Residents of rural central Appalachia, an area characterized by poverty, low dental insurance coverage, and health professional shortages, bear a disproportionate burden of oral disease. Reports document adult loss of most or all teeth and children's dental decay in the region at rates 7 times that of the nation. To improve southwest Virginians'access to oral healthcare, in February 2009 Governor Tim Kaine approved an unfunded pilot project allowing public health dental hygienists to provide basic services in the region. Because no evaluation resources were committed for this pilot project, district health directors must use rudimentary measures, such as number of sealants provided, to fulfill the project's mandatory reporting requirements. This community-based dissertation proposal was developed with the input of district health directors to improve evaluation efforts by using a range of qualitative methods to describe the project in more detail. I will draw on multiple ethnographic methods, including semi-structured interviews, focus group discussions, and participant observation research, to document the experiences of adult patients, parents of child patients, and dental hygienists and the dentists who supervise them remotely, as well as stakeholders, and patients and providers who chose not to participate in the project. Consistent with AHRQ's strategic goals of fostering research that investigates health care Efficiency and Effectiveness, this proposal aims to determine how the pilot project to expand access to dental care fared. Following data collection and analysis, I will develop recommendations for how subsequent iterations could be improved to deliver better oral healthcare to one AHRQ priority population, low-income rural residents. This proposal is particularly timely given current debates, nationally, about the possibility of establishing a mid-level dental provider classification in order to increase access to affordable, culturally appropriate dental care in Dental Health Professional Shortage Areas. Finally, this project aims to point toward longitudinal studies of treatment narratives as a novel evaluation methodology.
The proposed research stands to impact state and possibly national policy on intra- and inter- professional jurisdictions of dental health care provision, and attendant practices by providers working in community-based and other public dental health clinics. In order to disseminate results to a wide audience of scholars, policy makers, dental health providers, and other stakeholders, I will produce (1) a dissertation manuscript, (2) a report to stakeholders which will contain recommendations for improving interventions which use task-sharing to increase access to oral health care among low- income rural residents, and (3) articles for publication and papers for presentation in a variety of journals. I will also impact practice by giving lectures to students of dental hygiene, public policy, and other fields at community colleges and 4-year institutions in central Appalachia, while I am in the field. Page 1 of 1 Qualitative description of a dental health pilot project