Fortalecendo a promoção da saúde bucal em uma população rural ribeirinha: um estudo de intervenção participativa de base comunitária

Abstract

Oral health promotion in Amazonian rural contexts requires territorialized and culturally sensitive approaches capable of addressing the structural inequities that shape access to and provision of health care among riverine populations. In these localities, the river-based way of life, the distance from urban centers, and the itinerant nature of Primary Health Care (PHC) services limit continuity of care and the implementation of preventive actions, maintaining high rates of untreated dental caries, tooth loss, and low service coverage. This study aimed to evaluate the effect of participatory community-based interventions on oral health promotion in a riverine community along the Negro River, in Manaus, Amazonas, based on the five action areas of the Ottawa Charter: strengthening community action, developing personal skills, creating supportive environments, reorienting health services, and building healthy public policies. It was a participatory community intervention study conducted between 2023 and 2024 in the rural riverine community of Santa Maria, located five hours by boat from the capital. The process was co-constructed by a local management committee composed of community leaders, community health agents, school and religious representatives, with technical-scientific mediation provided by professionals experienced in public health. The actions included educational workshops, home visits focused on health education, training for community health agents, collective construction of a school toothbrushing station, implementation of a community oral health map, and the creation of a local hygiene kit distribution program. The evaluation involved interviews and clinical examinations with 61 residents aged 15 to 60 years, conducted at two time points: baseline (T0) and eight months after the interventions (T1). The study analyzed health promotion outcomes (oral health literacy, beliefs, and behaviors), intermediate outcomes (service utilization), and health and social outcomes (periodontal conditions, dental caries, and oral health-related quality of life), using paired Wilcoxon, McNemar, and Cochran’s Q tests (p < 0.05). After the interventions, there was a significant improvement in oral health literacy (p < 0.001), especially in the access and use domains, as well as in oral health beliefs (p < 0.001). The frequency of dental visits increased (p = 0.004), oral health-related quality of life improved (p < 0.001), and there was a notable reduction in gingival bleeding (from 27.1% to 4.8%; p < 0.001) and dental calculus (from 10.6% to 5.7%; p = 0.001), with no significant change in the DMFT index. The interventions strengthened the integration between the community and the river-based health services, enhanced local autonomy, and fostered sustainable behavioral changes. The results show that participatory and intersectoral strategies, anchored in the Ottawa Charter and co-created with the population, can reorient care practices, strengthen public policies, and reduce oral health inequalities in hard-to-reach territories. This experience contributes to advancing oral health promotion by demonstrating the transformative potential of social participation in building more equitable, participatory, and culturally coherent environments and services aligned with Amazonian ways of life.