This exploratory grant proposal responds to NCI/NIDCR PAR-13-132: Understanding and Promoting Health Literacy (R21), and aims to understand current oral health literacy of dental providers (dentists and dental hygienists) regarding human papillomavirus (HPV)-related oral disease. "Health literacy is not just about individual patients, but also includes health care providers and other decision makers".1 Broadening traditional applications of health literacy that focus exclusively on patients'ability o obtain, process, and understand health information,2 this exploratory grant examines dental providers'health literacy and their ability to promote HPV-related health literacy among patients. Current primary care providers involved in the prevention of HPV-related ano-genital cancers (e.g. cervical and anal) include pediatricians, family practitioners and OB/GYNs.3 The emerging evidence linking HPV and oropharyngeal cancers (head and neck) necessitates that dental providers become the next group of primary care providers who will become involved in HPV-related cancer prevention. Despite an overall reduction in the incidence of oral cavity and pharynx cancers in the US,4 the incidence of HPV-related oropharyngeal cancers has increased.5,6 In response, the American Dental Association (ADA) recommends dentists "educate themselves and their patients about the relationship between HPV and oropharyngeal cancer..."7 It is therefore critical that dental providers are aware of HPV and oropharyngeal cancer connections and be prepared to communicate information about HPV to patients.8 Despite recognizing the role dental providers play in informing patients about HPV and oropharyngeal cancers, professional associations have not yet provided guidelines or educational tools for how dental providers should discuss these connections with patients. Our study is therefore guided by the following specific aims: 1) Understand the current state of HPV-related oral health literacy among dental providers by conducting focus groups with dental providers at national conferences. 2) Determine multilevel system factors for promoting HPV-related oral health literacy through in-depth interviews with dental professional association officers and opinion leaders. 3) Create a systems model (based on Aims 1 and 2) for future development and testing for increasing HPV-related health literacy among dental providers at intrapersonal, social, economic, and professional levels via a systems-thinking approach with the research team and expert panel.
These aims contribute to the study's overall objective to identify and model multilevel determinants for oral health literacy among dental providers. This study is innovative as it engages dental providers in primary prevention efforts, and is timely in that it responds to three Healthy People 2020 objectives, as well as a growing need for reducing the rate of oropharyngeal cancers.
By 2020, it is estimated that oropharyngeal cancers will be the leading cancer attributed to human papillomavirus (HPV). As both biomedical evidence and public awareness of the HPV-oral cancer link increases, dental providers can play a critical role in discussing the association between HPV and oral cancer. The purpose of this exploratory study is to understand dental providers'oral health literacy, and to engage dental providers as key agents of change by assessing their current knowledge of HPV-related oral cancers while exploring what factors may allow or impede providers'ability to discuss HPV-related cancer prevention with patients.