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Assessment of Changes in Access/Utilization and Oral Health Behaviors Among Children Participating in the Oral Health Project at 12-Month Follow-Up
By Juan M. Chavez
Professor Annette Aalborg, Dr. PH, Faculty Advisor Professor Gayle Cummings, MPH, Faculty Co-Advisor
Master of Public Health Touro University – California, 2015
Acknowledgements A sincere thank you…Advisors• Professor Annette Aalborg, Dr. PH, Faculty Advisor• Professor Gayle Cummings, MPH, Faculty Co-Advisor• Professor Jaesin Sa, Ph.D., CHES, Faculty
Elsa Widenmann School Based Clinic: Dental Clinic • Janelle Glosser • Maruluz Rodriguez• Dr. English, DDS
Kristine Lalic – Solano County Coalition for Better Health
All the parents and students who participated in the Oral Health Project
Presentation Outline Capstone Thesis Project: Study Overview
Literature Review/Related Work
Background of Oral Health Project
Problem Statement
Introduction to Oral Health Project
Study Aim
Methodology
Results
Summary
Literature Review
o Oral health key to overall child health (Kwan, et al., 2005)
o Access to preventive case important (Gillcrist et. al, 2001)
o Many children do not have equal access to dental services (Butani, et al., 2009)
o Parents participation in is key (Gould, et al., 2008)
o School Based Interventions found to be successful (Stokes, et al., 2009)
Related Work• The the project incorporated elements from two large national
family oral health projects:
o One in Detroit/University of Michigan focused on low-income African-
American families. (Finlayson, et al., 2007)
o Another major Oral Health Project in New York (NYU) (Tellez, et al., 2006)
• Both focused on general pediatric populations with significant oral
health problems.
• The project adapted elements from these two projects (Surveys)
Oral Health Project Background• Oral health Project is a collaboration between:
• School-Based Health Center at Elsa Widenmann• Vallejo City Unified School District • Touro University • Dental Health Professionals • Solano County Coalition for Better Health
• This collaboration identified oral health care as an unmet need for the families
• This project integrates oral health with existing primary care.
• Serves low-income families lacking access to oral health services.
• The project is grant funded by the Health Resources and Services Administration (HRSA).
• TUC’s role was designing and implementing the program evaluation.
Problem Statement
• Oral health is a serious and often neglected Public Health problem particularly in communities like Vallejo
• The goal of the Oral Health Project is to reduce the disparity in oral health care.
• The Oral Health Project uses SBHC as a platform to provide much needed dental services.
• The objective is to instill the importance of oral health in childhood
What is the Oral Health Project?The Oral Health Project
• Established an fully functional oral health clinic.
• Dental professionals provide mainly on-going preventive care children.
• Children qualify if they are considered underinsured.
• Parents are assisted to obtain dental insurance for their child.
• Further, the project provides an standardized oral health education at clinic and in their schools.
This Project’s SummaryProject’s Objective: Assess changes in oral health behaviors and access/utilization of oral health services among the children utilizing parent report data.
Study Procedures: • Enroll participants (parents and children)
• Collect parents reported data from baseline and a one-year follow-up questionnaires (n=100).
• Data collection by Student Research Assistants
Goal:• Provide data to the program stakeholders and the funders
Study Aim
• Our study aim is:
TO DETERMINE IF CHILDREN WHO PARTICIPATED IN THIS PROJECT HAVE IMPROVED ACCESS AND UTILIZATION OF ORAL CARE AND IMPROVED ORAL HEALTH BEHAVIOR AND PRACTICES OVER TIME
MethodologyStudy Design: • Quasi-experimental • Pre-post intervention design
Study Sample • 436 participants were enrolled in the Oral Health Project, this
project sample is a subset of 100 whose follow-up survey was completed.
• The participants:• Underserved• Lacking access to oral health services. • Mostly of low-income• Immigrant Latino families • No dental insurance
MethodsStudy Procedures • Parents/guardians are explained the study (overview) at child’s first clinic
visit..
• Their basic information is collected and they are given a uniquestudy identifier number.
• Informed consent forms are reviewed with parents in detail and the study questionnaire is administered.
• Both English and Spanish.
• Parents complete the survey while the dental professionals see their children.
• At follow-up (12-months post baseline), a shorter version of survey is administered.
• Data collectors are all trained MPH Student Researchers in the Community Health Track from TUC.
Methodology
Data Management
• An identifying number is generated per survey
• Surveys were stored in a secured cabinet
• Data dictionary was developed
• Surveys were coded and entered into SPSS software
• Data was cleaned for analysis
Methodology
Oral Health Project Parent Survey
Measuring Tool
• Adapted from two larger studies
• Developed the survey for our project
• Translated the survey into Spanish
• Survey Main topics
• Takes approximately 40 mins
MethodologyAnalysis Plan:• Descriptive statistics were used to describe the study’s population.
• We are analyzing the first 100 matched participants from the baseline and follow-up surveys.
• The data was entered into SPSS (PASW) software.
• We looked at basic demographic data to describe the sample.
• We used descriptive univariate analysis to provide indications of benefit of the intervention. (Change in access and Behavior)
• For a statistical significance, the “Pearson’s Chi Squared Test” was used.
ResultsDemographics of Children
• 70% Latino/Hispanic
• 75% from married households
• 50% living in households incomes of $10,000-39,000 (Within FPL)
• 56% with parents not employed (staying home to care for children)
• Average age is 7 (2 and 14 most frequented)
• 49 mothers, 1 father, 1 grandmother (n=101)
• Family size per household: 21 families with only one child 15 families with two children 10 families with three children 5 families with four children.
Results
Access to Dental Care for Families
ResultsSignificant Findings • Children having a dentist
Increased from baseline to follow up dramatically from 29% to 78%Chi-Square (having insurance):
P=0.262 at baseline to p=0.007 at follow-up
• Caregivers taking their child to see a dentist Increased from 83% from 94% Chi-square (having insurance):
P=0.039 at baseline to P=0.001 at follow-up
• Having dental insurance that covered dental care Increased from 54% to 67% Government insurance increase 57% to 83%
Results
Oral Health Behaviors
Caregivers intent to take their child to see a dentist within:
• Three-months: Decreased from 48% to 21%
• Six-months: Increased from 42% to 72%
Brushing and Flossing Practices:
• Brushing at least twice a day: Increased 58% to 69%
• Flossing at least at least once a day: Increased 35% to 44%
Summary• School Based Health Centers appear to be an effective way to deliver
oral health services for school children.
• The objective was to observe changes in access and utilization of oral care and improved oral health behavior and practices over time.
• Using this model, the Oral Health Project appeared to have accomplished the aim to reduce the disparity in dental health access among participants.
• Improved access to oral health services was corroborated using Chi-square statistical tests.
• Improved access to oral health services was corroborated using Chi-square statistical tests.
Summary• Data supports an overall increase benefit of the Oral Health
Project in reducing oral health disparity.
• The final study analysis should provide more conclusive and concrete results.
• We can conclude that School Based Health Centers have a strong potential to improve access to oral health services and to potentially reduce disparities in oral health among low-income children.
• More research in the effectiveness of School Based Health Centers could provide enough significant evidence of the value of SBHS in reducing health disparities.
SummarySignificant Limitations• Baseline to Follow-Up Survey Consistency
• Lack of access to the actual visit records of patients
• Study size of the sample
Future Direction
• Oral Health Project will continue to collect data of all participants
enrolled (n=436)
• Final analysis will be similar in methodology as this project
• Abstract for this project was submitted to APAHA
• If selected, will be presented at the annual conference in Chicago, Illinois,
October 31st-November 4th, 2015
ReferencesButani, Y., Gansky, S.A., & Weintraub, J.A. (2009). Parental Perception of Oral Health Status of Children in Mainstream and Special Education Classrooms. Spec Care Dentist. 29(4): 156-162. Finlayson TL, Siefert K, Ismail AI, Sohn W. (2007). Psychosocial factors and early
childhood caries among low-income African-American children in Detroit. Community Dent Oral Epidemiology. 2007 Dec: 35(6):439-48.
Gould, Ellen, RDH, MPA; Goodson, J. Max, DDS, Phd; Soncini, Jennifer DMD; Tavares, Mary, DMD, MPH; Osborn, Valarie RDH; Niederman, Richard, DMD, MA. (2008). A Model For Extending The Reach Of The Traditional Dental Practice: The Forsythkids
Program. American Dental Association. JADA, Vol. 139: 1040-1050. August 2008.
Kwan, Stella Y.L.; Erik Petersen, Poul, et al. (2005). Health-Promoting Schools: An Opportunity For Oral Health Promotion. Bulletin of the World Health Organization. September
2005, 83 (9).Stokes, E., Pine, C.M., & Harris, R.V. (2009). The promotion of oral health within the healthy School context in England: a qualitative research study. BMC Oral Health. 9(3): 1-10. Tellez, Marisol, BDS, MPH, PhD, Sohn, Woosung, DDS, DrPH, PhD, Burt, Brian A.
BDS, MPH, PhD, and Ismail, Amid I. BDS, MPH, DrPH. (2006). Assessment of the Relationship between Neighborhood Characteristics and Dental Caries Severity among Low-Income African-Americans: A Multilevel Approach. Journal Public Health Dent. 2006 ; 66(1): 30–36.