Health Promotion with Vulnerable Populations: Testing a Pilot Intervention to Improve Pediatric Oral Health

Background and Purpose: Oral health affects key elements of health and well-being such as self-esteem, activity level, and quality of life (Martino, 2011; Drum, Chen, Duffy, 1998). Early childhood caries is the most prevalent chronic disease of childhood in the United States. Approximately 80% of caries disease burden is carried by 25% of children between the ages of 5 – 17. Children in minority and traditionally underserved populations are disproportionately affected by caries and less likely to receive preventive care and treatment. Given that early childhood caries can be prevented and treated, interventions—like the one reported here—present opportunities to eliminate disparities and inequalities. Ecological perspectives and psychosocial interventions have been empirically associated with improved oral health outcomes. Social work, therefore, has a unique opportunity for interdisciplinary collaborations to increase family involvement in oral health prevention and maintenance to enhance positive oral health outcomes for children. We hypothesized that following a training intervention, support staff in a large teaching hospital dental clinic would have increased self-efficacy, knowledge, and attitudes to communicate with families about dental caries.

Methods: This pilot study used a one-group pretest-posttest design to test the effectiveness of a training intervention. Utilizing constructs from the Theory of Planned Behavior and the Social Cognitive Theory, knowledge, attitudes, and self-efficacy, we framed the content of a training intervention and administered a 28-item survey individually and in-person to the dental clinic support staff (n = 20), two weeks before the intervention and six weeks after the intervention. The two hour training intervention, empirically supported by formative data, was delivered by the clinic's Dentist in Chief.

Results: The pre-test and post-test results indicated a significant improvement in mean test scores from baseline (p < .01). The training intervention demonstrated merit in increasing self-efficacy, attitudes and knowledge among clinical care staff. Specifically, a paired-samples t test for the sample was conducted to evaluate whether there was a change in self-efficacy and attitudes and a Wilcoxon test for the sample was conducted to evaluate whether there was change in knowledge of etiology and risk factors for early childhood caries.

Conclusions and Implications: Although the findings support our hypothesis, the non-comparison group design has significant weaknesses. Despite these limitations, findings from this pilot study support the efficacy of training to increase support staff's self-efficacy, knowledge, and attitudes to communicate with families about dental caries. Support staff are more likely to spend more face-to-face clinic time with families than dentists, and are often closer to the patient population across dimensions of age, culture, and social class. They are, therefore, ideally situated to deliver appropriate and consistent messages about oral health preventive care and maintenance to parents of children at high risk for caries. Findings from this pilot study are being used as formative data in a larger and now ongoing investigation of oral health outcomes in the clinic population. Additionally, this pilot study confirms the role social work can play in the training of dental staff to improve their interactions with patients.