Can you work on this

Oral Health Care, Education, Awareness and Intervention in the Southside of Chicago

BACKGROUND AND RATIONALE

Oral health is the strength of your mouth, including our teeth, gums, throat, and the bones around the mouth. Issues similar to gum illness might be a sign that you have medical problems. Gum disease is a disease brought about by plaque, which is a tacky film of microbes that structures on your teeth (U.S. Division of Health and Human Service, 2017).

According to the U.S. Department of Health and Human Services, oral health is relevant to general health as it can give indications of nutritional deficiencies and infections that influence the whole body that be first detected on account of oral issues. More than 33% of the U.S. population (100 million individuals) do not have access to community water fluoridation (U.S. Division of Health and Human Services, 2017). Also, more than 108 million children and adults do not have dental insurance, which is over 2.5 times the number who do not have medical insurance. (U.S. Division of Health & Human Services, 2017).

Oral health can affect personal health, mental, and psychological health. The effect of oral health can undermine one's self-image and self-esteem. This low self-esteem might lead to depression if not managed properly. In the U.S, dental care is an issue that is yet to be solved for most Americans. The rising cost of dental services as well as the unethical preference of most dental care clinics for private or self-pay patients and premium insurance patients further alienate patients with dental needs. Being selective of dental coverage by some dental care clinics greatly affects low-income individuals who depend on government insurance as they are unable to get care as needed because of their insurance plan. In the U.S, people of color experience a disproportionate level of oral health problems as compared to white individuals (Office of the Surgeon General, 2019). According to a research report by Feinberg, 36% of African American and Hispanic adults have an untreated disease, as compared to the 22% of Caucasians in the U.S. (Feinberg, 2015).

TARGET AUDIENCE

The target population used for oral health intervention is women and children. According to a report by CDC, children aged 5-19 years with untreated dental caries: 16.9% (2013-2016) of adults aged 20-44 with untreated dental caries: 31.6% (2013-2016) (Center for Disease and Prevent, 2017). Also, one in four American adults has untreated tooth decay which equates to almost 2.5 million in the U.S. (University of Illinois College of Dentistry, n.d). In Chicago, it is estimated that at least half of the population of 11 years and under have cavities. Also, about 65% of third graders have cavities and more than half go untreated (University of Illinois College of Dentistry, n.d)

The proposed program intervention will be conducted in the Southside neighborhoods of Chicago. This location was chosen because the inhabitants make up a population that is underserved and do not have access to oral health education, awareness, and care. Oral health is an essential and integral part of people's overall health. According to the report by Heartland Alliance, good oral health requires a comprehensive approach to prevention where oral health education and awareness of care like the use of fluoride toothpaste, access to fluoridated water, regular access to dental care, a routine of home dental care, and a nutritious diet that contains less sugar.

The intervention offered in the Southside of Chicago will incorporate the above-listed stated comprehensive approach for the target population for the intervention. According to the health assessment report by Heartland Alliance (2011), there were about 66 safety net dental clinics in Chicago that provide care for the underserved population. There were about 753,281 Medicaid enrollees in Chicago with only one safety net clinic for 11,400 enrollees. The dental care offered to the 11,400 enrollees was further limited because the majority of these clinics do not provide a full range of basic dental services to its recipients (Heartland Alliance, 2011).

The first intervention is to assess the community for their input with regards to dental needs. When this is completed, next we offer oral health education workshop to parents to understand the community needs, as well as identify good intervention services that will meet the needs of the people on the South Side of Chicago.

The next intervention to be implemented is to provide low-income and vulnerable populations especially mothers and children in the Southside of Chicago with access to dental care. These will be by partnering with FQHCs clinics located in the South Side of Chicago to offer free dental care to mothers and children in the community aged 18months to -12 years old. Also, the investigators in the intervention will partner with Cook County hospital to offer sliding scale fees to patients with advanced dental care like teeth surgery, etc. Furthermore, investigators will partner with hospitals in Chicago like Presence Health Care that have mobile vans to provide free dental services every six weeks to mothers and children in the Southside of Chicago.

Community Health Workers involved in the intervention will be able to incorporate dental health education and awareness to mothers and children. This exercise will be conducted in three sections which is offering dental health education to participants that show up for the dental service outreach, and scheduling home visits and phone call conversations to educate mothers and children about dental health.

During the dental van service outreach, trained CHWs will engage in registering mothers and children who show up to receive dental care, then followed by dental health education and awareness. The education section would be fluoride awareness and education where trained CHWs will give a brief overview of the fluoride effects, and the different measures to get fluoride to the teeth. Fluoride varnish will be recommended for mothers to receive during their visit to the dentist. Mothers will also be educated on the different measures of how to incorporate fluoride daily in toothpaste and water.

After the dental education and awareness, the mother will be allowed to see a dental assistant or dental hygienist. After each dental care, mothers or children with severe dental health will be referred back to CHWs to schedule a follow-up appointment either through a home visit or phone call conversation.

Intervention will be scheduling home visits. Two assigned home visits will be carried out during the intervention. This home visit will be conducted twice a year. The first home visit will consist of a brief overview of dental health, the effect, and the awareness of fluoride to the teeth, and the benefit of brushing and flossing regularly especially at bedtime. The home visit will create an opportunity for participants who were involved in the dental van outreach and were recommended for further dental care will be referred to hospitals and clinics that will be able to take care of their dental needs. Furthermore, participants that are unable to schedule a dental appointment by themselves will be offered the opportunity to help schedule an appointment for them.

The second home visit will be a follow up visit where participants will be evaluated to see how there are doing and what had changed after the first scheduled home visit. The follow-up appointment will also enable participants to ask questions about their dental health as well as other issues that they might need clarity on.

Another form of intervention will be through the phone. This will be offered to participants who prefer receiving dental education and awareness through the phone. CHWs will present a brief overview of dental health, the effect, and the awareness of fluoride to the teeth as well as the benefit of brushing and flossing often especially at bedtime. Referrals will also be offered to participants who require dental care in the hospital or clinics.

The first goal of the intervention is by the end of 12 months, mothers and their children ages 18months to -12 years old in Southside Chicago will exhibit significantly improved oral health because of increased access to oral healthcare. The second goal of the intervention is to reduce tooth caries and cavities in children ages 18 months-12 years old on the Southside Chicago because of knowledge implemented by mothers through educational programs and awareness through the home visit and dental van outreach services.

The evaluation research design plan used for the intervention is a Pre & Post-test with Follow-Up. This kind of research design collects data before the program begins, at the end of the program, and at some point in the future of the program. The research design is appropriate for the intervention and the target population because it will help the investigators understand what kind of intervention approach through the data collection will best fit the people on the South Side of Chicago.

Before the program begins a pre-test will be conducted by parents of children who will participate in the oral health education workshop. The post-test will be conducted during their routine visit at dental van service outreach. The pre-test will have the following questions:

· How many times a day are your children brushing their teeth?

· How many times a day do you (mother/father) brush your teeth?

· What kind of food do the parents provide their children to eat?

· Does the family have dental insurance?

· How often do parents visit dental clinics with their children?

The data collected from these pre-test questionnaires will inform the intervention investigators on understanding the community needs, as well as identifying good intervention services for meeting the needs of the people on the South-Side of Chicago.

A post-test will be conducted

Once the participant decides that they no longer want to participate in the program. The post-test may be conducted at any point during the intervention. Parents in the South Side of Chicago will be asked the following

Questions in a post-test questionnaire:

·       Do parents feel they have benefited from the intervention program that has been going on for the past year?

·       Do parents have any concerns or need more clarity about the intervention?

The Follow - Up will be conducted 6 months after their last date of participation with the program. This will be conducted as a phone call interview where participants will be asked about their current oral health habits and if they have seen any changes in their oral health since participating in the program.

 

Intervention Strategy:

Oral Health care will be conducted through outreach dental van services, FQHCs Clinics, Cook County Hospital, and Phone calls conversations, home visits, and seminars to educate and create awareness to participants recruited for the intervention. The intervention will involve CHWs, Research Specialist, Program Manager, dental assistants, and hygienists. This intervention will target people of color living in the Southside of Chicago.

References

Centers for Disease and Prevention (CDC). (2017). Oral and Dental Health [Website]. Retrieved from: https://www.cdc.gov/nchs/fastats/dental.htm

Feinberg, M. (2015). Minority oral health in America: despite progress, disparities persist. Kelly RL. Kelly report.https://www.ada.org/~/media/ADA/Advocacy/Files/160523_Kelly_Report_Dental_Chapter.pdf?la=en

Heartland Alliance. (2011). The Burden of Oral Disease in Chicago Chicago Community Oral Health Forum (CCOHF). Retrieved from [website]: https://www.heartlandalliance.org/oralhealth/wp-content/uploads/sites/19/2016/0/the-burden-of,-oral-disease-in-chicago.pdf

Journal of American Academic of the Pediatrician. (2008). Preventive Oral Health Intervention for Pediatricians. Retrieved from [website]: https://pediatrics.aappublications.org/content/122/6/1387

Office of the Surgeon General. (2019). Surgeon General Priority: Oral Health [Website]. U.S. Department of Health &Human Services. Retrieved from:

https://www.hhs.gov/surgeongeneral/priorities/oral-health/index.html

University of Illinois Chicago College of Dentistry.(n.d). Prevention and Public Health

[Website].Retrieved from https://dentistry.uic.edu/community-health/prevention-public health

U.S. Department of Health and Human Services.(2017).Oral Health [Website]. Retrieved from:

https://www.womenshealth.gov/a-z-topics/oral-health