The goal Of RC3 is to demonstrate the effectiveness of specially trained American Indian (Al) Community Oral Health Specialists (COHS) for delivering a caries prevention program to children enrolled in Head Start programs on a large Al reservation in the Southwest.
The specific aims of the project are: 1) to develop a manualized intervention protocol for a caries prevention program delivered by COHS;2) to implement and evaluate the feasibility and acceptability of a COHS-delivered program of oral health promotion and fluoride varnish (FV), as well as a more traditional FV program delivered by dental assistants;and 3) to compare the two programs in terms of secondary outcomes (caries patterns, cost-effectiveness, dispersion effects), as well as any differences identified by potential moderators and mediators that appear to affect outcomes. Head Start Centers (N=32) in communities across the reservation will be randomly assigned to one of the program conditions. The COHS condition will differ from the VAR condition primarily in that activities will include a proactive approach to working with children and their parents to initiate effective home oral health behaviors, as well as community educational activities. Fluoride varnishes will be provided quarterly in both programs. Children will be followed for two years, with caries assessments by calibrated dental hygienists at baseline, 1 year, and 2 years. The content of the COHS training protocol, which originally was developed in a pilot study that was implemented on a Northern Plains reservation, will be reviewed and revised with community input. This study provides a conservative evaluation of the COHS approach, which is designed to overcome resistance to cultural barriers to accessing established dental care services, and to make preventive services more widely available. Rather than comparing the COHS model with standard, higher cost, professional services, we are making a comparison with low-cost providers who will be deployed in a community setting to provide an intervention that consists primarily of a pharmacotherapeutic service (FV) that has proven efficacy for caries prevention. COHS providers, also low cost personnel, will deliver FV as well, so the central research question is whether a focus on personalized and community oral health promotion provided by someone clearly identified with the community provides a significantly greater effect on caries incidence than a low-cost pharmacotherapeutic prevention program. As questions continue to be raised about new delivery models for populations in rural and other underserved settings, this study will provide important information about the model of a prevention specialist trained in a 4-week program to work for improvement in the oral health of preschool children. It is anticipated that this study will be informed and further shaped by early results from RC1.
|Braun, Patricia A; Lind, Kimberly E; Henderson, William G et al. (2015) Validation of a pediatric oral health-related quality of life scale in Navajo children. Qual Life Res 24:231-9|
|Wilson, Anne; Brega, Angela G; Batliner, Terrence S et al. (2014) Assessment of parental oral health knowledge and behaviors among American Indians of a Northern Plains tribe. J Public Health Dent 74:159-67|
|Albino, Judith; Tiwari, Tamanna; Henderson, William G et al. (2014) Learning from caries-free children in a high-caries American Indian population. J Public Health Dent 74:293-300|
|Tiwari, Tamanna; Quissell, David O; Henderson, William G et al. (2014) Factors Associated with Oral Health Status in American Indian Children. J Racial Ethn Health Disparities 1:148-156|
|Quissell, David O; Bryant, Lucinda L; Braun, Patricia A et al. (2014) Preventing caries in preschoolers: successful initiation of an innovative community-based clinical trial in Navajo Nation Head Start. Contemp Clin Trials 37:242-51|
|Batliner, Terrence; Wilson, Anne R; Tiwari, Tamanna et al. (2014) Oral health status in Navajo Nation Head Start children. J Public Health Dent 74:317-25|
|Tiwari, Tamanna; Casciello, Alana; Gansky, Stuart A et al. (2014) Recruitment for health disparities preventive intervention trials: the early childhood caries collaborating centers. Prev Chronic Dis 11:E133|
|Batliner, Terrence; Fehringer, Karen A; Tiwari, Tamanna et al. (2014) Motivational interviewing with American Indian mothers to prevent early childhood caries: study design and methodology of a randomized control trial. Trials 15:125|