Health Literacy and Empowerment in Oral Health among Visually Impaired Children: Insights from a Qualitative Study in Kerala

Abstract

Oral disease is one of the most common yet preventable diseases among children globally and the visual impaired children are disproportionately affected by oral diseases. Although the oral hygiene status and caries experience in visually impaired children in India has been documented in various quantitative studies, there is little knowledge about how these children perceive, access and act on oral health information, nor what the conditions are like in which they feel confident to take control of their oral health. The present qualitative study aimed to examine the level of health literacy and empowerment related to oral health among visually impaired children attending both residential and integrated schools of Kerala, a state where the overall health literacy is very high and health promotion is an established tradition. The study was conducted in a semi-structured manner using 18 children aged 10-17 years who were interviewed, two focus group discussions, and interviews with teachers and caregivers. Reflexive thematic analysis was used for the analysis of the data. Five interconnected themes emerged: sensory-adapted learning, balance of dependence and autonomy, institutional setting, mediation by caregivers and peers, and challenges to access of dental care. The data indicate that although knowledge about oral health is often present and fragile, tactile and auditory learning styles are important elements of empowerment and supportive social mediation is critical, while critical health literacy, or questioning and advocating, is not developed. The research paper calls for an "oral health education for children that is sensory-inclusive and intentionally shifts children from receiving instruction to having autonomy and voice.