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

Abstract

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-hour 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 tooth brushing 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 posttests, and again between post-test and three 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 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). Statistically significant improvements were seen in 4 aspects of toothbrushing (p≤.008) between pretest and posttest (all but adult assistance). The second posttest showed 3 of these improvements were maintained, while adult assistance and the other reported behaviors improved (p≤.008). Between pretest and posttest, 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 12.83 of 16), but 6 knowledge items improved significantly between pretest and posttest. Improvements were maintained at second posttest. Conclusions CCOHEP 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.

Acculturation and Pediatric Minority Oral Health Interventions

“…They have been used extensively to reach some groups, such as migrant farm workers, Latino and some Asian communities (47, 56, 58). Several studies have successfully used community health workers or lay community members (who have been trained to deliver interventions) to engage immigrant parents in dialogue about accessing oral health prevention services, providing oral health counseling, and helping in initiating oral health behavior change through Motivation Interviewing (54, 55–59). A study that used a Vietnamese lay health counselor to provide oral health counseling to Vietnamese mothers of preschool children, emphasized that similar cultural background of the counselor was an essential part of adoption of healthy oral health behaviors (58).…”

“…In the Latino community, Promotora -based pediatric interventions for oral health prevention are readily accepted and have been shown to ease recruitment of participants in oral health interventions, increase attendance for intervention activities, and retain the participants for a longer period of time (55, 56, 59). Participating parents seem more comfortable in these setting and, therefore, may ask more questions than in a dental clinic setting, which in turn may help increase the understanding of oral health of their children and could also transform some cultural beliefs that do not support oral health.…”

“…The first successful MI intervention to reduce dental caries in children was done in a South Asian Punjabi-speaking immigrant population in British Columbia, using lay community women to deliver the intervention (57). Another recent study reported on the sustained effectiveness of a culturally sensitive, peer-led caries prevention intervention for Spanish-speaking Latino parents (59). The intervention included components of MI, such as goal setting and participant-driven education.…”

“…The intervention included components of MI, such as goal setting and participant-driven education. However, it also included the elements of social and group support which were appreciated by study participants (59). It has been speculated that MI can help to bridge the gap between the requirements of the Western Dental culture and the cultural beliefs of the immigrant population (57).…”

The role of psychological theories in oral health interventions: A systematic review and meta‐analysis

“…A total of 156 studies were reviewed in full text for the eligibility check, and finally, 19 articles were entered into the meta-analysis [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] ( Table S4). Our findings indicated that the SMD of HBM was 0.37 (95% CI: 0.24, 0.51; Figure 2).…”