The objective of this proposal is to use community-based participatory research (CBPR) methods to increase understanding of how uninsured, low-income, racially and ethnically diverse families with children aged 3 to 10 years access and use dental care, and to identify potential strategies for improvement in their access to care. Our hypothesis, That receipt of oral health services and oral health status among uninsured children from families with low-income is related to cultural attitudes, the priority that individuals assign to preventive dental care, environmental barriers such as transportation, child care, language barriers, and lack of knowledge, in addition to challenges in accessing and maintaining insurance coverage, and the availability of dentists, will be used to explore barriers to accessing oral health care. This study will address gaps in the literature by following uninsured children that receive free oral health care services and whose parents received education regarding oral health and available resources at existing community-based events, Give Kids a Smile (GKAS), in 2011 and 2012 with personal structured parent interviews to determine behaviors, perceptions and barriers and with focus groups to further explore the barriers identified in the interviews.
The Specific Aims are to: (1)Describe the oral health status, oral health behaviors, and SES of children participating in a free community oral health care event through analysis of survey data collected from their parents/guardians at the event and to review children's event dental charts to assess services provided and recommended follow-up care;(2)Examine family follow-through on recommendations for further care and public insurance enrollment and identify barriers to accessing care for preventive and restorative oral health care for children by conducting structured interviews using survey tools with parents/guardians of children within three months following the 2011 and the 2012 community events. (3) Probe barriers to enrolling in public insurance and obtaining dental care and facilitate brainstorming by parents to identify potential strategies to overcome barriers by conducting focus groups with a random sample of parents/guardians using bi-lingual, trained facilitators;and (4) Mail surveys to dentists regarding their attitudes toward and barriers to acceptance of public insurance and/or pro bono care for the uninsured and publicly insured populations. This study uses CBPR methods to follow a difficult to reach population following a community oral health intervention. Using both qualitative and quantitative research methods, it will explore environmental and cultural barriers to care beyond the insurance and health care system. The findings will contribute information to address cultural and environmental barriers to oral health care, help providers improve practice and access;stimulate further studies, targeted health/dental interventions, and policy changes;inform development of more effective interventions;and enhance the translation of the research results into oral health practice.
This exploratory research study is significant in that it will contribute to the timely and beneficial use of information that may help the public health community and dental care providers to promote increased health and dental care services to the economically disenfranchised target population. The findings could stimulate further studies, targeted health and dental interventions, and policy changes which might benefit uninsured children. This study has strong implications for translating research into practice and policy.