A theory-based intervention to increase dental utilization by disadvantaged children.

Oral disease is the greatest unmet healthcare need of disadvantaged children in the United States, with only 20% of disadvantaged Medicaid-eligible children receiving routine dental care. Peter Margolis proposed a theoretical model of access to healthcare services and reported the effectiveness of a case manager intervention in increasing medical care utilization by disadvantaged mothers and infants. This study was based on Margolis\u27s theory and used a case manager to assist parents in obtaining dental care. Methods. The study was based on secondary analyses of data from the Parental Help Seeking for Dental Care project. The randomized, controlled intervention study was conducted with 202 parents/caregivers of Medicaid insured children in Louisville, Kentucky, from March 2004 to April 2005. The research questions were: (1) What is the direct effect of the intervention on dental care utilization? (2) Do contextual factors moderate the intervention effects on utilization? (3) What is the effect of the intervention on barriers? The primary dependent variable was dental care utilization and the primary independent variable was group assignment. Covariates included socioeconomic and psychosocial factors. Analyses were conducted using univariate, bivariate, and multivariate statistical techniques. Results. One-fourth of the children enrolled were regular dental utilizers and the intervention did not have a direct effect on utilization for the entire sample of children. Subgroup analyses, however, indicated that younger children in the intervention group were three times more likely to visit the dentist than younger children in the control group. Additional subgroup analyses indicated that intervention families who did not routinely utilize dental care, who had a low family annual income, and/or who completed all study activities were almost three times more likely to see the dentist than similar families in the control group. The intervention did not have any obvious effect on perceived barriers. Conclusions. The intervention was effective in increasing utilization only by younger children, those who had not previously received routine dental care, and those families in the lowest income brackets. Important information was gained from this study that could help develop effective interventions for disadvantaged families, thus reducing oral health disparities

Improving the oral health of residents with intellectual and developmental disabilities: An oral health strategy and pilot study

AbstractThis article presents an oral health (OH) strategy and pilot study focusing on individuals with intellectual and/or developmental disabilities (IDD) living in group homes. The strategy consists of four components: (1) planned action in the form of the behavioral contract and caregiver OH action planning; (2) capacity building through didactic and observation learning training; (3) environmental adaptations consisting of additional oral heath devices and strategies to create a calm atmosphere; and (4) reinforcement by post-training coaching. A pilot study was conducted consisting of pre- and post-assessment data collected 1 week before and 1 week after implementing a 1-month OH strategy. The study sample comprised 11 group homes with 21 caregivers and 25 residents with IDD from one service organization in a Midwestern city. A process evaluation found high-quality implementation of the OH strategy as measured by dosage, fidelity, and caregiver reactions to implementing the strategy. Using repeated cross-sectional and repeated measures analyses, we found statistically significant positive changes in OH status and oral hygiene practices of residents. Caregiver self-efficacy as a mechanism of change was not adequately evaluated; however, positive change was found in some but not all types of caregiver OH support that were assessed. Lessons learned from implementing the pilot study intervention and evaluation are discussed, as are the next steps in conducting an efficacy study of the OH strategy

Barriers to parental care seeking behavior for children’s oral health among low income parents

Objectives. We identified psychosocial, structural, and cultural barriers to seeking dental care among nonutilizing caregivers of Medicaid-enrolled children.Methods. We used Medicaid utilization records to identify utilizing and nonutilizing African American and White caregivers of Medicaid-enrolled children in Jefferson County, Kentucky. We conducted 8 focus groups (N=76) with a stratified random sample of responding caregivers; transcripts were qualitatively analyzed.Results. Psychosocial factors associated with utilization included oral health beliefs, norms of caregiver responsibility, and positive caregiver dental experiences. Utilizing groups reported higher education; health beliefs included identifying oral health with overall health and professional preventive dental care with caregiver responsibility for children’s overall health. These beliefs may mediate shared structural barriers, including transportation, school absence policies, discriminatory treatment, and difficulty locating providers who accept Medicaid. Expectation of poor oral health among some low-income caregivers was among factors identified with nonutilization.Conclusions. Disadvantaged caregivers reported multiple barriers to accessing dental care for their children. Providers, Medicaid administrators, and schools must coordinate steps to encourage caregiver-controlled dental care, build trust, and link professional preventive dental care with caregiver responsibility for children’s overall health

Childhood caries in the state of Kentucky, USA: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Untreated dental caries afflicts almost one third of school-aged children in the United States and many of them are from disadvantaged families. This cross-sectional study was undertaken to investigate the prevalence of untreated caries in north central Kentucky, USA and to examine the relationships between the available demographic variables and untreated childhood caries as reported on the forms from the Smile Kentucky! program.</p> <p>Methods</p> <p>During the fall of 2008, caries status was assessed during the visual oral screening examination component of “SmileKentucky!”– a model of the American Dental Association’s Give Kids A Smile program. Parents had completed brief surveys concerning 3,488 elementary school children aged 5 to 13 years who participated in the program. A secondary analysis was conducted using univariate, bivariate and multivariate statistical methods.</p> <p>Results</p> <p>Untreated caries was reported in 33% of children. Bivariate and logistic regression analyses found that the most significant risk factors for having untreated caries were living in the metropolitan Louisville, Kentucky area, not having had a dental visit in the previous 3 years and not having any form of dental insurance.</p> <p>Conclusions</p> <p>Untreated caries in elementary school children is prevalent in north-central Kentucky despite efforts to improve access to care. The results suggest that additional family and community preventive initiatives are needed to reduce the development of childhood caries in this area of the United States.</p