Original Research
Strengthening oral health promotion in remote riverine populations: a community-based participatory intervention study
AUTHORS
Diego Cordeiro1,2 MSc, PhD Student *
Fernando J Herkrath2,3,4 PhD, Public Health Researcher 
Carlos Augusto da Silva Araújo Junior2,4 MSc, PhD Student
Ana Paula CQ Herkrath1,2 PhD, Adjunct Professor
AFFILIATIONS
1 School of Dentistry, Federal University of Amazonas, Manaus, Amazonas, Brazil
2 Doctoral Program in Public Health in the Amazon, Manaus, Amazonas, Brazil
3 Leônidas and Maria Deane Institute, Oswaldo Cruz Foundation, Manaus, Amazonas, Brazil
4 Superior School of Health Sciences, Amazonas State University, Manaus, Amazonas, Brazil
ACCEPTED: 3 December 2025
Early Abstract:
Introduction: Strengthening oral health promotion in remote riverine populations is essential for reducing persistent inequities in oral health. This study evaluated the outcomes of a community-based participatory intervention designed to enhance oral health knowledge, behaviors, and conditions among residents of a remote riverine community in the Brazilian Amazon.
Methods: A community-based participatory intervention was implemented based on the five action areas of the Ottawa Charter. Data were collected at baseline (T0) and after eight months (T1) through face-to-face interviews using the HeLD-14 and OHIP-14 instruments, for oral health literacy and oral health-related quality of life, complementary questionnaires on health behaviors and service use, and clinical oral examinations. Differences between T0 and T1 were analyzed using Wilcoxon paired, McNemar, and Cochran’s Q tests.
Results: Following the intervention, participants demonstrated improvements in oral health literacy and oral health beliefs (p<0.001), oral health-related quality of life (p<0.001), and periodontal conditions, with significant reductions in gingival bleeding and dental calculus (p≤0.001). Dental service utilization increased (p=0.004), although economic barriers persisted. No change was observed in the DMFT index.
Conclusions: The intervention positively influenced key oral health outcomes in this remote riverine population. These findings highlight the potential of participatory, community-driven strategies to strengthen oral health promotion in rural and remote settings.
Keywords: Brazilian Amazon, community participation, oral health, riverine populations, rural health.