Evaluating the Effect of a Community-Based Lay Health Advisor Training Curriculum to Address Immigrant Children's Caries Disparities

Abstract

Previous programs had not designed the culturally adequate Lay Health Advisor (LHA) oral health training curriculum for medically underserved population. We evaluated the effects of LHA training curriculum for addressing immigrant children's caries disparities in their access to dental care. We used a pre/post-test study design. Immigrant women were recruited from churches, schools, and immigrant centers in an urban area. Four training classes were held. Each training cycle lasted 15 consecutive weeks, consisting of 1 weekly 2-h training session for 12 weeks followed by a 3-week practicum. The curriculum included training in caries-related knowledge, oral hygiene demonstrations, teaching techniques, communication skills, and hands-on practice sessions. Thirty-seven LHA trainees completed the course and passed the post-training exam. The data were collected using self-report questionnaires. The level of oral health knowledge, self-efficacy and attitudes toward oral hygiene were significantly increased after LHA training. There was a significant and over twofold increase in trainees' oral hygiene behaviors. An increase of >20% in LHA and their children's dental checkup was observed following training. After training, LHAs were more likely to have 3+ times of brushing teeth [Odds Ratio (OR) = 13.14], brushing teeth 3+ minutes (OR = 3.47), modified bass method use (OR = 30.60), dental flossing (OR = 4.56), fluoride toothpaste use (OR = 5.63) and child's dental visit (OR = 3.57). The cross-cultural training curriculum designed for immigrant women serving as LHAs was effective in improvement of oral hygiene behaviors and access to dental care.

Association of Oral Health Literacy and Dental Visitation in an Inner-City Emergency Department Population

“…In fact, the Institute of Medicine 2011 report Oral Health in America recommends promoting oral health education through all state and local health systems, and not just dental providers [39]. Alternatively, the use of community-based lay health advisors has demonstrated improvements in OHL in Taiwanese children—a strategy that holds the potential for effective improvements in OHL in other populations [40]. Regardless of the mechanism, pre-test and post-test designs should be implemented to evaluate the effectiveness of such interventions.…”

Enabling Elements for the Implementation of Community Health Promoter Led Interventions: A Literature Review

“…Thus, the importance of conducting culturally relevant actions in the health promotion framework has been widely demonstrated through literature. This is specifically evident in experiences carried out with social minorities where the intervention success rate depends on the proper selection of health promoters who belong to these minorities and/or bilingual speakers who are able to establish open and regular communication that allows them to address the health issues in their community due to the deep knowledge they have about the context, daily actors and the problems faced, as well as taking part in the constitution of a supportive network (Szilágyi, 2002;Ayala et al;Tran et al, 2014;Hsu et al, 2015).…”

“…Five interventions focused on the community members who got benefited by them. Thus, the "Community-Based Lay Health Advisor Training Curriculum to Address Immigrant Children's Caries Disparities", the "Community-based safe Motherhood promoters" and the "Peer-led school-based HIV/ AIDS prevention among youths", based intervention assessment impact on those aspects related with acquired knowledge, as well as self-efficacy reports with respect to the main subject addressed by the different programs (Cai et al, 2008;Mushi et al;Hsu et al). Meanwhile "The World of Malaria" and "Peer led AIDS prevention program for students in an alternative school" evaluated the intervention impact with just one parameter: acquired knowledge and selfefficacy perceived for the risk factor management and exposure leading to the disease, respectively (O'Hara et al, 1996;Carvajal et al, 2010).…”

Long‐term effects of a lay health advisor intervention on immigrant children’s dental caries and maternal preventive behaviour: A randomized controlled trial

“…The 5-year Lay Health Advisor Approach to Promote Oral Health Program (LHA-POHP) was first implemented in the Kaohsiung area, Taiwan, in 2011. 1,8,14 Our previous studies have highlighted an oral health disparities between immigrant and Taiwanese children 1 and poor dental caries-related knowledge, attitudes towards oral hygiene, and oral hygiene behaviours among immigrant mothers. 8 We therefore implemented an LHA intervention strategy for immigrant mothers.…”

“…8 We therefore implemented an LHA intervention strategy for immigrant mothers. 14 In the present study, we evaluated the long-term effectiveness of the LHA intervention on immigrant children's dental caries experience and maternal dental cariesrelated preventive behaviours.…”