MOTHERS AS GATEKEEPERS: THE SOCIAL ROLE OF WOMEN IN SHAPING CHILDREN'S ORAL HEALTH

Abstract

Background: Mothers serve as primary caregivers and play a pivotal role in shaping children’s oral health behaviors. Despite their central role, limited research exists on how maternal knowledge, attitudes, practices, and socio-cultural factors influence children’s oral hygiene in Pakistan.

Objective: This study aimed to explore mothers’ roles as gatekeepers of children’s oral health, examining knowledge, behaviors, socio-cultural influences, and barriers to effective oral health promotion.

Methods: A qualitative research design was employed in urban and rural areas of District Nowshehra, Khyber Pakhtunkhwa, Pakistan. Purposive and snowball sampling identified 28 mothers of children aged 3–12 years (16 rural, 12 urban). Data collection included 18 in-depth interviews (IDIs) and 3 focus group discussions (FGDs), conducted in Pashto/Urdu, audio-recorded, transcribed verbatim, and supplemented by field notes. Reflexive thematic analysis (Braun & Clarke, 2021) using NVivo 12 was applied to identify themes and sub-themes. Methodological rigor was ensured through prolonged engagement, triangulation, peer debriefing, member checking, and audit trails.

Results: Analysis revealed five interrelated themes: (1) mothers as primary health decision-makers, reflecting responsibility and autonomy in oral health decisions; (2) knowledge gaps and mixed attitudes, indicating uneven oral health literacy and reliance on informal sources; (3) modeling and habit transmission, demonstrating the impact of maternal routines on children’s habits; (4) socio-cultural expectations and family influence, highlighting extended family pressures and cultural norms; and (5) barriers to effective promotion, including financial, geographic, time, and behavioral constraints.

Conclusion: Mothers are central gatekeepers of children’s oral health, yet their effectiveness is influenced by knowledge gaps, socio-cultural norms, and structural barriers. Interventions that enhance maternal oral health literacy, engage families, and improve access to preventive services may promote sustainable oral hygiene behaviors in children.