People with disabilities in Johnston County, North Carolina : an action-oriented community diagnosis : findings and next steps of action

During the 2004-2005 academic year, a team of six University of North Carolina-Chapel Hill School of Public Health graduate students conducted an Action-Oriented Community Diagnosis (AOCD) in Johnston County, North Carolina to learn more about what life is like there for people with disabilities. The students were guided by two field preceptors, who served as their liaisons to this community. The goal of an AOCD is to gather, analyze, and summarize the perspectives of community members and service providers in a community to create a complete vision of the community’s strengths, challenges, and existing resources. The AOCD process is designed to culminate in a community forum where all community stakeholders come together to create action steps to work towards change. The purpose of this document is to summarize the AOCD process, present findings, and suggest future action steps to improve life for people with disabilities in Johnston County. The AOCD process began with an overview of secondary data, which provided the team with a context of what life is like for people with disabilities living in Johnston County. The team also attended community meetings and events to gain a better understanding of disability issues in general and specifically in the county. Next, the team conducted 32 interviews and two focus groups with people in Johnston County, including community members with disabilities, family members of people with disabilities and service providers. The team then analyzed the interviews to identify themes that emerged frequently. The next step was to plan a community forum in which the team could share the findings from their interviews and focus groups with the Johnston County community. A Community Advisory Board (CAB) was formed to help plan the forum. The CAB prioritized six themes from the 18 that had emerged from the data. Approximately 100 Johnston County residents and other supporters attended the community forum held on April 28, 2005 in Smithfield. At the forum, the team presented an overview of the AOCD process and their findings on the six prioritized themes of transportation, schools, support for families, housing, awareness of services and knowledge of services. Next, forum attendees broke into discussion groups and came up with action steps around these themes. Afterwards, the group reassembled to share action steps and discuss their vision for the future in Johnston County for people with disabilities and their families. At the community forum, the great potential for change in Johnston County was apparent in the number of participants, their energy and the ideas and action steps they generated. Based on these action steps, the interviews, and observations, the team makes the following recommendations for the future: Continue to recognize the need to combine resources and work together in order to effect change; the team supports the suggestion of a community member that a forum become an annual event in the county. Continue to cooperate and share resources among service providers, family members and community members with disabilities in Johnston County. Develop a central location where community members can learn more about services and resources available in the county; Make a comprehensive list of resources and services for people with disabilities available at this center. Train and educate parents about available services and disability rights. Consider the needs of people with disabilities (housing, schools, recreation, and employment) in future planning efforts and county development. Create a plan to address the transportation needs of all residents. Continue to invest in the establishment and growth of The Arc of Johnston County, NC as they work to empower and improve the lives of children and adults with disabilities. The subcommittees of The Arc can be a valuable resource for future organizing efforts in the county. Develop a program in which key community members shadow people with disabilities to increase awareness and understanding. Build a village, an assisted living community in which adults with disabilities are able to live independently from their parents and pursue their goals in a supported environment. This document was written to serve as a resource to the people of Johnston County. The paper is divided into the following sections: secondary data, findings from the interviews and team observations, community forum, methodology, and conclusion and recommendations for the future. The team intends for this document to contribute to the work currently taking place in Johnston County around the issues facing people with disabilities and their families. The AOCD team further hopes that the action steps and energy generated during this project will build upon and enhance existing efforts in the community.Master of Public Healt

A qualitative assessment of barriers and facilitators to implementing recommended infant nutrition practices in Mumbai, India

Background: Childhood malnutrition has been a longstanding crisis in Mumbai, India. Despite national IYCF (Infant Young Child Feeding) guidelines to promote best practices for infant/toddler feeding, nearly one-third of children under age five are stunted or underweight. To improve child nutrition, interventions should address the cultural, social, and environmental influences on infant feeding practices. This study is an in-depth qualitative assessment of family barriers and facilitators to implementing recommended nutrition practices in two Mumbai slum communities, within the context of an existing nutrition education-based intervention by a local non-governmental non-profit organization. Methods: The population was purposively sampled to represent a variety of household demographics. Data were collected through 33 in-depth semi-structured interviews with caregivers (mothers and paternal grandmothers) of children age 0\u20132 years. Transcripts were translated and transcribed, and analyzed using qualitative analysis procedures and software. Results: A complex set of barriers and facilitators influence mothers\u2019/caregivers\u2019 infant-toddler feeding practices. Most infants were fed complementary foods and non-nutritious processed snacks, counter to IYCF recommendations. Key barriers included: lack of nutrition knowledge and experience, receiving conflicting messages from different sources, limited social support, and poor self-efficacy for maternal decision-making. Key facilitators included: professional nutrition guidance, personal self-efficacy and empowerment, and family support. Interventions to improve child nutrition should address mothers\u2019/caregivers\u2019 key barriers and facilitators to recommended infant-toddler feeding practices. Conclusions: Nutrition interventions should prioritize standard messaging across healthcare providers, engage all family members, target prevention of early introduction of sugary and non-nutritious processed foods, and strengthen maternal self-efficacy for following IYCF recommended guidelines

Parental preventive behaviors and oral health in Latino children

Tooth decay is the most prevalent chronic infectious condition experienced by children in the United States, disproportionately affecting children in low-income Latino families. A theory-based, promotora-led curriculum, Contra Caries Oral Health Education Program (CCOHEP), was developed to improve low-income Spanish-speaking parents’ oral hygiene behaviors for their young children. The objective of this dissertation was to evaluate CCOHEP for acceptability, feasibility, effectiveness, and the utility of Social Cognitive Theory constructs for improving parental knowledge and behavior around their children’s oral health. Acceptability was assessed through qualitative analysis of twelve Spanish-language focus groups (n=51). Feasibility was assessed through implementation data including attendance and attrition. Effectiveness and theoretical constructs were assessed through a questionnaire verbally administered before, immediately after, and 3 months after attendance at CCOHEP. And within-person change was measured between timepoints. Overall, 105 caregivers participated in CCOHEP (n= 105 pretest, n=95 posttest, n=79 second posttest). 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 posttest, 44% of parents reported completing all aspects of tooth brushing according to professional guidelines (p<.001). Knowledge was high at baseline (mean 12.8 of 16), but 6 knowledge items improved significantly between pretest and posttest. Social Cognitive Theory constructs of outcome expectations and situation were found to be significantly associated with a caregiver brushing their child’s teeth twice a day at baseline and with improvements in that behavior after CCOHEP. Self-efficacy to brush child’s teeth with fluoridated toothpaste, outcome expectation, and environment were all significantly associated with caregivers brushing child’s teeth with fluoridated toothpaste at baseline and with improvements in that behavior after CCOHEP. Eight of the 10 measured SCT constructs improved after attendance at CCOHEP, and were maintained or further improved 3 months after. CCOHEP was acceptable to and 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. Five social cognitive theory constructs were associated with baseline behaviors and improvements in behavior. Further study of CCOHEP is warranted

Implementing care coordination in a large dental care organization in the United States by upskilling front office personnel.

BACKGROUND: Care coordination is a key strategy used to improve health outcomes and efficiency, yet there are limited examples in dentistry. A large dental accountable care organization piloted care coordination by retraining existing administrative staff to coordinate the care of high-risk patients. Following the pilots success, a formal dental care advocate (DCA) role was integrated system-wide. The goal of this new role is to improve care, patient engagement, and health outcomes while integrating staff into the clinical care team. We aim to describe the process of DCA role implementation and assess staff and clinician perceptions about the role pre- and post-implementation. METHODS: Guided by the Consolidated Framework for Implementation Research, semi-structured interviews with clinical and operational administrative staff and observation at the company-wide training session were combined with pre- and post-implementation electronic surveys. Descriptive statistics and mean scores were tested for significance between each survey sample (t-tests), and qualitative data were thematically analyzed. RESULTS: With preliminary evidence from the pilot and strong executive support, a dedicated leadership team executed a stepwise rollout of the DCA role over 6 months. Success was facilitated by an organizational culture of frequent interventions deployed rapidly through a centralized system, along with supportive buy-in from managerial teams and high staff acceptance and enthusiasm for the DCA role before implementation. Following implementation, significant changes in attitudes and beliefs about the role were measured, though managers held stronger positive impressions than DCAs. DCAs reported high confidence in new skills and dental knowledge post-implementation, including motivational interviewing and the ability to confidently answer patients questions about their oral health. Overall, the fast-paced implementation of this new role was well received, although consistent and significant differences in mean attitudes between managers and DCAs indicate more work to fine-tune the role is needed. CONCLUSIONS: Successful implementation of the new DCA role was facilitated by a strong organizational commitment to team-based dentistry and positive impressions of care coordination among staff and managers. Upskilling existing administrative staff with the necessary training to manage some high-risk patient needs is one method that can be used to implement care coordination efforts in dentistry

Building School Nurses’ Capacity to Undertake School Dental Screening: A Pilot Project in Santa Rosa, California

ABSTRACTBackground California school nurses have cited a lack of training as an obstacle to conducting dental screenings. The objectives of this pilot project were to develop educational materials, train school nurses to perform basic dental screening examinations, and evaluate the acceptability and perceived effectiveness of the training program.Methods A two-part training program (synchronous webinar followed by practical session) to train school nurses from Santa Rosa City Schools, California, for conducting basic screening surveys was developed during the COVID-19 pandemic. This was a mixed methods study.Results At baseline, half of the nurses did not feel confident in performing dental screening (10-point Likert scale scores ranged from 2 to 4). After the training, the nurses reported enjoying the training program as well as an improvement in their knowledge and increase in confidence to 1) screen children’s mouths, 2) identify decayed teeth that need treatment, 3) triage oral health care needs appropriately, and 4) refer children to a dentist (average Likert scale scores of 7–8).Conclusions The training program was acceptable to school nurses and increased their perceived capacity to perform school dental screening. This study shows that by training and educating school nurses, it is possible to build their capacity up to the point where they are empowered to confidently perform basic dental screenings.Practical Implications School-based dental programs should consider partnering with school nurses to screen for children with dental needs. This study adds to the literature on inter-sectoral collaborations and team-based partnerships to improve oral health

Maintaining Traditions: A Qualitative Study of Early Childhood Caries Risk and Protective Factors in an Indigenous Community

In lower middle-income economies (LMIE), the nutrition transition from traditional diets to sugary foods and beverages has contributed to widespread early childhood dental caries. This qualitative study explores perceived risk and protective factors, and overall experiences of early childhood nutrition and oral health in indigenous Ecuadorian families participating in a community-based oral health and nutrition intervention. Dental exams of 698 children age 6 months through 6 years determined each child’s caries burden. A convenience sample of 18 “outlier” families was identified: low-caries children with ≤2 carious teeth vs. high-caries children with ≥10 carious teeth. Semi-structured in-depth interviews with parents/caregivers explored the child’s diet, dental habits, and family factors related to nutrition and oral health. Interviews were transcribed and thematically analyzed using grounded theory. In the high-caries families, proximity to highway and stores, consumption of processed-food, and low parental monitoring of child behavior were identified as risk factors for ECC (early childhood caries). In the low-caries families, protective factors included harvesting and consuming food from the family farm, remote geography, and greater parental monitoring of child behavior. The study results suggest that maintaining traditional family farms and authoritative parenting to avoid processed foods/drinks and ensure tooth brushing could improve early childhood nutrition and oral health

Kellerhals Jean (Recueil d'études introduites par), « Le juste : normes et idéaux », L'Année sociologique, vol. 45, n° 2, 1995

Kourilsky-Augeven Chantal. Kellerhals Jean (Recueil d'études introduites par), « Le juste : normes et idéaux », L'Année sociologique, vol. 45, n° 2, 1995. In: Droit et société, n°36-37, 1997. On Side of a Dialogue. Exemples actuels de Socio-Legal Studies au Royaume-Uni. pp. 486-489

Shades of Decay: The Meanings of Tooth Discoloration and Deterioration to Mexican Immigrant Caregivers of Young Children

The objective of this article is to investigate parental understanding of tooth discoloration and decay and their related care seeking for young, Mexican-American children. The research design entailed semi-structured, face-to-face interviews conducted in Spanish with a convenience sample of 37 Mexican immigrant mothers of young children in a low-income urban neighborhood. Five major color terms - white, off-white, yellow, brown, and black - were used to describe tooth discoloration, the causes of which were mainly unrecognized or attributed to poor oral hygiene and exposure to sweet substances. Mothers also described three major levels of deterioration of the structural integrity of teeth due to caries, from stains to decayed portions to entirely rotten. A trend was observed between use of darker discoloration terms and extensive carious lesions. Teeth described as both dark in color and structurally damaged resulted in seeking of professional care. The paper concludes with the finding that Spanish terms used to describe tooth discoloration and carious lesions are broad and complex. Mexican immigrant mothers' interpretations of tooth discoloration and decay may differ from dental professionals' and result in late care seeking. Increased understanding between dental practitioners and caregivers is needed to create educational messages about the early signs of tooth decay

Rollout of the Oral Health Literacy Toolkit in California: A Mixed-Methods Analysis

Background: Formative assessment of the rollout process of the California Oral Health Literacy (OHL) toolkit uses a mixed-methods approach. The OHL toolkit is an educational resource for dental professionals to improve communication with patients. This study was intended to obtain user feedback and suggestions for improvement. Methods: This mixed-methods assessment of the OHL toolkit rollout included anonymous post-training surveys distributed at regional dental societies in California and 1:1 interviews with dental champions who would work with the research team on toolkit rollout. Anonymous and deidentified data were analyzed using R and Dedoose. Results: From surveys (n = 37), the OHL toolkit components of highest interest to respondents were teach-back, increasing health literacy awareness among staff and learning to use plain language communication. Perceived implementation barriers were time constraints, insufficient staffing and a need for more training on communication techniques. Impressions, implementation prospects and recommendations for the OHL toolkit were obtained from qualitative interviews (n = 6). Overall, participants had positive impressions of the training presentation, OHL toolkit and implementation prospects. Conclusion: This study identified interest areas and implementation barriers, data that can be used to further improve the OHL toolkit and reduce barriers faced by practitioners. Further assessments at clinician and patient levels will be helpful for outcomes evaluation. Practical implications: The OHL toolkit is perceived positively by dental practitioners in California. Facilitators and barriers identified by dental providers and champions can be addressed through changes to the OHL toolkit and training. Rollout at the national level is being considered