Smile Today, Smile Tomorrow
Access to Oral Health Initiative
Katelyn Espenship
Liberty University
HLTH 634-B01
March 5, 2020
Overview
Smile Today, Smile Tomorrow is a nonprofit organization, originally founded in Morehead City, North Carolina, and has recently started a new chapter based out of Lynchburg, Virginia. The main focus is on providing dental health education and services for children and low-income adults. Smile Today, Smile Tomorrow’s sponsoring agency is The Virginia Dental Association Foundation. For more information contact Katelyn Espenship at kespenship@liberty.edu.
Vulnerable populations, like underserved children and adults, needs these services the most yet are the last ones to receive them. Instead of bringing the patients to the services, bringing the services to the patients fills in the unmet gaps and disparities within oral health. For ages 5-17, the most common chronic disease is dental caries (tooth decay). Each year, about 250,000 school hours are lost due to dental disease.13 For low-income adults, 25% of one research study’s respondents stated that due to cost they have not received needed dental care.10 Other issues relating to oral health is the belief that if someone does not feel any pain or see any issues then him or her does not need to visit a dentist, and the belief that flossing is not as important as brushing the teeth.
School-based oral health programs were found to be more effective and efficient in addressing and providing oral health care and preventative services to underserved children than community-based programs.5 Additionally, research studies have stated that mobile dental units/clinics are appropriate for enabling access to oral health preventive and treatment services, addressing unmet oral health service needs and increasing oral health literacy.8
In order to help children and low-income adults living in Lynchburg, Virginia to access oral health services and practice better oral hygiene, we will focus on the benefits from oral health education and treatments through school-based oral health programs and mobile dental clinics.
Objective 1: By August 2021, at least 40% of all participants in the school-based oral health programs will utilize at least 1 oral hygiene technique, as measured by a 6 month follow up survey.
Objective 2: By August 2021, at least 30% of all participants who visited a mobile dental unit/clinic will utilize at least 1 oral hygiene technique, as measured by a 6 month follow up survey.
After the oral hygiene education intervention, the participants should be able to utilize the given information to practice better oral hygiene and prioritize oral health. One short-term outcome is the increase of children and low-income adults using proper oral hygiene techniques. A long-term outcome is the increase in annual dental visits for checkups and teeth cleanings. While the intervention includes providing education, resources (toothbrushes, toothpaste, and floss) and services (dental cleanings, screenings, sealants, etc.), establishing a dentist can be hard for both priority populations. This barrier steams from lack of access to a dentist, transportation issues, and financial burdens. This intervention will help ease the financial burden of dental care services and provide necessary oral hygiene education in hopes to increase preventative care measures taken. My company will emphasize the importance of “bed side” manners and meeting the true needs of the community. Hopefully, the intervention will continue to be available in the Virginia school systems as well as the continuous availability of the mobile dental units/clinics. Using a combination of school-based oral hygiene programs and mobile clinics can address the gaps in access to oral health care services.
In regard to the communication objectives, the promotional materials will give a basic, brief description on our nonprofit organization, Smile Today, Smile Tomorrow, and the school-based oral health programs and mobile dental clinics. It will be stated that the mobile dental clinic services are either free or on a sliding scale depending on the location. Most importantly, the promotional materials will mention the importance of oral health in relation to overall health and that everyone deserves a reason to smile.
My primary target audience is children of all income levels attending public school in Lynchburg, Virginia and adults of low-income level status living in Lynchburg, Virginia. Two physical characteristics of these audiences are age and sex, children in kindergarten through high school, and adults ages 18 to 65 and both sexes, respectively. As for the cultural category, this program will focus on all racial and ethnical groups. Dental care services had the highest financial barriers over all other types of health care services across all age groups and all insurance categories.10 With that being said, the main demographic characteristic utilized by this intervention is income. Those with no pressing dental issues do not see the necessity in going to the dentist for annual exams and teeth cleanings. This is the main psychographic characteristic of both groups. Both groups also tend to choose less healthy meal options due to costs as well as accessibility of food options. The secondary target audiences are the parents and guardians of the children as well as those living with low-income adults. They will have knowledge of this intervention and indirect access.
Market Research
To pretest the materials, I visited Passion Community Church Service and approached a group of children and their parents. I spoke with all the parents about my assignment and asked for their permission for their kids to participate in evaluating my brochure. The children were in 7th and 8th grade, which falls into one of my target audiences of children in kindergarten to high school in Lynchburg, Virginia. As a group, I asked the children these questions:
- Do you understand the message?
- What parts of the brochure make sense? What parts don’t make sense?
- Do you think the information is relatable to you?
- Does the topic make you uncomfortable?
Overall, the group understood the message of the brochure and said that the information was relatable to them. They stated that the topic of preventive oral health tips did not make them uncomfortable, but that they had seen gross pictures at their dentist offices. One child mentioned specifically that she liked the fluoride information because she had heard about it but never understood why it was important. The children thought the brochure was interesting but not as colorful or eye-catching as it could be.
Material Distribution and Program Promotion
Because this intervention is implemented in multiple age groups and socioeconomic statuses, a multi-channel approach is needed. The intervention will be marketed through posters and flyers throughout schools, community centers, health departments, clinics, and hospitals in the State of Virginia as well as on Virginia school websites and other Virginia social media platforms. Some examples include the Lynchburg Health Department, the Bedford County Health Department, and the Campbell County Health Department. Additionally, Virginia radio stations including WINC (92.5 FM), WSLC (94.9 FM), and WROX (96.1 FM), will broadcast the mobile dental clinic locations three times a week.
Table 1. Budget for Advertising Materials
| Item | Quantity | Cost (per item) | Subtotal (per month) | Annual Total |
| Flyers/Brochures | 5,000 | $0.10 | $500* | $500 |
| Use of websites, and other social media platforms | – | $150 | $150 | $1,800 |
| Radio Station airtime | 3 | $100 | $300 | $3,600 |
| Total | – | – | – | $5,900 |
While school-based oral health programs are required for all public health schools, the mobile dental clinics need advertisement to maximize support. Advertisement through flyers and brochures throughout schools and common community areas also help maximize support for the school-based oral health programs. By using print and digital promotional materials, more people are likely to utilize these dental health interventions.
The education, treatments, and resources provided through the school-based oral health programs will be free for children. The mobile dental clinics will be free or use a sliding scale for the patients depending on the location. Both interventions will require funding from donors and grants as well as time from dental health professionals. This intervention is worth the price because of the short-term and long-term benefits including an increase in oral health hygiene and an increase in self-confidence among patients.
Partnerships
Potential partner organizations include The Delta Dental of Virginia Foundation and Johnson Health Center as well as local dentists in the community. A potential future collaboration with the local dentists would include a dental health program series at local community centers. The series would focus pediatric oral health, adult dental health, dental health knowledge, and dental health insurance. For example, the pediatric oral health program the dentists will go over everything parents and guardians would need to know to help teach and support the children when it comes to oral health practices including proper flossing and brushing, dental visits, teeth cleanings, and mouth guards for sports.
Guardians and caretakers would also learn how to teach their children to avoid smoking and vaping. Vaping and smoking increase the risk of many types of cancer including oral cancer. Additionally, the dentists would talk about what to do for dental emergencies and be available to answer questions and make referrals. At least one registered dietician (RD) would be available at each location. The RDs would speak about eating habits, teething, use of pacifiers, and sucking thumbs/fingers. The RDs will be available to answer questions and make referrals for attendees. Each location would have a booth with community resources and educational materials about oral hygiene and dental health for adults and children. The Delta Dental of Virginia Foundation has kindly donated oral health kits that will be given out at the end of the program.
Evaluation
Planning, implementing, and evaluating are all important steps of changing behavior through interventions. Program evaluation is essential in understanding how and why interventions work or do not work. Reasons for evaluation include the ability to monitor the progress of the intervention, to determine if desired outcomes are being produced, to justify any further support or funding, to ensure program effectiveness is maintained, and to provide continuous adjustments and improvements.15
The program evaluation for my intervention will focus on answering these three questions:
- Was the program beneficial in knowledge gained for the participants?
- Was the program beneficial in encouraging participants to implement learned strategies?
- Did the program meet stakeholder expectations?
Data will be collected informally through stakeholder interviews before and after the intervention is implemented in the community, which will determine if the stakeholder expectations were met. Pretests and posttests will be used to determine if the intervention was beneficial in knowledge gained for the participants. Additionally, follow up surveys will be disseminated 6 months after the intervention is implemented. This will measure if the program was beneficial in encouraging participants to implement any learned oral health and hygiene techniques or strategies. Incentives such as oral hygiene kits, which include toothbrushes, toothpaste, floss, and mouthwash, will be given to participants.
To conduct a culturally competent evaluation, the pretests, posttests, and follow up surveys will be the same layout for all sub-groups within the priority populations; however, they will be tailored in regard to literacy levels for each respective sub-group.16 Furthermore, these materials will be available in English and Spanish. To limit bias and provide confidentiality, personal identifiers will be removed, and each participant will be assigned a number. A third party will be responsible for assigning the numbers upon receiving the matching pretests and posttests as well as follow up surveys. The pretests and posttests will be analyzed via a paired sample t-test through SPSS after it is cleaned and properly coded. After the data is analyzed, an evaluation report, including recommendations, will be created and sent to stakeholders. Potential limitations include the accuracy of the self-reported data via follow up surveys, and whether the behavior change is due to this specific intervention or outside sources.
I chose to apply the Social Cognitive Theory to my intervention. This theory focuses on personal characteristics, behavior, and social environment. By using the social cognitive theory, I am able to focus on participant’s values and actions but most importantly, their environment before and after receiving access to oral health education and dental services. Additionally, this theory perceives the environment (social, physical, etc.) as a major influence on health behavior and the ability to change health behaviors. As mentioned in a previous discussion board, I chose to use the Health Belief Model for this intervention. The intervention uses skills-based education to address the constructs of the HBM including perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. Overall, the theory and model chosen will work hand in hand in to support the intervention by concentrating on the individual’s characteristics and the environment.
Psalm 23:3 