Using community participation to assess acceptability of "Contra Caries", a theory-based, promotora-led oral health education program for rural Latino parents: a mixed methods study

Validating a Conceptual Model on Topical Fluoride Hesitancy With Latino Parents

Fluoride hesitancy is a growing public health challenge and interventions to address it may need to be tailored for minoritized subgroups to address oral health inequities. The goals of this qualitative study were to investigate the extent to which an existing conceptual model on topical fluoride hesitancy is applicable to Latino parents and whether applicability differed between Spanish-speaking Latino (SL) and English-speaking Latino (EL) parents. We conducted semi-structured one-on-one interviews with non-Latino English-speaking parents (N = 50), SL parents (n = 8), and EL parents (n = 8). We coded the transcripts deductively and compared our findings both qualitatively and quantitatively to an existing model on topical fluoride hesitancy comprising 21 categories classified into six domains. We compared frequencies across model domains and categories for Latino versus non-Latino parents as well as for SL versus EL parents. Latino parents were represented across all six domains and 21 categories of the conceptual model. Comparing Latino and non-Latino parents, representation was similar across Domains 1 to 3 (necessity, chemicals, and harm); Latino parents were more highly represented in Domains 4 to 6 (uncertainty, pressure, and choice) compared with non-Latino parents. A larger proportion of EL parents thought a healthy diet was more important than fluoride (Category 1d) and a larger proportion of SL parents felt they did not know enough about fluoride (Category 4a). An existing conceptual model on topical fluoride hesitancy was generally a good fit for SL and EL parents. However, differential representation across model categories suggests that fluoride-related communication and intervention approaches may need to be tailored to Latino parents based on language preference.

Study protocol for a pilot quasi-experimental study on oral health education for nurses and community health workers in Nigeria

Introduction

The primary health care system provides an ideal setting for the integration of oral health into general health care as well as equitable access to oral health care. However, the limited oral health knowledge of primary health care workers necessitates appropriate training before they can participate in health promotion efforts. This pilot training was designed to examine the impact of the Oral Health Education module for Nurses and Community Health Care Workers on their oral health awareness and referral practices.

Methods

This study will utilize a quasi-experimental design (pre-and post with a non-equivalent control group) to assess the impact of a five-day pilot oral health education program on the knowledge and referral practices of Nurses and Community Health Workers in primary health care centers in three states in Nigeria-(Lagos, Oyo, and Kano). The training modules were developed based on the six iterative steps described in the intervention mapping framework - needs assessment, highlighting program objectives and outcomes, selection of theory and mode of intervention, designing program based on theory, designing implementation plans, and developing an evaluation plan. Only the intervention group will participate in the full educational training sessions but both groups will complete the pre-and post-intervention questionnaires.

Discussion

This pilot training combined the standardized training modules from the recently launched "Oral Health Training Course for Community Health Workers in Africa" and a newly developed maternal and child oral health module by our group using an evidence-based approach. To the best of our knowledge, this is the first program to examine the impact of the standardized OpenWHO modules. The success of this training will lay the foundation for developing a sustained channel for providing oral health education at the primary health care level in Nigeria, West Africa, and Africa.

Pediatric Oral Health Online Education for Rural and Migrant Head Start Programs in the United States

Children living in rural and migrant areas in the United States disproportionately suffer from poor oral health. Additionally, there continues to be a shortage of pediatric dentists practicing in rural/migrant areas. The purpose of this formative research study was to assess whether staff, teachers and families from rural/migrant Head Start/Early Head Start (HS/EHS) programs in California were receptive to oral health online education workshops conducted by pediatric dental residents who were assisted by bilingual (English and Spanish) community oral health workers (COHWs). Our findings suggest that partnering pediatric dental residents with bilingual COHWs to educate HS/EHS teachers, staff and parents on oral health care in rural/migrant areas could result in a rewarding experience for pediatric dentists that might lead them to practice in these communities upon graduation from their residency program. Furthermore, the positive feedback received from the teachers, staff and parents who participated in the workshops indicates they were receptive to receiving oral health information related to oral health literacy from the dental providers and COHWs. COHWs can help increase access to oral health care by serving as a bridge between families and providers by relaying information in a cultural, linguistic and sensitive manner.

An ethnographic study of a community dentistry network serving Latine migrant farmworkers in Vermont: Barriers and access to care during the COVID-19 pandemic and beyond

BACKGROUND AND OBJECTIVES

Primary dental healthcare services are not accessible for a majority of Latino/a/e migrant farmworkers in the United States. Unmet dental health needs are well documented in larger states like California, Florida and New York, but the dental healthcare picture in smaller states is not well understood. The goal of this qualitative ethnographic study was to understand the delivery model of a free dentistry network serving Latine farmworkers in rural Vermont and specific barriers experienced at the network during the COVID-19 pandemic.

METHODS

Semi-structured ethnographic interviews were carried out with clinicians and transcripts were analysed using the constant comparison method to identify salient concerns and recommendations about barriers and delivery of care.

RESULTS

Clinicians highlighted structural issues including farmworkers' lack of time off work and absence of transportation to attend appointments, concerns about COVID-19 safety, concerns about immigration surveillance and language barriers. Providers outlined steps for improved service delivery including mobile care at local farms, enhanced intercultural training for providers, recognizing dentistry as essential healthcare at the state level and the leverage of existing appointments for preventive health. Drawing on anthropological frameworks of place-based care and deservingness of healthcare, our ethnographic findings emphasize the role of community dentistry in bridging gaps in migrant healthcare during and beyond the COVID-19 pandemic.

Design, implementation, and evaluation of community health worker training programs in Latinx communities: A scoping review

This review examines the current reporting trends of program design, implementation, and evaluation of training programs for Latinx community health workers. Five scholarly databases were searched using a scoping review methodology to identify articles describing training programs for Latinx community health workers. The timeframe was 2009 to 2021. We identified 273 articles, with 59 meeting inclusion criteria. Researchers thematically coded the articles to identify reporting strategies related to program design, implementation, and evaluation. Findings suggest a lack of consensus in reporting elements critical to program resources, instructor qualifications, frequency and length of training implementation, theoretical background, and pedagogical tools associated with the training program. We offer detailed reporting recommendations of community health worker training programs to support the consistent dissemination of promising practices and facilitate the initiation of new programs for Latinx community health workers.

Feasibility and acceptability of home delivery of water for dental caries control in Latinx children-"Sediento por una Sonrisa," Thirsty for a Smile: Single-arm feasibility study

Background

Outcomes of surgical treatments under general anesthesia for early childhood caries of young children from low-income groups are poor requiring retreatment within 2 years. Dietary sugar is an ideal intervention target given that it is the most prominent risk factor for dental caries and there is increasing evidence of successful interventions to reduce its intake. Our aim is to investigate the feasibility and acceptability of the Thirsty for a Smile intervention, designed to promote consumption of water in lieu of sugar sweetened beverages, among children who underwent surgery for early childhood caries and their caregivers, mostly from Latino heritage.

Methods

A single-arm feasibility study was conducted in a dental practice from a community health center in eastern Washington State. Bottled water was delivered to the participants' homes and caregivers received patient-centered counseling for setting goals to increase children's water intake and reduce sugar sweetened beverages consumption. We assessed the feasibility and acceptability of the intervention and study procedures through participation rates, interviews and a questionnaire completed by the caregivers. Data was analyzed and themes and descriptive statistics presented.

Results

Twenty-two dyads of caregivers and their children between 2 and 9 years old who recently had surgical treatment for early childhood dental caries were enrolled. All study assessments were completed by more than 90% of participants, except for the final 24-h dietary recall (73%). Dietary counseling, both in person and brief telephone calls, was highly acceptable to the caregivers, and they also reported their children enjoyed and used the water bottles. On a scale from 1 to 10, the average rating for the helpfulness of the dietary counseling component for changing child's drinking habits was 9.62 and for the water delivery component, 8.86.

Conclusions

This study tested the feasibility of conducting a trial in a dental practice setting, and the acceptability among caregivers of young children who underwent surgery for early childhood caries. It demonstrated that the Thirsty for a Smile intervention and study processes were feasible and acceptable. The study provides useful information for implementation of a two-arm randomized controlled trial in this setting and may also benefit other researchers attempting to test similar interventions.

Multicenter Randomized Controlled Trial Comparing the Contribution of Proxabrushes with Regular Toothbrushes and Only Regular Toothbrushes to the Oral Health of Thai Elderly

Objective

The aim of this two-group experimental study was to explore the effects of proxabrush on Thai elderly oral health. Design and Setting. Multicenter randomized controlled trial, parallel grouped, open label, blocked randomization was used at each province to allocate treatment. The study was conducted at public hospitals in 16 provinces in Thailand between November 2019 and January 2020.

Methods

Participants in the test group used proxabrushes and regular toothbrushes, and participants in the control group used only regular toothbrushes for 6 weeks. Plaque accumulation, gingival status, and oral healthcare data were collected at baseline and at 6-week follow-up. Clinical oral health examiner was blinded to group assignment. Randomization was computer-generated, with allocation concealment by opaque sequentially number sealed envelopes. Data analysis compared plaque and gingival indices between the test and control groups.

Results

A total of 510 elderly with at least 20 natural teeth and interdental spaces were randomized (test n = 255; control n = 255), and 35 were excluded from analysis because of early drop out leaving 239 in the test group and 236 in the control group. A sample of 475 aged between 60 and 91 years participated in the study; 158 (33.3%) were males and 317 (66.7%) were females. The results revealed that, compared to baseline knowledge, attitude and practice were improved at follow-up for both the test and control groups (p < 0.05). At follow-up, the independent-samples t-test compares the test group plaque index mean of 0.49 (SD 0.44) to the control group mean of 0.60 (SD 0.56); a mean difference of 0.11 (95% CI 0.02 to 0.20) obtained demonstrated statistical significance (p = 0.014), and comparing the test group gingival index mean of 0.52 (SD 0.50) to the control group mean of 0.65 (SD 0.60), a mean difference of 0.13 (95% CI 0.03 to 0.23) obtained demonstrated statistical significance (p = 012). At follow-up, the test group had lower plaque accumulation and better gingival status than the control group. Gender, medical problems, educational level, occupation, and age were not different between the test and control groups. A combination of daily proxabrush and regular toothbrush use yielded significant benefits over regular tooth-brushing alone.

Conclusions

In conclusion, proxabrush has been found to be an effective interdental cleaning aid among Thai elderly. This trial is registered with TCTR20220127004.

Saving a seat at the table for community members: co-creating an attachment-based intervention for low-income Latin parent-youth dyads using a promotor/a model

Evidence for the effectiveness of attachment-based interventions in improving youth’s socioemotional health increases each year, yet potential for scalability of existing programs is limited. Available programs may have lower acceptability within low-income immigrant communities. Co-designing and implementing interventions with trained community workers (Promotors) offers an appealing solution to multiple challenges, but community workers must have high investment in the program for this to be a workable solution. This study examines the experiences of promotors involved in the co-creation and delivery of an attachmentbased intervention program for low-income Latinx youth (ages 8 to 17) and their mothers. Promotors (N=8) completed surveys, reporting on the experiences of each therapy group in terms of group dynamic (e.g., promotors’ connectedness to each group, perceived program relevance). Following the completion of the intervention study, promotors participated in interviews in which they described their experiences in co-creating the intervention, delivering the intervention to the community, and their recommendations for improving the intervention. Overall, promotors perceived group dynamics as positive, though the mother groups were evaluated as significantly higher in quality (e.g., lower conflict) than the youth groups. Interviews revealed that promotors enjoyed the cocreation process and identified important areas for improvements for the intervention (incorporation of more visuals, creation of agelimited groups, reducing number of youth sessions) and evaluation (reduction in length, modification of language). Integrating input from promotors in the process of co-creating and implementing an intervention can benefit every member of the community from the program participants to the providers themselves.

Using a Machine Learning Algorithm to Predict the Likelihood of Presence of Dental Caries among Children Aged 2 to 7

BACKGROUND

Dental caries is the most common chronic childhood infectious disease and is a serious public health problem affecting both developing and industrialized countries, yet it is preventable in most cases. This study evaluated the potential of screening for dental caries among children using a machine learning algorithm applied to parent perceptions of their child's oral health assessed by survey.

METHODS

The sample consisted of 182 parents/caregivers and their children 2-7 years of age living in Los Angeles County. Random forest (a machine learning algorithm) was used to identify survey items that were predictors of active caries and caries experience. We applied a three-fold cross-validation method. A threshold was determined by maximizing the sum of sensitivity and specificity conditional on the sensitivity of at least 70%. The importance of survey items to classifying active caries and caries experience was measured using mean decreased Gini (MDG) and mean decreased accuracy (MDA) coefficients.

RESULTS

Survey items that were strong predictors of active caries included parent's age (MDG = 0.84; MDA = 1.97), unmet needs (MDG = 0.71; MDA = 2.06) and the child being African American (MDG = 0.38; MDA = 1.92). Survey items that were strong predictors of caries experience included parent's age (MDG = 2.97; MDA = 4.74), child had an oral health problem in the past 12 months (MDG = 2.20; MDA = 4.04) and child had a tooth that hurt (MDG = 1.65; MDA = 3.84).

CONCLUSION

Our findings demonstrate the potential of screening for active caries and caries experience among children using surveys answered by their parents.

Interventions Targeting Bottle and Formula Feeding in the Prevention and Treatment of Early Childhood Caries, Overweight and Obesity: An Integrative Review

Overweight, obesity and early childhood caries (ECC) are preventable conditions affecting infants and young children, with increased prevalence in those formula-fed. Previous research has focused on distinct outcomes for oral health and healthy weight gain. However, the aetiology may be linked through overlapping obesogenic and cariogenic feeding behaviours, such as increased sugar exposure through bottle propping and overfeeding. Best-practice bottle feeding and transition to cup use may concurrently reduce overweight, obesity and ECC. This integrative review aimed to identify interventions supporting best-practice formula feeding or bottle cessation and examine the intervention effects on feeding, oral health and weight outcomes. The reviewers searched nine databases and found 27 studies that met the predetermined inclusion criteria. Eighteen studies focused on populations vulnerable to ECC or unhealthy weight gain. All studies focused on carer education; however, only 10 studies utilised behaviour change techniques or theories addressing antecedents to obesogenic or cariogenic behaviours. The outcomes varied: 16 studies reported mixed outcomes, and eight reported worsened post-intervention outcomes. While some studies reported improvements, these were not maintained long-term. Many study designs were at risk of bias. Effective intervention strategies for preventing ECC and child obesity require the holistic use of interdisciplinary approaches, consumer co-design and the use of behavioural change theory.

Effectiveness of message-framing to improve oral health behaviors and dental plaque among pregnant women

BACKGROUND

Oral health is considered a prominent factor that contributes to quality of life. Hormonal changes during pregnancy can influence oral health. Message framing can play an important role in oral health. The aim of the present study was to investigate the effect of message framing on oral health and dental plaque among pregnant women.

METHODS

The study was conducted in 2017 on 108 pregnant women in Izeh county, Iran. Participants were randomly assigned to gain-framed, loss-framed, and control groups. The research instrument included a two part questionnaire containing demographic information and oral health knowledge, attitude, behavioral intention, self-efficacy, practice, and dental plaque index. Gain-and loss-framed messages were sent to the intervention groups via cell phone texts, but the control group did not receive any messages. Participant dental plaque was clinically assessed. Analysis of covariance with follow-up tests were performed using SPSS version, 23.0 with p-value set at 0.01 for significance.

RESULTS

Intervention groups had better oral health (knowledge, atttitude, intention, efficacy, practices and plaque) scores compared to the control group (p < 0.001), but intervention (gain- vs loss-framed) groups did not differ on outcomes.

CONCLUSION

Text message intervention improved knowledge, attitude, behavioral intention, self-efficacy, practice, and dental plaque among pregnant women. While differences between control and both intervention groups indicated text messaging had an impact on oral health outcomes, message framing (i.e., gain vs loss) had no discernable impact on oral health outcomes.

Correlation of Oral Health Education by Community Health Workers with Changes in Oral Health Practices in Migrant Populations in Washington State

INTRODUCTION

An important question for oral health education is whether knowledge gained during lay-led workshops is retained and applied in daily practice. This study assessed the knowledge retention and changes in oral health practices several months after oral health education workshops were held for migrant farmworkers by Community Health Workers (CHWs).

METHODS AND RESULTS

Follow-up surveys were conducted with 32 participants 1 to 43 months post participation (60% between 6 and 21 months). The results showed a high degree of retention, in such areas as general oral health knowledge, and brushing/flossing frequency and technique among this sample. There was no relationship between length of time since the educational workshop and knowledge retained or behaviors changed.

CONCLUSIONS AND RECOMMENDATIONS

An interactive, lay-led oral health education program run by CHWs can be an effective way to deliver sustained improvements in oral health knowledge and changes in oral health practice in migrant populations.

Important aspects of conducting an interdisciplinary public preventive oral health project for children in areas with low socioeconomic status: staff perspective

Background

To achieve good and equal oral health in children, interdisciplinary preventive oral health actions, directed toward disadvantaged areas, can be an important means. Staff play a crucial role in the implementation of these actions. The aim of the present study was to analyze circumstances of importance for conducting an interdisciplinary public preventive oral health project for children, directed toward parents in areas with low socioeconomic status from the interdisciplinary perspective of the involved staff.

Method

The present study consisted of a qualitative content analysis with an inductive approach, based on interviews with interdisciplinary staff who had participated in a public preventive oral health project directed toward parents in areas with low socioeconomic status. The interviews were analyzed using text-driven analysis.

Results

The main category concerned the staff members’ prerequisites and understanding necessary to perform their tasks in interdisciplinary public preventive oral health project. To have the right prerequisites and understanding regarding the oral health project enabled staff to be committed, able and willing to perform in it. Important aspects of this are to have knowledge, motivation and to experience a supportive professional context, to have good leadership and for certain resources to fulfilled. A crucial aspect was to reach the targeted mothers.

Conclusions

For interdisciplinary cooperation in preventive oral health care to be achieved, it is essential for the involved disciplines and professions to embrace a common view on the project’s aim, their duties, and oral health, from the leadership to the individual level. Staff require competent leadership but also allocated time and adapted method support to be successful in this context. When allocating preventive health actions directed at low SES areas, it is important to acknowledge the risk of stigmatization and for staff to understand that families might be facing social challenges that prevent them from taking part in health-promoting actions. An important conclusion is that to be able to reach people, it is important for both those who design preventive programs for oral health and the staff who administer them to have sufficient knowledge about the target group.

Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud

Rural populations in the United States are faced with a variety of health disparities that complicate access to care. Community health workers (CHWs) and their Spanish-speaking counterparts, promotores de salud, are well-equipped to address rural health access issues, provide education, and ultimately assuage these disparities. In this article, we compare community health workers in the states of Indiana and Texas, based on the results of two separate research studies, in order to (1) investigate the unique role of CHWs in rural communities and (2) understand how their advocacy efforts represent a central form of caregiving. Drawing on ethnographic, qualitative data-including interviews, photovoice, and participant observation-we analyze how CHWs connect structurally vulnerable clients in rural areas to resources, health education, and health and social services. Our primary contribution to existing scholarship on CHWs is the elaboration of advocacy as a form of caregiving to improve individual health outcomes as well as provoke structural change in the form of policy development. Finally, we describe how CHWs became especially critical in addressing disparities among rural populations in the wake of COVID-19, using their advocacy-as-caregiving role that was developed and well-established before the pandemic. These frontline workers are more vital than ever to address disparities and are a critical force in overcoming structural vulnerability and inequities in health in the United States.

Talk to PAPA: A Systematic Review of Patient/Participant (PAPA) Feedback on Interactions With Community Health Workers Using a Depth Analysis Approach

Because of their shared backgrounds, community health workers' (CHWs) care of patients/program participants (PAPAs) is assumed to be acceptable, and often not evaluated empirically. Using PRISMA guidelines, we reviewed 9560 articles from 5 databases, selected 37 articles for full-text review, and developed a 5-dimensional depth analysis (focus, context, meaning, range, and voices) to characterize quality/quantity of PAPA feedback. Depth analyses clarified a spectrum of PAPA responses from extremely positive to ambivalence to outright distrust and frustration with perceived CHW limitations. Designing evaluations with 5-dimensional depth analysis can enhance PAPA feedback quality and improve evidence-based, patient-centered, CHW care delivery.

Impact of the promotora model on the improvement of oral health knowledge of caregivers

OBJECTIVE

The objective of this quasi-experimental study was to determine the impact of the Promotora Model (PM) as an educational strategy to increase oral health knowledge in parents/caregivers of children aged 2-5 years at high risk for dental caries.

MATERIALS AND METHODS

Sixty-three caregivers who provided informed consent were included in the study. A structured 37-item survey was administered prior to conducting the Promotora educational intervention (PEI) that covered oral health topics and behaviors. Three (3) months after the PEI session, during their child's next dental visit, the same instrument was administered to 46 of the parents/caregivers that had completed the first instrument.

RESULTS

Most caregivers were Hispanic (73.9%) and 50% reported completing high school. Before PEI, 56.5% of participants scored as having "good" general knowledge. Three months after PEI, 82.6% achieved that score (paired sample T-test, p< 0.00001).

CONCLUSION

Based on the results, it was concluded that the PM significantly increased caregivers' oral health knowledge.

Oral Health Behavior Change in Mexican-American Caregivers: A Community-Based Intervention Study

An oral health prevention intervention was conducted with Mexican-American (MA) caregivers, focused on improving their oral health knowledge, behavior, and self-efficacy. Five in-person intervention sessions were conducted with caregivers, followed by a 15 min skill-building exercise. A goal-setting sheet was provided, and two goals were chosen for fulfilment during the three month intervention period. The data on parental oral health knowledge, behavior, and self-efficacy were collected pre- and post-intervention using a portion of Basic Factors Research Questionnaire (BRFQ). Paired t-tests were conducted to test significant differences in the means of pre- and post-intervention oral health behavior, knowledge, and self-efficacy scores, and pre- and post-intervention individual item scores. Forty six primary caregivers were enrolled. There were significant differences in the means of pre- and post-intervention oral health knowledge (p = 0.003), oral health behavior (p = 0.0005), and self-efficacy scores (p = 0.001). The individual item mean scores showed that there was a significant increase in the number of times caregivers checked for spots (p = 0.016) and a significant decrease in the consumption of sweet or sugary drinks (p = 0.032) post-intervention. Most of the caregivers believed that cavities were caused by germs in the mouth (p = 0.001), sharing utensils with children was bad for their teeth (p < 0.001), and fluoride toothpaste was best for a child’s teeth (p < 0.001). The intervention resulted in improved caregiver oral health knowledge, behavior, and self-efficacy.

Oral Care Experiences of Latino Parents/Caregivers with Children with Autism and with Typically Developing Children

As a result of various barriers, several pediatric populations are at risk for poor oral health, including children with disabilities and children from under-represented populations, such as Latinos. To this end, this study aimed to better understand the factors that affect the oral health experiences of 32 Latino parents/caregivers from 18 families (n = 8 with a typically developing child and n = 10 with a child with Autism). Using a qualitative descriptive methodology, each family was interviewed twice. Interviews were audio-recorded, transcribed verbatim, and coded thematically to identify the individual, social, systemic, and culturally rooted factors contributing to oral health disparities in the families. The three themes that arose were "Why would I want to start trouble?": Latino parents' dissatisfaction with dental treatments, costs, and fear of the dentist and health care providers because of their ethnic minority status as key factors inhibiting receipt of dental care; "We have to put our children first": prioritizing the oral care activities of their children over their own individual oral care needs; and "We always keep baking soda around": familial and cultural influences on oral care habits. Understanding the oral health beliefs and experiences of Latino parents and caregivers of children with and without autism is critical for developing targeted prevention and intervention programs and reducing oral health disparities.

Developing an Effective Community Oral Health Workers-"Promotoras" Model for Early Head Start

Purpose: To determine the effectiveness of a train-the-trainer program for Community Oral Health Workers (COHWs) with the goal of reducing Early Childhood Caries (ECC). Methods: Thirteen Latina caregivers from a local Early Head Start program participated in an 8 h bilingual oral health training program that provided information and hands-on experiences pertaining to prenatal and children's oral health. Once trained, the 13 COHWs conducted a series of bilingual interactive oral health promotion workshops at local community sites. Pre/post-tests were conducted after each workshop with a total of 157 caregivers of young children. Bivariate analyses were used to assess changes in knowledge, attitudes, and practices of the COHWs and caregivers regarding children's oral health. Results: Significant positive changes (p < 0.05) in COHWs' knowledge were observed for age a child can brush his/her teeth alone and what a pregnant woman with morning sickness can do to protect her teeth. Positive trends were observed for knowing that tap water with fluoride prevents cavities and that poor oral health of parents affects their children's dental health. While community caregivers in the workshops reported a high consumption of sweet snacks and beverages, there was a significant positive increase (p < 0.05) in knowledge and attitudes regarding oral health care. Significant increases in knowledge were obtained regarding: when a child can brush his/her teeth well alone, the age when fluoridated toothpaste can be used, ways tooth decay can be prevented, when a child's first dental visit should be, and what a pregnant woman with morning sickness can do to protect her teeth. Significant positive improvements were found regarding caregiver's favorable attitude that fluoridated water can help prevent cavities, disagreeing that tap water is dangerous, and agreeing that a parent's dental health affects their children's dental health. Conclusions: The study showed a targeted and culturally competent oral health program can significantly improve knowledge, attitudes, and self-reported practices of COHWs and the caregivers they trained. Although longitudinal studies are needed to determine if a COHW model can help reduce ECC in underserved communities, preliminary results support the utilization of this model as a viable option that should be expanded.

Longitudinal Impact of a Randomized Clinical Trial to Improve Family Function, Reduce Maternal Stress and Improve Child Outcomes in Families of Children with ADHD

Objective Evaluate the efficacy of a 12 month nursing case-management intervention over a period of 18 months, 6 months after the end of intervention, for families of children attention deficit hyperactivity disorder (ADHD). Methods Mother and child dyads were enrolled to participate in a randomized controlled clinical trial. Children were 4-18 years old. Data were collected at baseline, 6, 12, and 18 months or 6 months after the termination of direct intervention. Longitudinal analyses, using generalized estimating equations, were conducted to assess change in study outcomes relating to family function, maternal stress, and child behavior over the 18 month period. Results Compared to control families, some family function outcomes were moderately improved in the intervention group. In particular, intervention families demonstrated substantial improvement in implementing family behavior controls (p value = 0.038) and improvement in family satisfaction (not statistically significant p = 0.062). Although there was improvement in the overall family function measure there was not a statistically significant difference between groups. Maternal stress and child behavior outcomes were not significantly different between control and intervention groups by the end of the intervention. Conclusions for Practice Addressing ADHD is complex and requires the assessment of comorbidities that might exacerbate negative behavior. Our findings support the latest American Academy of Pediatrics guidelines to use behavioral therapy as the first line of treatment in young children. Nursing case-management interventions that provide direct family education and improve family function, especially with respect to providing structure and behavior control, may complement and facilitate behavioral therapy for treatment of ADHD and improving child behavior.

Poor HPV vaccine-related awareness and knowledge among Utah Latinas overdue for recommended cancer screenings

Individuals overdue for recommended cancer screenings may not be receiving adequate cancer prevention education. Since Latinas have the highest incidence of cervical cancer among all racial/ethnic groups, human papillomavirus (HPV) vaccination education is especially important for this population. The correlates of HPV vaccine-related awareness and knowledge were assessed among Latinas who were overdue for recommended cancer screenings. N = 206 Latinas who were overdue for recommended cancer screenings were recruited by health educators from local community groups. Bivariate analyses and multivariable regression models were used to investigate factors associated with HPV vaccine-related awareness and knowledge among participants as well as to assess correlates of HPV vaccine receipt for eligible children of participants. In multivariable regression analyses, years living in the U.S. (p = 0.05) and health insurance status (p = 0.03) were significantly related to HPV vaccine-related knowledge measures. Age (p < 0.01), birthplace (p = 0.02), years living in the U.S. (p = 0.05), annual household income (p = 0.05), cervical cancer screening status (p = 0.03), and HPV vaccine-related knowledge measures (p < 0.01) were significantly associated with HPV vaccination outcomes for eligible daughters of participants. Cervical cancer screening status (p = 0.02) and HPV vaccine-related knowledge measures (p = 0.01) were significantly associated with HPV vaccination outcomes for eligible sons of participants. Results indicate poor HPV vaccine-related awareness and knowledge among Latinas. Interventions to improve HPV vaccine-related awareness and knowledge in Utah's growing Latino population should target vulnerable individuals (e.g., not employed outside the home, less educated, less acculturated, poor, uninsured, overdue for cervical cancer screening) by using materials that are culturally sensitive, linguistically appropriate, and easily accessible.

Importance of Content and Format of Oral Health Instruction to Low-income Mexican Immigrant Parents: A Qualitative Study

PURPOSE

This study's purpose was to explore how content and format of children's oral health instruction in the dental clinic is perceived by parents and might affect parents' knowledge and behaviors.

METHODS

Thirty low-income Mexican immigrant parents of children age five years and under were recruited from dental clinics in 2015 to 2016. In-person qualitative interviews in Spanish about their children's and their own experiences of dental care and home oral hygiene practices were conducted, digitally recorded, translated, and transcribed. Data analysis involved iteratively reading text data and developing and refining codes to find common themes.

RESULTS

Twenty-five of 30 parents recalled receiving oral hygiene instruction, and 18 recalled receiving nutrition instruction and were included in analyses. The format and effectiveness of instruction varied. More engaging educational approaches were recalled and described in more detail than less engaging educational approaches. As a result of oral hygiene and nutritional instruction, most parents reported changing their oral hygiene home behaviors for their children; half aimed to reduce purchasing sugary foods and drinks.

CONCLUSIONS

Most parents recalled receiving oral hygiene and nutrition instruction as part of their child's dental visit and reported incorporating the instruction and recommendations they received into their children's home routine.

Four-level evaluation of health promotion intervention for preventing early childhood caries: a randomized controlled trial

Background

Early childhood caries (ECC) is the most common dental disease among children, which can affect children’s primary teeth during their teething. This study evaluates an intervention for preventing early childhood caries in a pediatric population in Ahvaz, Iran.

Method

The population of this study (IRCT2017070210804N10) consists of 104 women with 12 to 36 months of age without dental caries referred to a health care center in Ahvaz, Iran. The children were randomly assigned to either an experimental or control group in equal numbers. First, the demographic information of participants was collected through a questionnaire containing components of perceived threat, health literacy, and oral health behaviors using a valid and reliable questionnaire. The ECC status of the children was established by a dentist. Control group received “standard well baby care”. The experimental group received standard well baby care in addition to educational interventions, including lecture and group discussion. After 6 months, the participant completed the questionnaire for the second time, and the children’s teeth were reexamined. Data were analyzed using SPSS version 15 at a significance level of p < 0.05.

Results

The mean ages of women and children were 31 ± 6.68 years and 18 ± 7.21 months, respectively. Before the intervention, no significant difference was documented between the groups for the study variables, p > 0.05. However, after the intervention, a significant difference was observed between the perceived threats (41.15 ± 4.46 in the experimental group and 38.26 ± 4.21 in the control group, p = 0.001), health literacy (20.98 ± 2.15 in the experimental group and 19.76 ± 2.70 in the control group, p = 0.01), oral health behaviors (7.75 ± 2.30 in the experimental group and 6.15 ± 2.65 in the control group, p = 0.01), and the incidence of ECC (13% in the experimental group and 35% in the control group,p = 0.001).

Conclusion

This intervention had positive effects on the perceived threat, health literacy, and health behaviors; and the intervention could reduce the incidence of ECC. The finding of this study provided a suggestion for evidence-based decision-making processes regarding ECCs prevention programs.

Trial registration

IRCT2017070210804N10 (retrospectively registered)

The basic research factors questionnaire for studying early childhood caries

BACKGROUND

We describe development of the Early Childhood Caries (ECC) Basic Research Factors Questionnaire (BRFQ), a battery of measures assessing common potential predictors, mediators, and moderators of ECC. Individual-, family-, and community-level factors that are linked to oral health outcomes across at-risk populations are included. Developing standard measures of factors implicated in ECC has the potential to enhance our ability to understand mechanisms underlying successful prevention and to develop more effective interventions.

METHODS

The Early Childhood Caries Collaborating Centers (EC4), funded by National Institute of Dental and Craniofacial Research, developed the BRFQ, which was used across four randomized trials to develop and test interventions for reducing ECC in at-risk populations. Forty-five investigators from across the centers and NIDCR were involved in the development process. Eight "measures working groups" identified relevant constructs and effective measurement approaches, which were then categorized as "essential" or "optional" common data elements (CDEs) for the EC4 projects.

RESULTS

Essential CDEs include 88 items, with an additional 177 measures categorized as optional CDEs. Essential CDEs fell under the following domains: oral health knowledge, oral health behavior, utilization/insurance and cost, parent/caregiver dental self-efficacy, quality of life, caregiver and family characteristics, and child characteristics.

CONCLUSIONS

The BRFQ makes available a battery of measures that support efforts to understand population risk factors for ECC and to compare oral health outcomes across populations at risk. The BRFQ development process may be useful to other clinical research networks and consortia developing CDEs in other health research fields.

TRIAL REGISTRATION

All the trial that used the BRFQ were registered at Clinicaltrial.gov NCT01116726 , April 29, 2010; NCT01116739 , May 3, 2010; NCT01129440 , May 21, 2010; and NCT01205971 , September 19, 2010.

A Community-Based Participatory Research Approach to Understand Urban Latino Parent's Oral Health Knowledge and Beliefs

The aim of this study is to describe oral health knowledge, behaviors, and beliefs of Latino parents with children under the ages of 6 years and to conduct a needs assessment with Latino families to better understand the challenges in maintaining oral health for their children. The investigator collaborated with a community serving the organization to recruit Latino primary caregivers for focus groups interviews and 30 primary caregivers were recruited. The focus groups data was transcribed and analyzed using a grounded theory approach using QDA Miner software. Findings from the focus groups demonstrate that the primary caregivers described barriers in maintaining oral health for their children including cultural barriers, child's temperament, lack of time, and easy access to high-risk foods. All participants said that they wanted to receive information on the oral health of their children; they wanted the dentist or the hygienist to demonstrate oral hygiene practices and explain to them the reasons for oral health behaviors. Although the primary caregivers recognized some factors related to caries development, their knowledge was limited in depth. Culturally appropriate oral health education is required for this population, which could lead to more adherent oral health behavior and a higher sense of self-efficacy in Latino parents.

Formative Research: Using a Community-Based Participatory Research Approach to Develop an Oral Health Intervention for Migrant Mexican Families

Oral health is a leading unmet health need among migrant families. This article describes the 1-year, community-based participatory research (CBPR) approach employed to plan and develop a Líder Communitario (lay community health worker)-led educational intervention for Mexican migrant adult caregivers and their families in three underserved, remote communities in North San Diego County, California. Four partner organizations collaborated, reviewed existing oral health curricula, and sought extensive input on educational topics and research design from key informants, migrant caregivers, and Líderes Communitarios. Based on community stakeholder input, partners developed a logic model and drafted educational intervention materials. Key informants ( n = 28), including several members from two community advisory boards, ranked program priorities and intervention subgroup population via online survey. Three focus groups were conducted with Líderes Communitarios ( n = 22) and three with migrant families ( n = 30) regarding the oral health program's design and content. Twelve Líderes Communitarios reviewed draft intervention materials during two focus groups to finalize the curriculum, and their recommended changes were incorporated. Formative research results indicated that community stakeholders preferred to focus on adult caregivers and their families. A 5-week educational intervention with hands on demonstrations and colorful visuals was developed, covering the following topics: bacteria and tooth decay, oral hygiene, nutrition, gum disease, and dental services. The CBPR process engaged multiple community stakeholders in all aspects of planning and developing the educational intervention.

Effectiveness evaluation of Contra Caries Oral Health Education Program for improving Spanish-speaking parents' preventive oral health knowledge and behaviors for their young children

OBJECTIVES

To determine the effectiveness of the Contra Caries Oral Health Education Program (CCOHEP) for improving low-income, Spanish-speaking parents' oral health knowledge and behaviors for their young children. Mexican American children in the United States suffer disproportionately high prevalence and severity of early childhood caries, yet few evaluated, theory-based behavioral interventions exist for this population. CCOHEP is a theory-based curriculum consisting of four 2-h interactive classes designed for and by Spanish speakers and led by designated community health educators (promotoras). Topics included children's oral hygiene, caries etiology, dental procedures, nutrition, child behavior management, and parent skill-building activities.

METHODS

Low-income Spanish-speaking parents/caregivers of children aged 0-5 years were recruited through community services in an agricultural city in California. Survey questions from the Oral Health Basic Research Facts Questionnaire measuring oral health-related behaviors and knowledge were verbally administered before, immediately after, and 3 months after attendance at CCOHEP. Five questions measured aspects of parental toothbrushing for their children (frequency, using fluoridated toothpaste, brushing before bed, not drinking or eating after nighttime brushing, adult assistance), three questions measured other oral health behaviors, and 16 questions measured oral health-related knowledge. Analyses of within-person changes between pre- and post-tests and again between post-test and 3-month follow-up consisted of McNemar's test for binary outcomes and sign tests for ordinal outcomes.

RESULTS

Overall, 105 caregivers participated in CCOHEP (n = 105 pretest, n = 95 post-test, n = 79 second post-test). At baseline, all parents self-reported doing at least one aspect of toothbrushing correctly, but only 13% reported performing all five aspects according to professional guidelines. At post-test, 44% of parents reported completing all aspects of toothbrushing according to professional guidelines (P < .001). Statistically significant improvements were seen in 4 aspects of toothbrushing (P ≤ .008) between pretest and post-test (all but adult assistance). The second post-test showed 3 of these improvements were maintained, while adult assistance and the other reported behaviors improved (P ≤ .008). Between pretest and post-test, checking child's teeth monthly and frequency of sweet drinks consumption improved (P ≤ .008), while frequency of eating sweet foods did not change. Knowledge was high at baseline (mean 12.8 of 16), but 6 knowledge items improved significantly between pretest and post-test. Improvements were maintained at second post-test.

CONCLUSIONS

Contra Caries Oral Health Education Program improved low-income Spanish-speaking parents' oral hygiene knowledge and self-reported behaviors for their young children, and change was sustained 3 months after the end of the intervention. Future, more rigorous evaluation of the intervention is recommended.