Programme planning and evaluation frameworks play a key role in guiding health planning by offering well-structured processes for planning, developing, implementing, monitoring and evaluating educational and clinical interventions (Gielen et al. 2022). Frameworks used in health programme planning provide structure, transparency, improve accuracy and strengthen stakeholder or community engagement (Fielding 2022). However, frameworks can become quite time-intensive, limit flexibility to emergent needs and require expertise (McMeekin et al. 2020). Despite these drawbacks, their benefits often outweigh their limitations, thereby making frameworks an essential mechanism in health programme planning (Fielding 2022).

There are essentially two key types of frameworks utilised in the health programme planning.

One common type is the logic model, which maps the sequence of inputs, activities, outputs, outcomes and long-term impacts of a health programme (Havsteen-Franklin, Cooper & Anas 2023).

Another widely utilised framework is the precede-proceed model, which has demonstrated its effectiveness in assisting health professionals in planning, designing and implementing health programmes (Ghaffari et al. 2021; Gielen et al. 2022).

The primary goal of the precede-proceed model is to ensure that all interventions are carefully planned for the benefit of the broader community, are evidence-based and can be effectively evaluated through their short- to medium-term and long-term goals (Crosby & Noar 2011).

The model looks to include the population of interest in developing the educational initiative by undertaking research to understand what their values, needs and interests are, then using this to structure a meaningful educational initiative that speaks to these issues (Ghaffari et al. 2021; Gielen et al. 2022). This model is aimed at ensuring that these educational initiatives are of value to the participants and their broader community (Gielen et al. 2022).

Despite the overall benefits of health programmes and planning frameworks, there remains a notable lack of evidence-informed frameworks to support learning interventions for diagnostic radiographers. Diagnostic radiography is a branch of radiography that fundamentally relates to diagnosing a patient’s condition through use of accurate and precise imaging techniques (Bushong 2021). This therefore requires diagnostic radiographers to possess core technical skills and competence that should be updated through lifelong learning (Makanjee, Zhang & Bergh 2023). Al Balushi, Watts and Akudjedu (2024) argued that although radiographers are motivated to engage in new learning, the structural mechanisms required to facilitate evidence-based learning, such as robust frameworks and institutional support, are either limited or underdeveloped. Similarly, Di Michele et al. (2024) called for more research into evidence-based practices to better guide and strengthen learning interventions within the diagnostic radiography profession.

This gap becomes even more evident within diagnostic radiography sub-areas, such as dental radiography, where programme planning frameworks are equally vital. High-quality dental imaging is dependent on the competence of the diagnostic radiographers and dental professionals, consisting of imaging techniques, patient positioning, appropriate selection of imaging techniques and accurate interpretation (Faculty of General Dental Practice [FGDP] (UK) & Public Health England 2020; International Atomic Energy Agency [IAEA] n.d.; Rai et al. 2018). Failure to apply these elements effectively can result in poor-quality images, which may compromise diagnosis, delay treatment and endanger patient safety (De-Azevedo-Vaz et al. 2013; Rai et al. 2018; Thakkar et al. 2019).

Despite these essential requirements, the available published literature suggests that there are gaps within training, exposure and ongoing professional development in dental radiography for diagnostic radiographers (Cheng et al. 2023; Ismail & Al Yafi 2024; Rai et al. 2018). This highlights the need for structured learning frameworks to support competence in the practice of dental radiography.

Furthermore, this misalignment between the expected competence and the availability of educational and training structures emphasises the limited use of structured evidence-based learning frameworks in dental radiography (Cheng et al. 2022, 2023; Rai et al. 2018). Therefore, enhancing such frameworks not only has the potential for supporting competence but also improving image quality, patient safety and overall diagnostic effectiveness (Faculty of General Dental Practice [FGDP] (UK) & Public Health England 2020; Siddique et al. 2024).

The purpose of this article is to illustrate how an adapted framework was used to systematically gather evidence to inform diagnostic radiography practice with specific reference to the provision for dental radiography services. This article forms part of a larger study that was conducted for degree purposes and is further explained next. This article, therefore, aimed to describe the framework used to guide the larger study, the underlying theoretical considerations and the methods used to show how the framework was operationalised. It is hoped that this evidence-based approach to review training and practice needs in diagnostic radiography can be replicated in other similar areas of health service provision.

Phase 1 of the larger study received a response rate of 57.8%. The online questionnaire items were centred around KAP. From the responses, 75.4% of participants agreed that they were aware of what dental radiography entails; 68.1% of participants reported not having adequate knowledge of the necessary dental radiography techniques; and 72.4% of participants did not know the key anatomical positioning landmarks in dental radiography. A total of 68.6% of participants disagreed that they were able to practise dental radiography techniques confidently and independently, while 87.5% of participants agreed that they were willing and keen to learn about dental radiography, and 89.9% of participants were open to gaining clinical experience in dental radiography (p < 0.001) (Govindasami & Singh 2025a).

Phase 2 reported key themes, which included the perceived understanding of the dental imaging scope of practice; under this theme, it was clear that dental radiography was part of the scope of practice and training for diagnostic radiographers. However, participants reported that there were inconsistencies in the depth of practice and variability across the training institutions. The second related theme was how limited exposure to undergraduate dental imaging training affects skills development. The limited availability of publicly accessible training documents creates an unclear picture of the extent to which dental imaging is incorporated into the undergraduate curriculum. Participants in this phase were in favour of more learning interventions (CPD) to be undertaken in this area (Govindasami & Singh 2025b).

Phase 3 reported that the post-programme assessment results (n = 54) showed that 96.3% of participants agreed that the CPD activity was useful and allowed them to learn something new. A total of 94.5% agreed that the CPD activity had met their expectations, and 92.5% agreed that the topic was relevant to their scope of practice. Additionally, 88.9% of participants agreed that the CPD activity assisted in improvement in their professional performance and competencies (p < 0.001) (Govindasami & Singh in press).

Phase 4 of the study synthesised findings from all phases to propose a framework to support and strengthen dental radiography training in SA. The framework development is further explained in the next section.

The framework was developed to support the practice of dental radiography for diagnostic radiographers in South Africa. It focuses on keeping the knowledge and skills of diagnostic radiographers in the field of dental radiography updated through the promotion of continuous professional development initiatives. Cheng et al. (2023, 2025) also expressed strong agreement that a continuing education course in dental radiology improved participants’ knowledge, practical skills and attitudes, while stimulating greater motivation for continued learning.

The framework demonstrated the value of IPC in developing such targeted CPD initiatives in dental imaging (Delawala, Heymans & Christmal 2023). It further highlighted the need for more concerted stakeholder engagement required to address challenges in learning and practical exposure in the field of dental imaging. The framework focused on systems such as individual, social, behavioural, resource allocation, organisational practices and training institutions, which influence how dental radiography is taught and learnt.

This concept is supported by systems theory, which reviews how various components of a system interact or influence the way in which an individual may perform or behave (Von Bertalanffy 1968).

Furthermore, the framework provides an in-depth picture (Miller pyramid) of findings on what diagnostic radiographers may (KNOW; KNOW HOW) – (SHOW) as depicted in the findings from Phase 1, as compared to what happens in actual practice (DOES) as demonstrated in the findings from Phase 2 regarding dental imaging (Millers 1990). Therefore, the framework can be used to reflect diagnostic radiographers’ current competencies, practice and training in the field of dental radiography. Ultimately, this could be used to inform, plan or design future learning interventions directed to support the practice and learning of diagnostic radiographers in the field of dental radiography.

This study considered social justice theory to better inform findings that were derived from Phases 1 and 2.

This study provided a needs assessment of the social determinants and epidemiological data which assisted the framework to be evidence-based and better support the practice of dental radiography for diagnostic radiographers. The concept of distributive justice was considered as if students’ knowledge and skills were enhanced or given the opportunity to be exposed to dental imaging techniques, which would improve their understanding and practical application. Authors Kumsa et al. (2022) and Ganjitsuda (2025) state that adequate clinical placements and exposure to specific radiographic modalities are essential for learning and acquiring key competencies in the knowledge, skill and professional attributes required for clinical radiography. Furthermore, this in turn would facilitate improved access to dental imaging for all population groups as besides increasing the skilled work force in this domain. Patients would be given equal access to safe and high-quality care from skilled professionals who operate dental equipment.

Additionally, improving basic intra-oral dental imaging skills for diagnostic radiographers facilitates shared use of dental imaging resources, which in turn will increase access for citizens requiring oral healthcare diagnostic services. Distributive justice is focused on providing all citizens with an equal portion of resources and benefits (Rawls 1971). The framework provided a deeper understanding of how creating or encouraging stakeholders’ collaborative practices in generating more dental imaging CPD targeted initiatives could have the potential to ensure lifelong development of safe and effective practice (Faculty of General Dental Practice [FGDP] (UK) & Public Health England 2020; Makanjee et al. 2023). Thereby ensuring that all citizens have fair and equal exposure to similarly skilled professionals. Shared learning, also known as interprofessional education (IPE) and IPC, creates an understanding of professional roles and responsibilities among multidisciplinary teams (Delawala et al. 2023).

The next subsection highlights the main strengths and further applications of the proposed framework.

The study offers a description of how a framework was applied through evidence-based research by first conducting a needs assessment, which then translated into practical outcomes that demonstrated immense potential for improving dental radiography training and practices for diagnostic radiographers. Overall, these efforts were grounded in the notion of equitable access to effective dental radiography services and, in turn, showed immense potential for improving access to dental radiography services for the diagnostic radiographer in oral health services in South Africa.