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Sheen A, Rubin MS, Edelstein BL. Innovative state oral health initiatives: A qualitative analysis of Centers for Medicare & Medicaid Services demonstrations. J Am Dent Assoc 2024:S0002-8177(24)00367-2. [PMID: 39140905 DOI: 10.1016/j.adaj.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 05/13/2024] [Accepted: 07/08/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND US health care delivery and financing arrangements are changing rapidly as payers and providers seek greater efficiency, effectiveness, and safety. The Centers for Medicare & Medicaid Services uses grants and technical assistance to drive such development through innovative demonstration programs, including for oral health care. The authors reviewed these dental demonstrations to identify common themes and identify barriers to and facilitators of implementation. METHODS The authors compared 12 identified demonstrations across 6 domains: grant and technical assistance, stakeholders, inner care settings, outer contextual settings, interventions, and outcomes. They developed program summaries for each demonstration and interviewed key informants using a semistructured guide to review, correct, clarify, and expand on program summaries. RESULTS Common across all programs were engagement of nontraditional providers, care in nontraditional settings, payment as a critical externality for program adoption, interventions that integrate medical and oral health care, use of alternative payment models, and tracking process measures. Adoption facilitators included an engaged oral health champion and obtaining mission support and alignment among stakeholders. Common barriers included unanticipated organizational disruptions, poor information technology infrastructure, cultural resistance to nontraditional care models, and lack of providers in high-need areas. CONCLUSIONS Descriptive findings suggest that oral health care may evolve as a more accountable, integrated, and accessible health service with an expanded workforce; collaboration between providers and payers will remain key to creating innovative, sustainable models of oral health care. PRACTICAL IMPLICATIONS The Centers for Medicare & Medicaid Services' efforts to advance health equity, expand coverage, and improve health outcomes will continue to drive similar initiatives in oral health care.
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Lumsden C, Edelstein B, Leu C, Zhang J, Levine J, Andrews H. Behavioral Outcomes of a Pragmatic Early Childhood Caries Management Trial. JDR Clin Trans Res 2024; 9:140-149. [PMID: 37553996 PMCID: PMC11289954 DOI: 10.1177/23800844231189483] [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] [Indexed: 08/10/2023] Open
Abstract
OBJECTIVES To evaluate a preventative behavioral intervention for managing early childhood caries (ECC) in a cohort of high-risk children. METHODS This pragmatic trial of the MySmileBuddy Program (MSB) evaluated preventive behavioral outcomes in a 1-y community health worker-delivered intervention to prevent ECC progression. Pre-/postintervention surveys assessed parent-reported child engagement in therapeutic toothbrushing (i.e., adult-assisted brushing with fluoridated toothpaste twice daily) and caries-related dietary behaviors and barriers. Generalized linear model with identity link for continuous variables and logit link for dichotomous outcomes evaluated pre-/postintervention comparisons and generalized estimating equations accounted for within-participant correlation (α = 0.05). RESULTS Among 1,130 children with postintervention data, the average age was 3.97 y, 99% were Medicaid insured, and 88% were Hispanic. Most parents (95%) were mothers/grandmothers, married or in a committed partnership (75%), unemployed (62%), and with modest education (80% high school degree or less). The odds of reported therapeutic brushing nearly doubled (n = 864; odds ratio [OR] = 1.79, 95% confidence interval [CI] = 1.46, 2.20, P < 0.001); day and night bottle/sippy cup frequencies dropped 0.29 units (n = 871; 95% CI = -0.37, -0.33, P < 0.001) and 0.22 units (n = 1,130; 95% CI = -0.30, -0.15, P < 0.001); nighttime breastfeeding reduced 0.15 units (n = 870; 95% CI = -0.21, -0.10, P < 0.001); sharing utensils reduced 0.30 units (n = 572; 95% CI = -0.39, -0.21, P < 0.001); not using sugary foods to calm child improved 0.37 units (n = 664; 95% CI = 0.31, 0.44, P < 0.001); odds of eating meals and snacks at a table increased (n = 572; OR = 1.57, 95% CI = 1.28, 1.93, P < 0.001; n = 572; OR = 1.80, 95% CI = 1.50, 2.15, P < 0.001) respectively; and reducing barriers to behaviors improved 0.38 units for toothbrushing (n = 666; 95% CI = 0.31, 0.44, P < 0.001) and 0.33 units for diet (n = 668; 95% CI = 0.29, 0.38, P < 0.001). CONCLUSION Despite limitations inherent to pragmatic trials, significant behavioral changes suggest that MSB yielded an important salutary impact. Forthcoming mediation analyses will explore causal pathways. Findings support integration of MSB's behavior change program in caries management initiatives. KNOWLEDGE TRANSFER STATEMENT The results of this study can be used by clinicians, public health leaders, and researchers to inform the development and implementation of community-based, preventative behaviorally focused early childhood caries prevention programs. Study findings may enhance the understanding of the impact of behavioral interventions that engage parents of young children and could lead to more effective prevention for populations at high-risk of caries.
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Affiliation(s)
- C.L. Lumsden
- Columbia University Irving Medical Center, Columbia University College of Dental Medicine, Section of Oral, Diagnostic, and Rehabilitation Sciences, New York, NY, USA
| | - B.L. Edelstein
- Columbia University Irving Medical Center, Columbia University College of Dental Medicine, and Mailman School of Public Health, Department of Health Policy and Management, New York, NY, USA
| | - C.S. Leu
- Teachers College Columbia University, Department of Human Development, New York, NY, USA
| | - J. Zhang
- Teachers College Columbia University, Department of Human Development, New York, NY, USA
| | - J. Levine
- Columbia University College of Dental Medicine, Section of Oral, Diagnostic, and Rehabilitation Sciences, New York, NY, USA
| | - H. Andrews
- Columbia Data Coordinating Center, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
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Joubert A, Reid M. Knowledge, skills, and training of community health workers to contribute to interprofessional education: a scoping review. J Interprof Care 2024; 38:308-318. [PMID: 36821383 DOI: 10.1080/13561820.2023.2176472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 10/12/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023]
Abstract
A scoping review of 32 publications was conducted with the aim of mapping literature to determine what is known about the knowledge, skills, and training of community health workers that could contribute to interprofessional education. Interprofessional education, as a pedagogical approach, prepares health professions students to serve patients in collaboration with other health professionals to improve patient outcomes. All over the world, the role of community health workers is vital for its support of community service and community health outcomes. However, no evidence could be found on the knowledge, skills, and training of community health workers that contribute to interprofessional education. The knowledge that community health workers need to contribute to interprofessional education, as reported by the literature, relates to case management, communication, health education, recordkeeping and referrals. Skills, such as critical thinking, interprofessional collaboration, and various clinical procedures, were noted. Training approaches reported included the use of technology such as mobile phones and web-based learning. The scoping review improved our understanding of the knowledge, skills, and training of community health workers that could contribute to interprofessional education. Applying a fit-for-purpose approach, and building on existing knowledge, skills, and training, could fast-track the contribution of community health workers to interprofessional education.
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Affiliation(s)
- Annemarie Joubert
- School of Nursing, University of the Free State, Bloemfontein, South Africa
| | - Marianne Reid
- School of Nursing, University of the Free State, Bloemfontein, South Africa
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Joubert A. Knowledge, skills, and training community health workers require to contribute to an interprofessional learning initiative. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2023. [DOI: 10.1016/j.ijans.2023.100531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Dlamini SB, Hlongwana KW, Ginindza TG. Lung cancer awareness training experiences of community health workers in KwaZulu-Natal, South Africa. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 36546485 PMCID: PMC9772754 DOI: 10.4102/phcfm.v14i1.3414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 07/21/2022] [Accepted: 09/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lung cancer is the leading cause of cancer mortality worldwide. Awareness interventions in the developing world remain scarce. Community health workers (CHWs) are a critical component towards ensuring efficient delivery of healthcare services in low- and middle-income countries. AIM This study explored the experiences of CHWs of their training as lung cancer awareness intervention implementers. SETTING The study was conducted in a resource-poor setting, with CHWs from previously disadvantaged communities. METHODS On the last day of training, 10 CHWs were requested to voluntarily participate in a focus group discussion regarding their experiences of the training, utilising a discussion guide. RESULTS The participants expressed positive experiences with the training. They cited the amenable and conducive learning environment established by the facilitator. The participants felt empowered through the newly acquired knowledge and wanted to help their communities. However, some participants expressed a desire to have other forms of learning incorporated in future training. The participants were also cognisant of existing gaps in their own knowledge that could be elaborated upon in preparation for potential questions by the community. Some participants confirmed their role as agents of change. CONCLUSION The authors propose large-scale intervention studies of lung cancer awareness utilising the CHW programme to gather conclusive evidence regarding their effectiveness at a community level.Contribution: This article provides insight into the training of community health workers on lung cancer awareness and future research on the integration of the intervention into already existing programmes.
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Affiliation(s)
- Siyabonga B. Dlamini
- Discipline of Public Health Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,Cancer & Infectious Diseases Epidemiology Research Unit, College of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Khumbulani W. Hlongwana
- Discipline of Public Health Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,Cancer & Infectious Diseases Epidemiology Research Unit, College of Health Science, University of KwaZulu-Natal, Durban, South Africa
| | - Themba G. Ginindza
- Discipline of Public Health Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,Cancer & Infectious Diseases Epidemiology Research Unit, College of Health Science, University of KwaZulu-Natal, Durban, South Africa
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Lumsden CL, Edelstein BL, Basch CE, Wolf RL, Koch PA, McKeague I, Leu CS, Andrews H. Protocol for a family-centered behavioral intervention to reduce early childhood caries: the MySmileBuddy program efficacy trial. BMC Oral Health 2021; 21:246. [PMID: 33962602 PMCID: PMC8103669 DOI: 10.1186/s12903-021-01582-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although largely preventable through diet management and topical fluoride use, early childhood caries (ECC) often progresses to severity that necessitates surgical repair. Yet repair often fails to mitigate caries progression. Needed is an effective behavioral intervention to address underlying behavioral causes. METHODS This randomized controlled trial will evaluate the efficacy of a behaviorally focused, family-centered intervention, the MySmileBuddy Program (MSB Program), to reduce ECC progression in high-risk preschoolers in New York City. Recruitment will target 858 children ages 24-71 months with ECC and their parents from primary care medical and dental clinics. The study aims to assess the MSB Program's efficacy to: (1) decrease ECC progression measured 12-months post-randomization; and (2) enhance adoption of a low cariogenic diet and twice-daily fluoridated toothpaste use compared to control group. Potential causal pathways (mediators and moderators) will be explored. The MSB Program equips community health workers (CHWs) with an app that facilitates multilevel risk assessment and provides motivational interviewing-based counseling to inform parents about the caries process, develop personalized goals, and create family-level action plans to achieve targeted behaviors. Social support from CHWs (4 interactions during the 6-month intervention, supplemented by up to 4 in-person/remote contacts throughout the 12-month study period, based on need) is bolstered by automated text messages. Participants will be randomized to a Control Group (paper-based educational handout plus toothbrushes and fluoridated toothpaste for the child) or Intervention Group (MSB Program, two tooth-brushing observations with feedback and instruction, and toothbrushes and toothpaste for the entire family). All children will receive visual ICDAS dental examinations and parents will complete study measures at baseline and 12-months. An incentive up to $150 plus round-trip transit cards ($5.50 value) will be provided. DISCUSSION This study hypothesizes that the MSB Program can reduce ECC progression in a high-risk population. Sufficient incentives and a focus on establishing rapport between participants and CHWs are anticipated to mitigate recruitment and retention challenges. If successful, this study will advance the long-term goal of reducing pediatric oral health disparities by demonstrating the efficacy of an acceptable and feasible intervention that shifts attention from dental repair to behavioral risk mitigation. TRIAL REGISTRATION Trial registration was completed on 4/13/2021 through the U.S. National Library of Medicine ClinicalTrials.gov website (Identifier: NCT04845594).
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Affiliation(s)
- Christie L. Lumsden
- Columbia University College of Dental Medicine, Section of Oral, Diagnostic, and Rehabilitation Sciences, 622 West 168th Street, PH7-322, New York, NY 10032 USA
| | - Burton L. Edelstein
- Dental Medicine and Health Policy & Management at Columbia University Irving Medical Center, Columbia University College of Dental Medicine, 622 West 168th Street, PH7-322, New York, NY 10032 USA
| | - Charles E. Basch
- Department of Health and Behavior Studies, Teachers College Columbia University, 525 West 120th Street, Box 137, New York, NY 10027 USA
| | - Randi L. Wolf
- Department of Health and Behavior Studies, Teachers College Columbia University, 525 West 120th Street, Box 137, New York, NY 10027 USA
| | - Pamela A. Koch
- Department of Health and Behavior Studies, Teachers College Columbia University, 525 West 120th Street, Box 137, New York, NY 10027 USA
| | - Ian McKeague
- Mailman School of Public Health, Department of Biostatistics, Columbia University Irving Medical Center, 722 West 168th Street, 6th Fl, Rm 639, New York, NY 10032 USA
| | - Cheng-Shiun Leu
- Mailman School of Public Health, Department of Biostatistics, Columbia University Irving Medical Center, 722 West 168th Street, 6th Fl, Rm 639, New York, NY 10032 USA
| | - Howard Andrews
- Mailman School of Public Health, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 47, New York, NY 10032 USA
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Seo K, Kim HN. Effects of oral health programmes on xerostomia in community-dwelling elderly: A systematic review and meta-analysis. Int J Dent Hyg 2019; 18:52-61. [PMID: 31394021 DOI: 10.1111/idh.12418] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/22/2019] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES While common in the elderly, dry mouth can negatively affect their oral health and nutritional status. Self-administered oral care by the elderly can improve their oral health and prevent oral diseases. This study aimed to identify the content of oral health promotion programmes for community-dwelling elderly and to determine which programmes are effective in improving oral health decreasing xerostomia in these populations. METHODS A systematic literature search and meta-analysis was conducted using the PRISMA guidelines. All available papers published in English or Korean were searched between 1 June and 13 June 2018. The relevant databases in PubMed Central, MEDLINE, CINAHL, the Cochrane Library and Embase, as well as open dissertation and academic searches, were performed. Data were extracted from the selected studies based on PICOS, and the health outcomes of the elderly were subjected to meta-analysis categorized by salivary secretion rates and oral health-related quality of life (OHQoL). RESULTS A total of nine studies had sufficient data for a systematic review and meta-analysis. The intervention programmes consisted mainly of oral health promotion programmes, mouth exercises, toothbrushing and salivary massage. The meta-analysis indicated that elderly participating in oral health programmes had significantly increased oral salivary secretion rates and OHQoL (effect sizes of 0.63 and 0.80, respectively). CONCLUSIONS Oral health promotion programmes in the elderly provide the positive effects of relieving dry mouth and improving OHQoL. This systematic review confirmed the contents and effects of the oral health promotion programmes provided to community-dwelling elderly.
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Affiliation(s)
- Kyoungsan Seo
- Department of Nursing, College of Health and Medical Sciences, Cheongju University, Cheongju, Korea
| | - Han-Na Kim
- Department of Dental Hygiene, College of Health and Medical Sciences, Cheongju University, Cheongju, Korea
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