, regression-based path analysis, and bias-corrected bootstrap tests of indirect associations. Results SHPs demonstrated moderate objective knowledge (score rate: 73.4%), relatively high perceived oral health knowledge (71.6%), positive educational attitude (86.4%), and moderately high educational practice (70.9%). In the supplementary analysis, perceived oral health knowledge was positively associated with personal oral-care practice ( ρ = 0.256, P = .023). In the path model, only training participation showed a significant direct association with educational practice ( β = 0.469, P < .001), while all indirect associations were nonsignificant. Conclusion Training participation demonstrated the strongest association with oral health educational practice, primarily through a direct pathway. Capacity-building initiatives for oral health promotion among SHPs may benefit from emphasizing practical, skills-oriented, interactive training to influence further knowledge translation. Given the study design and sample size, these associations warrant further investigation.