Cultural Themes Related to Oral Health Practices, Beliefs, and Experiences in Nigeria: A Scoping Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

1.      Consider altering the title, e.g., Deciphering Cultural themes related to Oral Health Practices, Beliefs, and Experiences in Nigeria: A Scoping Review.

2.      On Line 29 (Abstract), it is stated that ‘Reviews’ were excluded. What type of reviews do you refer to? Systematic/Literature/Narrative etc?

3.      Consider adding: ‘dental public health’ to the list of keywords, since the article has such a focus.

4.      On Line 25, it appears that you may have missed out a citation: “[ref]” – please address this.

5.      The Discussion section contains a lot of unsupported statements and recommendations that must be backed up by appropriate examples and references, otherwise the authors could be susceptible to allegations of plagiarism. For instance, Lines 336-337 makes a valid suggestion about the need for collaboration with community and religious leaders, but lacks any supporting example(s) and reference(s). Please look at the following resources that may act as examples and supporting references for this statement:

-Modha, B., 2022. Utilising dentist-dental health educator skill-mix to implement oral health promotion that better supports diverse communities. Journal of Integrated Care, 30(3), pp.237-250 (dental professionals collaborating with an Iman to promote oral health in a mosque in the UK)

-Campbell, M.K., Hudson, M.A., Resnicow, K., Blakeney, N., Paxton, A. and Baskin, M., 2007. Church-based health promotion interventions: evidence and lessons learned. Annual review of public health, 28(1), pp.213-234 (implementing health promotion interventions via collaborating with a church in the US)

*Please assess the whole paper carefully and ensure that all unsupported statements are backed up with relevant, fairly up-to-date examples and references.

6.      There must be considerable discussion within the paper on why cultural themes are of importance to dental and related professionals throughout the world.

7.      In places, there are discrepancies in the language, grammar, punctuation, spelling, sentence structures, and organisation and structure of ideas; this impacts on readability and flow. Henceforth, the language, grammar, punctuation, spelling, sentence structures and organisation of ideas etc require meticulous assessment and polishing to ensure coherence and conciseness. The necessary scientific English language reading and editing assistance should be obtained, if necessary, so that the manuscript can reach a standard where it has the potential to be read and understood with ease by an international readership to include both professionals and laypersons.

8.      Overall, this is a very unique, interesting and worthwhile article, raising some very important contemporary dental public health issues pertaining to Nigeria. Such research will be applicable to other countries. The authors’ hard work, thoughts, and ideas are commended and appreciated. The article definitely has potential, but requires significant improvements before publication can be considered. Please consider making the above stated changes and additions with appropriate, up-to-date supporting references.

Comments on the Quality of English Language

1.      In places, there are discrepancies in the language, grammar, punctuation, spelling, sentence structures, and organisation and structure of ideas; this impacts on readability and flow. Henceforth, the language, grammar, punctuation, spelling, sentence structures and organisation of ideas etc require meticulous assessment and polishing to ensure coherence and conciseness. The necessary scientific English language reading and editing assistance should be obtained, if necessary, so that the manuscript can reach a standard where it has the potential to be read and understood with ease by an international readership to include both professionals and laypersons.

Author Response

Reviewer I

Comments and Suggestions for Authors

1. Consider altering the title, e.g., Deciphering Cultural themes related to Oral Health Practices, Beliefs, and Experiences in Nigeria: A Scoping Review.

Response: Thanks for the suggested revision. The suggestion effected

 

2. On Line 29 (Abstract), it is stated that ‘Reviews’ were excluded. What type of reviews do you refer to? Systematic/Literature/Narrative etc?

Response: Thanks for raising this. We wrote:  All forms of literature reviews were excluded.

 

3. Consider adding: ‘dental public health’ to the list of keywords, since the article has such a focus.

Response: Thanks for the suggestion. This has been done.

 

4. On Line 25, it appears that you may have missed out a citation: “[ref]” – please address this.

Response: Yes, we did. This has now been rectified. Thanks for picking it up.

 

5. The Discussion section contains a lot of unsupported statements and recommendations that must be backed up by appropriate examples and references, otherwise the authors could be susceptible to allegations of plagiarism. For instance, Lines 336-337 makes a valid suggestion about the need for collaboration with community and religious leaders, but lacks any supporting example(s) and reference(s). Please look at the following resources that may act as examples and supporting references for this statement:

-Modha, B., 2022. Utilising dentist-dental health educator skill-mix to implement oral health promotion that better supports diverse communities. Journal of Integrated Care, 30(3), pp.237-250 (dental professionals collaborating with an Iman to promote oral health in a mosque in the UK)

-Campbell, M.K., Hudson, M.A., Resnicow, K., Blakeney, N., Paxton, A. and Baskin, M., 2007. Church-based health promotion interventions: evidence and lessons learned. Annual review of public health, 28(1), pp.213-234 (implementing health promotion interventions via collaborating with a church in the US)

*Please assess the whole paper carefully and ensure that all unsupported statements are backed up with relevant, fairly up-to-date examples and references.

Response: Thanks for highlighting these. The first 4 paragraphs are a summary of the study findings. We have edited the opening sentences of the paragraph to highlight this. We found the references useful and have used them.

 

6. There must be considerable discussion within the paper on why cultural themes are of importance to dental and related professionals throughout the world.

Response: Thanks for highlighting the need to discuss culture further. we wrote: Cultural themes are essential in the study of oral health care practices because they can inform policy formulation and the development of practice guidelines [71]. With global migration and regional cultural variations, dental professionals need evidence to be able to adapt to diverse cultural contexts to provide inclusive and equitable care. Cultural themes also the socioeconomic challenges faced by marginalized groups [72] like the Almajiri children in Nigeria. Addressing these factors through culturally competent interventions can reduce disparities and promote sustainable health improvements. In addition, by integrating traditional cultural values and practices with evidence-based oral health care practices, it is possible to bridge the gap between modern dental care and local cultural beliefs [73] and by fostering a more inclusive approach, communities may be more willing to adopt healthy behaviours while preserving cultural identity [74]. Addressing cultural barriers is not just about changing behaviours; it's about respecting and working within existing cultural frameworks to build trust and improve access to care sustainably [75,76]. Monitoring and ensuring intervention effectiveness are equally critical through regular assessments, community feedback mechanisms, and longitudinal studies can track progress, inform program adjustments, and strengthen the long-term impact of oral health initiatives.

 

7. In places, there are discrepancies in the language, grammar, punctuation, spelling, sentence structures, and organisation and structure of ideas; this impacts on readability and flow. Henceforth, the language, grammar, punctuation, spelling, sentence structures and organisation of ideas etc require meticulous assessment and polishing to ensure coherence and conciseness. The necessary scientific English language reading and editing assistance should be obtained, if necessary, so that the manuscript can reach a standard where it has the potential to be read and understood with ease by an international readership to include both professionals and laypersons.

Response: Thanks for the advice. We have done a grammar check also to improve the spellings and grammar.

 

8. Overall, this is a very unique, interesting and worthwhile article, raising some very important contemporary dental public health issues pertaining to Nigeria. Such research will be applicable to other countries. The authors’ hard work, thoughts, and ideas are commended and appreciated. The article definitely has potential, but requires significant improvements before publication can be considered. Please consider making the above stated changes and additions with appropriate, up-to-date supporting references.

Response: Thanks for the positive feedback. The feedback has been very helpful and has helped improve the quality of the manuscript.

Reviewer 2 Report

Comments and Suggestions for Authors

Title: Scoping Review of Studies on Culture and Oral Health in Nigeria

 

The manuscript is interesting and may be considered for publication, after taking into account some observations and considerations:

·       It is suggested to change the title, the study design should go at the end.

·       The entire manuscript should be reviewed so that no words, sentences and ideas appear without references, for example: Poor oral health is a public health crisis affecting over 3.5 billion people worldwide [ref].

·       Include the references of the scoping design and the number and platform where it was registered, for example, PROSPERO.

·       Include information on how the evaluators were standardized to extract and analyze the information from the articles.

·       Table 1 should be complemented with a column that includes the main findings found, this is more useful to readers.

·       The discussion should be duly justified using references that help support what is described and comparisons with other studies are always desirable; the first 6 paragraphs lack references and in my opinion there are explanations that should be based on previously reported evidence.

·       Otherwise, the conclusions section, this section should be specific to the study, limited to the study itself and not include references.

·       To better highlight the possible practical applications.

·       Although the study is conducted with studies from Nigeria, it is important to highlight how a study of this nature can be applied or used in other populations.

 

Minor:

Abstract:

Eliminate: “Little is known about how culture affects oral health in Nigeria”.

 

Author Response

The manuscript is interesting and may be considered for publication, after taking into account some observations and considerations: It is suggested to change the title, the study design should go at the end.

Response: Thanks for the suggestion. The title has been changed to reads as: Cultural themes related to Oral Health Practices, Beliefs, and Experiences in Nigeria: A Scoping Review

 

• The entire manuscript should be reviewed so that no words, sentences and ideas appear without references, for example: Poor oral health is a public health crisis affecting over 3.5 billion people worldwide [ref].

Response: Thanks for hihghlighting this oversight. The reference is now fixed.  

 

• Include the references of the scoping design and the number and platform where it was registered, for example, PROSPERO.

Response: The registration number of the scoping review with the Open science Foundation (DOI: https://doi.org/10.17605/OSF.IO/VQRUK) has been included in the manuscript.

 

• Include information on how the evaluators were standardized to extract and analyze the information from the articles.

Response:  Thanks a million for this information. Information on the inter-rater reliability has now been included.  

 

• Table 1 should be complemented with a column that includes the main findings found, this is more useful to readers.

Response: Thanks for raising this. These findings can be found in Table II.

 

• The discussion should be duly justified using references that help support what is described and comparisons with other studies are always desirable; the first 6 paragraphs lack references and in my opinion there are explanations that should be based on previously reported evidence.

Response: Thanks a million. The first six paragraphs are the study summary (paragraphs 1-4, and the strengths (paragraph 5) and limitations (paragraph 6) of the study. This is in line with the strobe guidelines. we have improved the narrative to indicate the focus of the paragraphs.

 

• Otherwise, the conclusions section, this section should be specific to the study, limited to the study itself and not include references.

Response: Thanks for highlighting this. we rewrote the conclusión:  In conclusion, addressing cultural barriers to oral health care access and uptake is a crucial step in reducing inequalities in oral health outcomes, especially in communities where traditional beliefs and practices heavily influence health behaviors, such as in Nigeria. By combining traditional cultural values with evidence-based oral health care practices, it becomes possible to bridge the gap between modern dental care and local cultural beliefs. Future research are needed to generate evidence on how to sustainably address cultural barriers in African communities, through working within existing cultural frameworks to build trust and sustainably improve access to care.

 

To better highlight the possible practical applications.

Response: This paragraph tries to address the concern raised here: Addressing these factors through culturally competent interventions can reduce disparities and promote sustainable health improvements. In addition, by integrating traditional cultural values and practices with evidence-based oral health care practices, it is possible to bridge the gap between modern dental care and local cultural beliefs [61] and by fostering a more inclusive approach, communities may be more willing to adopt healthy behaviours while preserving cultural identity [62]. Addressing cultural barriers is not just about changing behaviours; it's about respecting and working within existing cultural frameworks to build trust and improve access to care sustainably [63,64]. Monitoring and ensuring intervention effectiveness are equally critical through regular assessments, community feedback mechanisms, and longitudinal studies can track progress, inform program adjustments, and strengthen the long-term impact of oral health initiatives.

 

• Although the study is conducted with studies from Nigeria, it is important to highlight how a study of this nature can be applied or used in other populations.

Response: Thanks for raising this. We have incorporated the need for this important point in the new section above. In addition, we wrote in the last concluding paragraph of the discussion that: These findings may be adaptable to other countries and regions with similar cultures to Nigeria.

 

Minor: Abstract: Eliminate: “Little is known about how culture affects oral health in Nigeria”.

Response: Done

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for submitting your manuscript titled "Scoping Review of Studies on Culture and Oral Health in Nigeria" for peer review. Your study addresses an important and often overlooked aspect of oral health by exploring the influence of cultural beliefs, practices, and traditions on oral health behaviors in Nigerian communities. This is a highly relevant topic with significant implications for public health strategies and culturally sensitive oral health interventions. While your manuscript presents valuable insights, several areas require further clarification and expansion to strengthen its scientific rigor and overall impact.

The introduction effectively outlines the study’s rationale and objectives. However, it would benefit from a more detailed explanation of how cultural factors influence oral health behaviors and outcomes globally, not just within Nigeria. Providing a broader context before narrowing the discussion to Nigeria would enhance the reader’s understanding of the study’s significance. Additionally, certain terms, such as "cultural competency" and "health literacy," should be defined more explicitly to ensure clarity for a diverse readership.

The methodology section is well-structured, but additional details are needed regarding the selection criteria for studies included in the review. It is not clear how studies were appraised for quality and relevance beyond their inclusion in specific databases. Were any standardized criteria or frameworks (such as PRISMA for systematic reviews) applied? Furthermore, specifying whether the search strategy was reviewed or validated by an information specialist would improve the methodological transparency of your review.

In the results section, while the thematic synthesis of cultural influences on oral health is insightful, it would be helpful to include a table summarizing key findings from the reviewed studies, including study design, population, main findings, and cultural determinants identified. This would facilitate a clearer comparison of findings across different studies and strengthen the evidence synthesis.

The discussion section is well-written but could be expanded to further elaborate on the implications of cultural beliefs in shaping oral health policies and intervention programs. Additionally, a paragraph discussing the potential limitations of the research would be beneficial. For example, since the review relies on studies conducted across different time periods, some of the cultural practices or beliefs discussed may have evolved. A discussion on how this factor may influence the interpretation of findings would be valuable.

It would also be beneficial to elaborate on the clinical implications of your findings. How can dental professionals use this information to improve oral health literacy among Nigerian communities? Providing specific recommendations for culturally adapted health promotion programs or community engagement strategies would enhance the study’s practical relevance.

 

 

Finally, we recommend that the authors expand the discussion of the study’s limitations, particularly in terms of potential biases arising from study selection and the inherent challenges of conducting a scoping review. Additionally, the conclusion should more explicitly summarize the key findings and provide clearer recommendations for future research directions.

Overall, your manuscript provides a valuable contribution to the understanding of the cultural determinants of oral health in Nigeria. By addressing these suggested revisions, the paper will offer an even more comprehensive and impactful resource for researchers and public health practitioners

Author Response

Thank you for submitting your manuscript titled "Scoping Review of Studies on Culture and Oral Health in Nigeria" for peer review. Your study addresses an important and often overlooked aspect of oral health by exploring the influence of cultural beliefs, practices, and traditions on oral health behaviors in Nigerian communities. This is a highly relevant topic with significant implications for public health strategies and culturally sensitive oral health interventions. While your manuscript presents valuable insights, several areas require further clarification and expansion to strengthen its scientific rigor and overall impact.

Response: Thanks for the constructive feedback. we have responded to the issues raised below. The feedback has helped strengthen the paper. We are grateful for the support.

 

The introduction effectively outlines the study’s rationale and objectives. However, it would benefit from a more detailed explanation of how cultural factors influence oral health behaviors and outcomes globally, not just within Nigeria. Providing a broader context before narrowing the discussion to Nigeria would enhance the reader’s understanding of the study’s significance. Additionally, certain terms, such as "cultural competency" and "health literacy," should be defined more explicitly to ensure clarity for a diverse readership.

Response: Line 63 to 74 addresses this very critical point raised. The term "cultural competency" was only used as a search term: it was not used throughout the manuscript. we have expounded on the reference to oral health literacy by writing: Low oral health literacy refers to an individual's limited ability to obtain, process, understand, and use basic oral health information and services to make appropriate decisions regarding their oral health [66]. This includes difficulties in comprehending dental care instructions, understanding the importance of preventive measures navigating the healthcare system to access dental services, and interpreting oral health-related materials, [67]. Low oral health literacy can lead to poor oral hygiene practices, delayed or inappropriate care-seeking behaviours, and a higher prevalence of oral diseases, as individuals may not fully grasp the significance of maintaining good oral health or the consequences of neglecting it [68, 69]. In the context of this study, low oral health literacy is particularly relevant in Nigerian communities where cultural beliefs, myths, and limited access to education may further exacerbate the challenges individuals face in understanding and managing their oral health effectively. Targeted education and services addressing these intersecting factors of culture and low oral health literacy, can promote equitable care. Recognizing individuals’ varying readiness to change, interventions should be tailored to behavioural stages, using storytelling for earlier stages and direct education for those ready to adopt healthier habits, per the Transtheoretical Model [70].

 

The methodology section is well-structured, but additional details are needed regarding the selection criteria for studies included in the review. It is not clear how studies were appraised for quality and relevance beyond their inclusion in specific databases. Were any standardized criteria or frameworks (such as PRISMA for systematic reviews) applied? Furthermore, specifying whether the search strategy was reviewed or validated by an information specialist would improve the methodological transparency of your review.

Response: Thanks for raising this. We wrote.  It was conducted in strict adherence to the Joanna Briggs Institute (JBI) guidelines for scoping reviews [17] and reported in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement [18]. It followed a five-stage framework, adapted to comprehensively explore the intersection of cultural factors and oral health in Nigerian communities. Each stage was conducted systematically to ensure rigor and transparency. To structure the review, we utilized the PCC (Population, Concept, Context) framework. The population focused on individuals in Africa. The concept centered on cultural norms, beliefs and practices can be barriers and facilitate oral health in Nigeria. The context was confined to studies conducted within in any of the 54 African countries recognized by the United Nations [19]. This approach ensured a comprehensive and systematic exploration of the literature, while maintaining clarity and relevance to the African context.

 

In the results section, while the thematic synthesis of cultural influences on oral health is insightful, it would be helpful to include a table summarizing key findings from the reviewed studies, including study design, population, main findings, and cultural determinants identified. This would facilitate a clearer comparison of findings across different studies and strengthen the evidence synthesis.

Response: Thanks for raising this. Table I highlights study design, population and Table II highlight study design, population main findings, and cultural determinants identified

 

The discussion section is well-written but could be expanded to further elaborate on the implications of cultural beliefs in shaping oral health policies and intervention programs. Additionally, a paragraph discussing the potential limitations of the research would be beneficial. For example, since the review relies on studies conducted across different time periods, some of the cultural practices or beliefs discussed may have evolved. A discussion on how this factor may influence the interpretation of findings would be valuable.

Response: Thanks a million for this suggestion. We wrote: Cultural themes are essential in the study of oral health care practices because they can inform policy formulation and the development of practice guidelines [71]. With global migration and regional cultural variations, dental professionals need evidence to be able to adapt to diverse cultural contexts to provide inclusive and equitable care. Cultural themes also the socioeconomic challenges faced by marginalized groups [72] like the Almajiri children in Nigeria. Addressing these factors through culturally competent interventions can reduce disparities and promote sustainable health improvements. In addition, by integrating traditional cultural values and practices with evidence-based oral health care practices, it is possible to bridge the gap between modern dental care and local cultural beliefs [73] and by fostering a more inclusive approach, communities may be more willing to adopt healthy behaviours while preserving cultural identity [74]. Addressing cultural barriers is not just about changing behaviours; it's about respecting and working within existing cultural frameworks to build trust and improve access to care sustainably [75,76]. Monitoring and ensuring intervention effectiveness are equally critical through regular assessments, community feedback mechanisms, and longitudinal studies can track progress, inform program adjustments, and strengthen the long-term impact of oral health initiatives

. ………….. Monitoring and ensuring intervention effectiveness are equally critical through regular assessments, community feedback mechanisms, and longitudinal studies can track progress, inform program adjustments, and strengthen the long-term impact of oral health initiatives

 

It would also be beneficial to elaborate on the clinical implications of your findings. How can dental professionals use this information to improve oral health literacy among Nigerian communities? Providing specific recommendations for culturally adapted health promotion programs or community engagement strategies would enhance the study’s practical relevance.

Response: Thanks a million for this suggestion. We wrote: In addition, by integrating traditional cultural values and practices with evidence-based oral health care practices, it is possible to bridge the gap between modern dental care and local cultural beliefs [61] and by fostering a more inclusive approach, communities may be more willing to adopt healthy behaviours while preserving cultural identity [62]. Addressing cultural barriers is not just about changing behaviours; it's about respecting and working within existing cultural frameworks to build trust and improve access to care sustainably [63,64].

 

 Finally, we recommend that the authors expand the discussion of the study’s limitations, particularly in terms of potential biases arising from study selection and the inherent challenges of conducting a scoping review.

Response:

 

Additionally, the conclusion should more explicitly summarize the key findings and provide clearer recommendations for future research directions.

Response: We rewrote the conclusion: In conclusion, addressing cultural barriers to oral health care access and uptake is a crucial step in reducing inequalities in oral health outcomes, especially in communities where traditional beliefs and practices heavily influence health behaviours, such as in Nigeria. By combining traditional cultural values with evidence-based oral health care practices, it becomes possible to bridge the gap between modern dental care and local cultural beliefs. Future research are needed to generate evidence on how to sustainably address cultural barriers in African communities, through working within existing cultural frameworks to build trust and sustainably improve access to care.

 

Overall, your manuscript provides a valuable contribution to the understanding of the cultural determinants of oral health in Nigeria. By addressing these suggested revisions, the paper will offer an even more comprehensive and impactful resource for researchers and public health practitioners

Response: Thanks once again for the constructive feedback

 

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Dear authors, thank you for taking on board the feedback to improve the manuscript. Consequently, the manuscript is now at a standard where publication can be considered. Minor editing of English language and text is required, which can be conducted during the proofing stage.

Comments on the Quality of English Language

Minor editing of English language and text is required, paying attention to the language, grammar, punctuation, spelling and sentence structures; this can be conducted during the proofing stage.

Reviewer 2 Report

Comments and Suggestions for Authors

The observations made previously have been addressed by the authors.