O ral H ealth L iteracy A ssessment: development of an oral health literacy instrument for S panish speakers

Objective To develop an oral health literacy instrument for S panish‐speaking adults, evaluate its psychometric properties, and determine its comparability to an E nglish version. Methods The O ral H ealth L iteracy A ssessment in S panish ( OHLA ‐ S ) and E nglish ( OHLA ‐ E ) are designed with a word recognition section and a comprehension section using the multiple‐choice format developed by an expert panel. Validation of OHLA ‐ S and OHLA ‐ E involved comparing the instrument with other health literacy instruments in a sample of 201 S panish‐speaking and 204 E nglish‐speaking subjects. Comparability between S panish and E nglish versions was assessed by testing for differential item functioning ( DIF ) using item response theory. Results We considered three OHLA ‐ S scoring systems. Based on validity and reliability comparisons, 24 items were retained in the OHLA ‐ S instrument. OHLA ‐ S was correlated with another health literacy instrument, S panish T est of F unctional H ealth L iteracy in A dults ( P  < 0.05). Significant correlations were also found between OHLA ‐ S and years of schooling, oral health knowledge, overall health, and an understanding of written health‐care materials ( P  < 0.05). OHLA ‐ S displayed satisfactory reliability with a Cronbach Alpha of 0.70‐0.80. DIF results suggested that OHLA ‐ S and OHLA ‐ E scores were not comparable at a given level of oral health literacy. Conclusions OHLA ‐ S has acceptable reliability and validity. OHLA ‐ S and OHLA ‐ E are two different measurement tools and should not be used to compare oral health literacy between E nglish‐ and S panish‐speaking populations.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/96765/1/jphd12000.pd

Framing Young Childrens Oral Health: A Participatory Action Research Project

Despite the widespread acknowledgement of the importance of childhood oral health, little progress has been made in preventing early childhood caries. Limited information exists regarding specific daily-life and community-related factors that impede optimal oral hygiene, diet, care, and ultimately oral health for children. We sought to understand what parents of young children consider important and potentially modifiable factors and resources influencing their children’s oral health, within the contexts of the family and the community

Oral Health Activities of Early Head Start and Migrant and Seasonal Head Start Programs

Guidelines recommend that Migrant and Seasonal Head Start programs (MSHS) address the dental needs of children of migrant and seasonal farmworkers. This study describes parent- and child-oriented oral health activities of North Carolina’s MSHS programs and compares them with non-migrant Early Head Start (EHS) programs using data collected from a questionnaire completed by teachers and family services staff. MSHS staff reported engaging in more oral health activities than EHS staff, which was confirmed by results of logit and ordered logit regression models. Despite promising findings about the engagement of MSHS staff, participation in oral health activities is lower than recommended. Differences between EHS and MSHS programs might be due to differing needs of enrolled children and families or to different approaches to meeting the needs of families

Oral Health Activities of Early Head Start Teachers Directed toward Children and Parents

Objectives—This cross-sectional study examined Early Head Start (EHS) teachers’ oral health program activities and their association with teacher and program characteristics. Methods—Self-complete questionnaires were distributed to staff in all EHS programs in North Carolina. Variables for dental health activities for parents (4 items) and children (4 items) were constructed as the sum of responses to a 0-4 Likert-type scale (never to very frequently). Ordinary least squares regression models examined the association between teachers’ oral health program activities and modifiable teacher (oral health knowledge, values, self-efficacy, dental health training, perceived barriers to dental activities) and program (director and health coordinator knowledge and perceived barriers to dental activities) characteristics. Results—Teachers in the parent (n=260) and child (n=231) analyses were a subset of the 485 staff respondents (98% response rate). Teachers engaged in child oral health activities (range=0-16; mean=9.0) more frequently than parent activities (range=0-16; mean=6.9). Teachers’ oral health values, perceived oral health self-efficacy, dental training, and director and health coordinator knowledge were positively associated with oral health activities (P<0.05). Perceived barriers were negatively associated with child activities (P<0.05). Conclusion—The level of oral health activity in EHS programs is less than optimal. Several characteristics of EHS staff were identified that can be targeted with education interventions. Evidence for effectiveness of EHS interventions needs to be strengthened, but results of this survey provide encouraging findings about the potential effects of teacher training on their oral health practices

Training pediatric health care providers in prevention of dental decay: results from a randomized controlled trial

Background: Physicians report willingness to provide preventive dental care, but optimal methods for their training and support in such procedures are not known. This study aimed to evaluate the effect of three forms of continuing medical education (CME) on provision of preventive dental services to Medicaid-enrolled children by medical personnel in primary care physician offices. Methods: Practice-based, randomized controlled trial. Setting: 1,400 pediatric and family physician practices in North Carolina providing care to an estimated 240,000 Medicaid-eligible children aged 0–3 years. Interventions: Group A practices (n = 39) received didactic training and course materials in oral health screening, referral, counseling and application of fluoride varnish. Group B practices (n = 41) received the same as Group A and were offered weekly conference calls providing advice and support. Group C practices (n = 41) received the same as Group B and were offered in-office visit providing hands-on advice and support. In all groups, physicians were reimbursed $38–$43 per preventive dental visit. Outcome measures were computed from reimbursement claims submitted to NC Division of Medical Assistance. Primary outcome measure: rate of preventive dental services provision per 100 well-child visits. Secondary outcome measure: % of practices providing 20 or more preventive dental visits. Results: 121 practices were randomized, and 107 provided data for analysis. Only one half of Group B and C practices took part in conference calls or in-office visits. Using intention-to-treat analysis, rates of preventive dental visits did not differ significantly among CME groups: GroupA = 9.4, GroupB = 12.9 and GroupC = 8.5 (P = 0.32). Twenty or more preventive dental visits were provided by 38–49% of practices in the three study groups (P = 0.64). Conclusion: A relatively high proportion of medical practices appear capable of adopting these preventive dental services within a one year period regardless of the methods used to train primary health care providers.Gary D Slade, R Gary Rozier, Leslie P Zeldin, and Peter A Margoli

Oral Health Activities of Early Head Start and Migrant and Seasonal Head Start Programs

Guidelines recommend that Migrant and Seasonal Head Start programs (MSHS) address the dental needs of children of migrant and seasonal farmworkers. This study describes parent- and child-oriented oral health activities of North Carolina’s MSHS programs and compares them with non-migrant Early Head Start (EHS) programs using data collected from a questionnaire completed by teachers and family services staff. MSHS staff reported engaging in more oral health activities than EHS staff, which was confirmed by results of logit and ordered logit regression models. Despite promising findings about the engagement of MSHS staff, participation in oral health activities is lower than recommended. Differences between EHS and MSHS programs might be due to differing needs of enrolled children and families or to different approaches to meeting the needs of families

Framing Young Childrens Oral Health: A Participatory Action Research Project.

BACKGROUND AND OBJECTIVES:Despite the widespread acknowledgement of the importance of childhood oral health, little progress has been made in preventing early childhood caries. Limited information exists regarding specific daily-life and community-related factors that impede optimal oral hygiene, diet, care, and ultimately oral health for children. We sought to understand what parents of young children consider important and potentially modifiable factors and resources influencing their children's oral health, within the contexts of the family and the community. METHODS:This qualitative study employed Photovoice among 10 English-speaking parents of infants and toddlers who were clients of an urban WIC clinic in North Carolina. The primary research question was: "What do you consider as important behaviors, as well as family and community resources to prevent cavities among young children?" Five group sessions were conducted and they were recorded, transcribed verbatim and analyzed using qualitative research methodology. Inductive analyses were based on analytical summaries, double-coding, and summary matrices and were done using Atlas.ti.7.5.9 software. FINDINGS:Good oral health was associated with avoidance of problems or restorations for the participants. Financial constraints affected healthy food and beverage choices, as well as access to oral health care. Time constraints and occasional frustration related to children's oral hygiene emerged as additional barriers. Establishment of rules/routines and commitment to them was a successful strategy to promote their children's oral health, as well as modeling of older siblings, cooperation among caregivers and peer support. Community programs and organizations, social hubs including playgrounds, grocery stores and social media emerged as promising avenues for gaining support and sharing resources. CONCLUSIONS:Low-income parents of young children are faced with daily life struggles that interfere with oral health and care. Financial constraints are pervasive, but parents identified several strategies involving home care and community agents that can be helpful. Future interventions aimed to improve children's oral health must take into consideration the role of families and the communities in which they live

Photograph discussed during the 3^rd Photovoice session.

<p>Photo of gummy candies which were discussed in the context of deleterious foods or detrimental child oral health-related behaviors that can be avoided.</p

Community maps drawn by participants after the end of the 4^h Photovoice session.

<p>The participants depicted grocery stores, playgrounds, churches, schools and health care settings along main roads in their communities.</p

Photograph discussed during the 2^nd Photovoice session.

<p>Photo of a household’s available beverage options, discussed in the contexts of finances and convenience.</p