The African American (AA) Gullah population has a higher rate of oral health (OH) disparities when compared to AAs nationally. OH disparities among this group can be attributed to several factors including fear, lack of trust in providers, past negative experiences, access to care and cultural beliefs. The proposed study will test the feasibility of a bundled, multi-level intervention, whose design is based on the preferences of the targeted rural Gullah population. If this study demonstrates feasibility we will broaden our recruitment for future R01 with other Gullah communities statewide. Our long-term partnership goal is to have a community clinic in Hollywood with MUSC dental students and faculty. This is a sustainable model where the students would be more engaged and exposed to treating the rural community and the community would have increased access and acceptable and relevant OH care.
The aims of this project are to: 1. Develop a novel, community preferred OH multi-level intervention (Hollywood Smiles-HS) in church settings;2. Evaluate the HS intervention feasibility including intervention dosage and fidelity as well as monitoring and measurement of target outcomes and cost;3. Evaluate preliminary efficacy indications of the HS and estimate outcome measurement variability needed to calculate sample size for a subsequent study of intervention efficacy. A social-ecological model is proposed to guide the intervention, providing a framework for intervening at multiple levels of influence (individual, peer and organizational) on OH behaviors. Cluster randomization will be used to assign 2 churches to an intervention (HS) group (n=30) and a control group (CG) (n=30), thru a coin- toss procedure, for a total of 60 participants. All participants will receive primary standard of care dental therapy at a community dental clinic and transportation passes for each of the dental visits. Participants, members of the church in the HS group will also receive a 3-month multi-level intervention that will include 1:1 contact with a community OH promoter (COHP), peer educational sessions, and church level interventions. As specified by the aims and guided by the conceptual framework, the outcome measures will include: a) dependent variables of oral health;b) intervention mediator variables (oral health behavior report, oral health literacy, oral health self-efficacy and dental anxiety level);and, d) independent variables (demographic and physiologic measures) and church climate. A systematic process evaluation will be conducted and measures of feasibility will include recruitment, adherence (dosage/fidelity), dropout proportions, acceptability, Church Advisory Board satisfaction, and reach of the intervention.

Public Health Relevance

of this application relates to the use of a non-dental community oral health promoter to improve oral health literacy and access to dental care in their community. The goal of this study is to educate and provide needed direction and assistance in accessing oral health care. Developing an intervention that promotes oral health literacy is necessary to help reduce disparities in this population.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Exploratory/Developmental Grants (R21)
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Health Disparities and Equity Promotion Study Section (HDEP)
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Nowjack-Raymer, Ruth
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Medical University of South Carolina
Internal Medicine/Medicine
Schools of Dentistry
United States
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