The goal Of RC3 is to demonstrate the effectiveness of specially trained American Indian (Al) CommunityOral Health Specialists (COHS) for delivering a caries prevention program to children enrolled in Head Startprograms on a large Al reservation in the Southwest.
The specific aims of the project are: 1) to develop amanualized intervention protocol for a caries prevention program delivered by COHS; 2) to implement andevaluate the feasibility and acceptability of a COHS-delivered program of oral health promotion and fluoridevarnish (FV), as well as a more traditional FV program delivered by dental assistants; and 3) to compare thetwo programs in terms of secondary outcomes (caries patterns, cost-effectiveness, dispersion effects), aswell 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 theprogram conditions. The COHS condition will differ from the VAR condition primarily in that activities willinclude a proactive approach to working with children and their parents to initiate effective home oral healthbehaviors, as well as community educational activities. Fluoride varnishes will be provided quarterly in bothprograms. Children will be followed for two years, with caries assessments by calibrated dental hygienists atbaseline, 1 year, and 2 years. The content of the COHS training protocol, which originally was developed ina pilot study that was implemented on a Northern Plains reservation, will be reviewed and revised withcommunity input. This study provides a conservative evaluation of the COHS approach, which is designedto overcome resistance to cultural barriers to accessing established dental care services, and to makepreventive services more widely available. Rather than comparing the COHS model with standard, highercost, professional services, we are making a comparison with low-cost providers who will be deployed in acommunity 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 aswell, so the central research question is whether a focus on personalized and community oral healthpromotion provided by someone clearly identified with the community provides a significantly greater effecton caries incidence than a low-cost pharmacotherapeutic prevention program. As questions continue to beraised about new delivery models for populations in rural and other underserved settings, this study willprovide important information about the model of a prevention specialist trained in a 4-week program to workfor improvement in the oral health of preschool children. It is anticipated that this study will be informed andfurther shaped by early results from RC1.
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