American Indian and Alaska Native (AIAN) children are particularly affected by disparities in oral health: AIAN children have double the caries experience of white children and 2 to 3 times higher rates of untreated caries. Despite great resilience in tribal nations, geographical isolation, dentist shortages, and community mistrust on health care systems exacerbate the inequity. In Alaska, Dental Health Aides, drawn from indigenous communities, are available to provide preventive and interim care and to serve as patient navigators so that children receive curative care. Disparities could be reduced if the dental care delivery system, including the community-based allied dental personnel, were more effective. However, no studies have yet evaluated the incorporation of evidence-based dental treatments into routine care delivered by a dental team as part of a comprehensive program to eliminate racial disparities in pediatric oral health. The proposed research (Oral Health Equity for Alaska, OHEAL) seeks to bridge the gap between research and practice by conducting a multi-level phase IV implementation study at the community, organization, provider, family and individual levels. The goal is to build on the existing system to design, implement and evaluate a series of dental care delivery system changes. The population of interest is 7,000 children, 2500 AIAN, living in communities served by the South East Alaska Regional Health Consortium (SEARHC). The intervention will result in a culturally competent, population-, risk- and evidence-based dental care delivery system. Case management, screening, risk assessment, preventive and caries arrest treatments will be delivered by Primary Dental Health Aides (PDHA) in alternative community settings, with seamless and timely referrals to Dental Health Aides Therapists (DHAT), as well as pediatric and primary care dentists at dental offices. Following the stages of the Active Implementation Framework, the study will use community-based participatory research with mixed-methods (interviews, focus groups, surveys and before and after controlled study).
The specific aims are to (1) conduct a needs and capacity assessment of the communities and the dental care organization; (2) develop Native-specific culturally-appropriate processes and materials for the OHEAL implementation and (3) reinforce stakeholder support during UH2; (4) install; (5) implement; and (6) evaluate the OHEAL model in relation to adoption, fidelity, costs and impact on oral health, access and quality of dental care, racial/ethnic equity in oral health and racial/ethnic equity in dental care access and qualit during UH3. By tailoring evidence-based practices to the cultural and social reality of the AIAN children and the communities they live, SEARHC will be more efficient in improving the oral health of the communities and contribute to the reduction of racial disparities in oral health of children. This project is collaboration among University of Washington (UW) Pacific Northwest/Alaska Center to Reduce Oral Health Disparities, UW Indigenous Wellness Research Institute, UW Partnerships for Native Health, DENTEX, and SEARHC.

Public Health Relevance

We propose to design, implement and evaluate a Native-specific culturally-competent, population-, risk-, evidence- and team-based dental care delivery system innovation to reduce racial/ethnic disparities in oral health and dental care among American Indian and Alaska Native children.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Exploratory/Developmental Cooperative Agreement Phase I (UH2)
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Special Emphasis Panel (ZDE1-SM (14))
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Nowjack-Raymer, Ruth
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University of Washington
Schools of Dentistry
United States
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Senturia, Kirsten; Fiset, Louis; Hort, Kim et al. (2018) Dental health aides in Alaska: A qualitative assessment to improve paediatric oral health in remote rural villages. Community Dent Oral Epidemiol 46:416-424