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Koh M, Kerr D, Hill CM, Chi DL. A Mixed-Methods Study on Topical Fluoride Beliefs and Refusal Behaviors for Caregivers of Children with Special Health Care Needs. Matern Child Health J 2024; 28:104-115. [PMID: 37966559 PMCID: PMC10876822 DOI: 10.1007/s10995-023-03806-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To understand topical fluoride-related beliefs and refusal behaviors for caregivers of children with special health care needs (CSHCN). METHODS This was an explanatory sequential mixed methods study. For the quantitative analyses, we surveyed 520 caregivers to (a) compare fluoride-related beliefs between caregivers of CSHCN and caregivers of healthy children and (b) evaluate the association between special health care need (SHCN) status and topical fluoride refusal. We used logistic regression models to generate unadjusted odds ratios, confounder-adjusted odds ratios (AOR), and 95% confidence intervals (CI). For the qualitative analyses, we interviewed 56 caregivers who refused or were hesitant about topical fluoride. Data were coded deductively and compared by SHCN status to an existing conceptual model of topical fluoride refusal. RESULTS In the quantitative analysis, 41.3% of caregivers refused or thought about refusing topical fluoride. There were no significant differences in fluoride beliefs by SHCN status (p-values > 0.05) nor was there a significant association between SHCN status and topical fluoride refusal (AOR: 0.65, 95% CI 0.37-1.14; p = 0.13). In the qualitative analysis, the relative importance of each domain of the conceptual model was similar between the caregiver groups. Two differences were that all caregivers of CSHCN thought fluoride was unnecessary and wanted to keep chemicals out of their child's body. CONCLUSIONS FOR PRACTICE While caregivers of CSHCN were not more likely to refuse topical fluoride than caregivers of healthy children, there may be important differences in the underlying reasons for refusing topical fluoride.
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Affiliation(s)
- Madelyn Koh
- Department of Oral Health Sciences, School of Dentistry, University of Washington, B530D, Box 357475, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Darragh Kerr
- Department of Oral Health Sciences, School of Dentistry, University of Washington, B530D, Box 357475, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Courtney M Hill
- Department of Oral Health Sciences, School of Dentistry, University of Washington, B530D, Box 357475, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Donald L Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, B530D, Box 357475, 1959 NE Pacific St., Seattle, WA, 98195, USA.
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Ko A, Chi DL. Fluoride hesitancy: A mixed methods study on decision-making about forms of fluoride. Community Dent Oral Epidemiol 2023; 51:997-1008. [PMID: 36219463 DOI: 10.1111/cdoe.12800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 09/19/2023]
Abstract
OBJECTIVES To investigate whether professionally applied topical fluoride-hesitant caregivers are also hesitant about other forms of fluoride for their child. METHODS This was a mixed methods study of 56 caregivers hesitant about professionally applied topical fluoride for their child recruited from the University of Washington Center for Paediatric Dentistry and Seattle Children's Hospital's Odessa Brown Children's Dental Clinic. A 32-item semi-structured interview script was piloted and finalized. One-time interviews with caregivers were conducted by phone in 2019. Associations between hesitancy of topical fluoride, fluoridated water and toothpaste were assessed quantitatively via two-tailed chi-squared tests. Qualitative data were coded using an inductive approach and content analytic methods to investigate reasons for hesitancy. RESULTS There were significant associations between hesitancy in all three pairwise comparisons of fluoride form (p < .01). Similar proportions of caregivers strongly or somewhat opposed fluoridated water compared with toothpaste (75% and 65%, respectively), but four times as many caregivers strongly or somewhat favoured fluoridated toothpaste compared to water for their child (25% and 7%, respectively). Concerns about harm were the most common reason caregivers opposed both fluoridated water and toothpaste. However, fluoride-hesitant caregivers reported being more comfortable with fluoridated toothpaste because amount and frequency can be controlled, and ingestion can be prevented. CONCLUSIONS Professionally applied topical fluoride hesitancy is significantly associated with fluoridated water and toothpaste hesitancy, but caregivers who were hesitant about topical fluoride was more comfortable with fluoridated toothpaste than fluoridated water for their child.
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Affiliation(s)
- Alice Ko
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Donald L Chi
- Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, Washington, USA
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Edwards TC, Carle A, Kerr D, Carpiano RM, Nguyen DP, Orack JC, Chi DL. Topical fluoride hesitancy among caregivers: Development of a content-valid topical fluoride hesitancy identification item pool. J Public Health Dent 2023; 83:116-122. [PMID: 36719013 PMCID: PMC10501325 DOI: 10.1111/jphd.12558] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/17/2022] [Accepted: 01/03/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To develop a content-valid set of items to characterize different types of topical fluoride hesitancy among caregivers. We will use this information to develop and test tailor-made interventions directed to caregivers with varied types and levels of topical fluoride hesitancy, to ultimately improve child oral health. METHODS Caregivers participated in three study activities, in the following order: (1) semi-structured concept elicitation interviews (n = 56), (2) cognitive interviews (n = 9), and (3) usability interviews (n = 3). Interviews were conducted via telephone and audio-recorded and transcribed for qualitative analysis. Twelve pediatric dental providers and researchers participated in item review. An assessment of reading level of items was made with goal of 6th grade reading level or less. RESULTS Based on elicitation interviews, we initially developed 271 items, which the investigative team evaluated for conceptual clarity, specificity to topical fluoride hesitancy, and sensitivity to potential interventions. After four rounds of review and cognitive interviews, we retained 33 items across five previously identified domains. Changes after cognitive interviews included item revision to improve comprehension and item re-ordering to avoid order effects. Changes after usability testing including clarification regarding referent child for families with multiple children. The reading level of the item pool is grade 3.2. CONCLUSIONS The resulting 33-item fluoride hesitancy item pool is content valid and will address an important need for identifying and addressing topical fluoride hesitancy in the context of dental research and clinical practice. Next steps include psychometric evaluation to assess scale and test-retest reliability and construct validity.
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Affiliation(s)
- Todd C Edwards
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Adam Carle
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Darragh Kerr
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Richard M Carpiano
- School of Public Policy, University of California, Riverside, Riverside, California, USA
| | - Daisy Patiño Nguyen
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Joshua C Orack
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
| | - Donald L Chi
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, USA
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Saini SJ, Carle AC, Forsyth AR, Chi DL. Association between caregiver opposition to topical fluoride and COVID-19 vaccines. Vaccine 2023; 41:1035-1041. [PMID: 36567141 PMCID: PMC9747692 DOI: 10.1016/j.vaccine.2022.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Caregivers who oppose topical fluoride in dental settings may be opposed to other preventive health treatments, including COVID-19 vaccines. The study objective was to examine the association between caregiver opposition to topical fluoride and COVID-19 vaccines. METHODS The study took place at the University of Washington in Seattle, WA. English-speaking caregivers of children aged < 18 years were eligible to participate. An 85-item REDCap survey was administered from February to September 2021. The predictor variable was topical fluoride opposition (no/yes). The outcome was COVID-19 vaccine opposition (no/yes). The models included the following covariates: child and caregiver age; caregiver race and ethnicity, education level, dental insurance type, parenting style, political ideology, and religiosity; and household income. Logistic regression models generated odds ratios (OR) and 95 % confidence intervals (α = 0.05). RESULTS Six-hundred-fifty-one caregivers participated, and 403 caregivers with complete data were included in the final regression model. Mean child age was 8.5 years (SD 4.2), mean caregiver age was 42.1 years (SD 9.1), 53.0 % of caregivers were female, 57.3 % self-reported as white, and 65.5 % were insured by Medicaid. There was a significant positive association between topical fluoride and COVID-19 vaccine opposition (OR = 3.13; 95 % CI: 1.87, 5.25; p < 0.001). Other factors associated with COVID-19 vaccine opposition included conservative political views (OR = 2.77; 95 % CI: 1.26, 6.08; p < 0.011) and lower education (OR = 3.47; 95 % CI: 1.44, 8.38; p < 0.006). CONCLUSIONS Caregivers opposed to topical fluoride in dental settings were significantly more likely to oppose COVID-19 vaccines for their child. Future research should identify ways to address both topical fluoride and vaccine opposition to prevent diseases in children.
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Affiliation(s)
- Sapna J Saini
- Department of Pediatric Dentistry, University of Washington School of Dentistry, 6222 NE 74th St #8158, Seattle, WA 98115, USA.
| | - Adam C Carle
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 7014, Cincinnati, OH 45229-3039, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, USA; Department of Psychology, University of Cincinnati College of Arts and Sciences, 1 Edwards Center, Cincinnati, OH 45221, USA.
| | - Anna R Forsyth
- Department of Pediatric Dentistry, University of Washington School of Dentistry, 6222 NE 74th St #8158, Seattle, WA 98115, USA.
| | - Donald L Chi
- Department of Pediatric Dentistry, University of Washington School of Dentistry, 6222 NE 74th St #8158, Seattle, WA 98115, USA; Department of Oral Health Sciences, University of Washington, 1959 NE Pacific Street, Box 357475, Seattle, WA 98195, USA; Department of Health Systems and Population Health, University of Washington, 1959 NE Pacific St., Box 357660, Seattle, WA, 98195, USA.
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Is It Mum or the Dad? Parental Factors That Influence the Use and Acceptance of Fluoride Varnish among Parents in Eastern Saudi Arabia. Int J Dent 2022; 2022:9109967. [PMID: 36561064 PMCID: PMC9767731 DOI: 10.1155/2022/9109967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/26/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To investigate parental factors that influence knowledge, use, and acceptance of fluoride varnish (FLV) application. Methods This cross-sectional study was conducted during December 2021. A multistage sampling technique was used to recruit parents with children aged 3 to 6 years and residing in Eastern Saudi Arabia, excluding those working in the dental field. The questionnaire consisted of four parts: demographics, knowledge, previous experience, and acceptance of FLV and was pilot-tested and distributed online using social media. Results A total of 623 parents responded to the survey. Only 36.9% of parents had good FLV knowledge with dentists being the main source of information. Gender, educational level, family income, being in the medical field, and source of knowledge were factors that significantly (P < 0.05) influenced parental knowledge. Only 24.6% of the parents applied fluoride varnish to their children before, of whom only 29% were satisfied with the experience. Parent's FLV knowledge, view of dental visits, satisfaction with previous experience, perception of children's oral health, and willingness to reapply FLV were factors that significantly (P < 0.05) influenced FLV use. Working in the medical field, perception of dental visits, and the source of knowledge were factors that significantly (P < 0.05) influenced the parent's acceptance to apply FLV. While lack of knowledge about fluoride benefits (15%) was the main reason for parental refusal to apply FLV. Conclusions The current study highlights the lack of knowledge and application of FLV among parents. There were more factors influencing mothers' acceptance of FLV application compared to fathers. Age, educational level, working in the medical field, perception, and patterns of dental visits were some of the identified factors. Dentists played a major role in parental knowledge and FLV acceptance. In a country with high caries prevalence, preventive programs such as FLV education and application are crucial.
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Unvaccinated children as community parasites in National Qualitative Study from Turkey. BMC Public Health 2020; 20:1087. [PMID: 32652961 PMCID: PMC7353754 DOI: 10.1186/s12889-020-09184-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 06/30/2020] [Indexed: 12/31/2022] Open
Abstract
Background This national qualitative study explores (1) the experiences, observations, and opinions of health care workers (HCWs) about beliefs, socioeconomic, cultural, and environmental characteristics of parents refusing vaccination and (2) regional differences in the identified risk factors; (3) recommended solutions to improve vaccine acceptance in each of 12 regions in Turkey. Methods In total, we carried out 14 individual semi-structured in-depth interviews and 10 focus group discussions with 163 HCWs from 36 provinces. A thematic analysis was performed to explore HCWs’ observations about the parents’ decisions to reject vaccination and possible solutions for vaccine advocacy. Results Within the analyzed data framework, vaccine refusal statements could be defined as vaccine safety, the necessity of vaccines, assumptions of freedom of choice, health workers’ vaccine hesitancy, lack of information about national vaccination schedule and components, not trusting the health system, anti-vaccine publications in social media and newspapers, and refugees. Suggestions based on the HCWs suggestions can be summarized as interventions including (1) creating visual cards with scientific data on vaccine content and disease prevention and using them in counseling patients, (2) writing the vaccine components in a way understandable to ordinary people, (3) highlighting the national quality control and production in the vaccine box and labels, (4) conducting interviews with community opinion leaders, (5) training anti-vaccine HCWs with insufficient scientific knowledge and (6) reducing the tax of parents whose children are fully and punctually vaccinated. Conclusions The solution to vaccine rejection begins with the right approaches to vaccination during pregnancy. Prepared written and visual information notes should present the information as “vaccination acceptance” rather than “vaccination refusal”. Further studies on vaccine refusal rates should be carried out in various regions of the world so that region-specific actions are implemented to decrease the anti-vaxxer movement and to prevent an outbreak of infectious diseases.
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Basch CH, Milano N, Hillyer GC. An assessment of fluoride related posts on Instagram. Health Promot Perspect 2019; 9:85-88. [PMID: 30788272 PMCID: PMC6377697 DOI: 10.15171/hpp.2019.11] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/19/2018] [Indexed: 11/09/2022] Open
Abstract
Background: Social media is a driving force in the sharing of information. The purpose of this study is to describe fluoride related content on Instagram, a popular social media platform. Methods: Content categories were created and coded to better describe the nature of the posts.Data collection occurred in three sessions, two months apart. Only relevant posts that included images and had text written in the English language were included. Results: The most common topics were conspiracy theory, contained in 37.3% of posts, followed by dangers of fluoride to health (30.3%) and benefits of fluoride to teeth (28.7%). Of the posts reviewed, 96/300 (32.0%) contained pro-fluoride content while 139/300 (63.0%) posts featured anti-fluoride content. Content varied significantly between pro- and anti-fluoride posts. Conclusion: Our review of Instagram posts revealed that there were approximately 300 posts focused on fluoride related content. Of these posts, there was a higher number of anti-fluoride related content compared to pro-fluoride related content. With accessibility comes the potential for misinformation. Future efforts from medical providers need to focus on educating consumers about reliable sources for health information on the internet.
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Affiliation(s)
- Corey H Basch
- Department of Public Health, William Paterson University, Wayne, NJ 07470, USA
| | - Nicole Milano
- School of Social Work, Rutgers University, New Brunswick, NJ 08901, USA
| | - Grace C Hillyer
- Department of Epidemiology, Mailman School of Public Health, Columbia University NY, NY 10032, USA
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