Health Education and Promotional Program Planning IIProject Binder

“Maintain Your Smile”

Hearts and Hands ClinicOctober 2, 2015 at 10am

Tiffani Carter

Morgan ChanceJordan FordhamAykel Haynes

Table of Contents

Project Planning Team Biographies.…………………………………….......…3

Project Plan…………………………………………………………………......

Abstract………………………………………………………………….

Introduction………………………………………………………….......8

Needs Assessment.……………………………………………...….…..11

Mission Statement, Goals, and Objectives ……………...……….…....12

Description of Project’s Theoretical Framework…………………...….15

Intervention………………………………………………………..…...17

Budget…………………………………………………………..……...18

Logic Model and Timeline………………………………………….....20

Methods………………………………………………………………..22

Results………………………………………………………………….

Discussion………………………………………………………………

References……………………………………………………………….

Appendix A………………………………………………………………….

Appendix B………………………………………………………………….

Jordan Fordham is a senior from Atlanta, Georgia. She is a Public Health and Promotion major

with a minor in Information Systems. She transferred at the end of her freshman year from

Southern University in Baton Rouge, LA. While attending Georgia Southern

University, she is a honor roll student-athlete as a sprinter for Track and Field.

She maintains a 3.0 GPA. After graduation she plans on going to Georgia State

to get her Masters in Healthcare Informatics. While she is doing that, she plans

to have a job working at the CDC, or Grady Hospital in Atlanta, Georgia.

Tiffani Carter is a senior from Vidalia, Georgia. She is soon to receive her

Bachelor of Science in Public Health. She transferred to Georgia Southern

from Valdosta State University where she was actively involved in the

Student Government Association, Alpha Lambda Delta honor society, and

Phi Mu. After transferring, she remained active in Phi Mu and in various

community service projects throughout the Bulloch County area. After

graduation, she plans to receive her Master of Healthcare Administration degree here at Georgia

Southern University. Go Eagles!

Morgan Chance is a Senior Undergraduate student with the College of Public

Health at Georgia Southern University, and has a minor of Military Science.

Originally from Anchorage, Alaska, Morgan has spent her time all over the

world. Actively involved within her community through various organizations

such as Alpha Phi Omega National Service Fraternity and Georgia Southern

University’s Army ROTC program, Morgan will continue to be an advocate of Health Education

upon graduation and commissioning in May of 2016.

Aykel Haynes is a senior from Girard, Georgia. She currently attends Georgia Southern

University where she is pursuing a Bachelor’s Degree of Science in Public Health with a minor

in Psychology. She is a member of the Office of Student Leadership and Civic Engagement. She

spends her free time volunteering at various place in her community helping any way she can.

After college she is going to Guam, where she plans on working in Health education and

Promotion.

Abstract

Diseases of the mouth such as tooth decay, cavities, and periodontal disease are among

the most common non-communicable, preventable, and neglected diseases in the world (Gruber,

2015). Dental services are scarce in Bulloch County’s rural community. The purpose of this

program was to emphasize the importance [AC1] of proper oral care to both the patients of the

Hearts and Hands Clinic and the general public (n=6). Since some individuals cannot afford

costly dental care, basic knowledge on proper oral hygiene offers many health benefits to both

the patients of the clinic and other individuals of a lower socioeconomic status. The recruitment

process for this program consisted of making phone calls, hanging up flyers, and providing

incentives. A pretest and posttest were given to test the participants’ knowledge on the topic

before and after implementation. The program consisted of a lecture, instructional videos, and a

knowledge-based Jeopardy game. Data was collected from the tests and analyzed through the use

of SPSS software. The results showed that while the study was not statistically significant, there

was an increase in the mean of the posttest by two points. Due to this increase, the program

proved to be effective in improving the participants’ knowledge associated with dental hygiene.

Introduction

There was a sixteen percent increase in emergency room visits due to preventable dental

conditions between 2006 and 2009 (Sanders, 2012). This is a clear representation of how the oral

health issue in America is constantly growing. Dental care is costly and health insurance is even

more expensive (Sanders, 2012). This prohibits those that are most in need from receiving even

the most basic form of dental care. Issues such as tooth decay is preventable, however, the lack

of available help and assistance for these individuals prevents them from receiving the

prevention care that they need (Sanders, 2012). This delays diagnosis, which causes even the

most minor tooth problems to develop into serious oral problems and diseases (Sanders, 2012).

From the age range of 5 to 44, a total of 44.9% of individuals suffer from untreated dental caries

in the state of Georgia (Centers for Disease Control and Prevention, 2012). Since dental care is

so expensive, most individuals without insurance would rather wait until the pain is unbearable

and the disease is advanced to seek professional help. The emergency room then becomes these

individuals’ only option for pain relief and treatment (Sanders, 2012). According to recent

statistics by the NIDCR, it is reported that approximately 5 to 12% of the population have

reported facial pain in relation to their oral state and 14% of all adults aged 20 to 64 reported the

condition of their teeth and mouth as poor (National Institute of Dental and Craniofacial

Research, 2015). Poor oral health treatment leads to a variety of problems such as periodontal

disease, oral cancer, and tooth loss. Without proper intervention, the number of individuals

suffering from a poor oral health state will only increase from here.

Like previously stated, 44.9% of individuals ranging from 5 to 44 years old have reported

suffering from untreated dental caries in Georgia, and the older population, ages 20 to 44, suffer

the most at 27.4% (CDC, 2012). Due to this statistic, there is a need for better oral health care

within the older population. Researchers have studied the older population over time through

many programs, surveys, and interventions to try to better understand why oral health is still an

issue. Researchers have found that demographics, socioeconomic status, and even food intake

can play an important role in the state of one’s oral health. These individuals are associated with

many risk factors that can result in poor oral health. This poor oral state can ultimately lead to

future problems such as infections, diseases, and more serious issues (Singh, H., et al. 2014).

Other research that has been conducted concludes that some older adults do not visit the dentist

regularly due to a lack of access and the high cost of care (Singh, H., et al. 2014). Researchers

believe that if oral health problems are not solved then this will eventually start to negatively

affect individuals’ everyday life such as chewing, biting, and speech impediments (Singh, H., et

al. 2014).

Problems associated with poor oral hygiene not only negatively affect an individual’s

regular teeth but their dentures as well (Singh, H., et al. 2014). Food avoidance and diet

modification can also affect an individual’s oral health state. This is caused by deficiencies in the

diet that can eventually lead to dental problems (Quandt, S., et al. 2009). One study has shown

that among multiethnic groups, especially those located in rural areas, have a lower income and a

poor education, are at greater need for oral services than whites (Quandt, S., et al. 2009).

However, the same study states that ethnicity plays a bigger role than socioeconomic status in

reference to one’s overall oral health state (Quandt, S., et al. 2009).

Oral health is obviously a silent epidemic that is mainly associated with socioeconomic

status, access to care, and level of education (Malecki, K. 2015). One of the major problems is

the cost of dental care (Malecki, K. 2015). According to a study that was completed both by the

Wisconsin Department of Health Services and the University of Wisconsin, 58.8% of the

population in Wisconsin could not afford the cost and 44.9% of the residents did not have

insurance (Malecki, K. 2015). While completing the assessments, they used the BSS objective

oral screening, which was done with the SHOW method and self-reporting interviews. By taking

a sample of 1,453 Wisconsin residents, the researchers discovered that more than 15% of the

participants had untreated cavities and 20% of the participants did not receive the basic oral care

that they needed (Malecki, K. 2015). The Wisconsin Department of Health Services created a

solution that involved increasing oral health prevention in primary medical care settings

(Malecki, K. 2015). The implementation of the Affordable Care Act was an effective way to start

improving health care availability for Americans (Malecki, K. 2015).

Although there were many studies found on the subject of oral care, none of them

focused on the target population of this particular program, which are individuals living 200%

under the federal poverty line. That is why the aim of this program is basic dental hygiene and

the steps individuals can take to maintain a healthy smile without having to make regular visits to

the dentist. There are simple steps that individuals can take to improve their overall oral health.

Brushing twice a day, flossing once a day, eating a healthy diet, and drinking tap water with

fluoride are all easy ways to help maintain a healthy smile and all can be done without dental

insurance.

The purpose of this program is to increase participants’ knowledge on the importance of

proper dental hygiene at the Hearts and Hands Clinic in Statesboro, Georgia. An objective of this

program is to use proper research to effectively evaluate the knowledge of the participants before

and after the implementation of the program. Another long-term objective of the program is to

improve the overall health of the participants by improving their dental hygiene skills, such as

brushing and flossing, their self-efficacy, and their diet.

Needs Assessment

Health Status

In the United States, oral health can be considered a preventative health issues, yet oral

health can be a problem for many Americans, who might not have access to appropriate care. In

oral health there are many common problems people deal with each year such as tooth decay,

gum (periodontal) disease, and oral cancer. According to the CDC, 25% of children ages 6 to 11

and 59% of adolescents ages 12 to 19 years have tooth decay, while in adults, almost one third

has tooth decay that is not being treated (2013). Adults ages 35 to 44 have a one in seven chance

of getting gum (periodontal) disease, while adults 65 and older have a one in four chance in

contracting this disease (CDC, 2013). Gum disease is more common in men with 56.4%, than

women with 38.4% (CDC, 2013). Oral cancer can consist of different cancers, such as of the

oral cavity and pharynx. Oral cancer is more commonly known in adults, especially adults who

smoke and/or drink a great deal (CDC, 2013).

In Georgia, 52% of third grade students have had a history of tooth decay (Fleming,

2013). In a 2008 Behavioral Risk Factor Surveillance System, Georgia ranked 45th in the United

States in a response of “yes” from 21.3% of adults in Georgia 65 years and older loss their teeth

to tooth decay or gum disease (CDC, 2010.) According to the CDC, out of the 65 years and older

adults in Georgia 20.2% were men and 25.3% were women (2010). In Georgia, the race was 20.2

whites, 32.2 black, and for other race they were not applicable (CDC, 2010). Also, within these

responses older adults with less than a high school 51.6% answer “yes” s compared to the 5.6%

of college graduates college (CDC, 2010). Income can also be included with 47.2 of the older

adults with less than $15,000 answering yes compared to the 5.6 whose income are over $50,000

(CDC, 2010). In Georgia, many people are affected by oral health problems.

Community Description

Statesboro was established on December 19, 1803. The population in Statesboro, GA is

about 29,937 ("Statesboro, Georgia", 2014). The total population in Bulloch County is 67,761

and they have a total of 682.6 square miles. Bulloch County has four cities in the county,

Statesboro, Brooklet, Portal, and Register ("Bulloch County", 2015). When it comes to health

care in Southeast Georgia, Statesboro is the leader as it has one main hospital called East

Georgia Regional Medical Center ("Our Community", 2014).

Preliminary Qualitative Data

When Ms. Urkovia Andrews was recently interviewed about the major health problems

facing the patients at the Hearts and Hands clinic, she revealed that her main concern was oral

health. She said that dental hygiene was “not tackled at the clinic beyond the actual dental

appointment” (Andrews, 2015). Poor hygiene is detrimental to an individual’s overall health and

quality of life and some people tend to forget this. Poor hygiene, such as not brushing or flossing,

can lead to other issues such as tooth loss and decay, gum disease, and even oral cancer. These

oral disorders can negatively affect an individual’s every day-to-day life (Allen, 2003). “Seeing

that many of our patients are diabetic and hypertensive good oral hygiene is key,” Andrews

simply stated. A healthy mouth is a healthy body and chronic diseases such as diabetes and high

blood pressure can affect oral health. Individuals with Type 2 diabetes, for example, are at a

higher risk for gum disease than those that do not have the disease (Demmer, 2008). Ms.

Andrews was asked if there were any programs already available in Bulloch County to help

those that are uninsured and of a lower socioeconomic status with their dental problems and

needs and her answer was unsettling. She informed us that there were no programs like that in or

even around Statesboro that helped with these issues and that often people were referred to them,

even from the emergency room (Andrew's, 2015). While there are several dentists in the

community that work with the clinic, Hearts and Hands is the only facility that “assists the

medically uninsured with respect to dental unless they have the ability to self-pay at a dental

office” (Andrews, 2015). Dental work is expensive and without insurance can be difficult to

afford. Dental care is the most unmet health need in the United States and Bulloch County is no

different (Mouradian, 2000). Due to these issues and concerns, we all agree that some sort of

dental hygiene program should be implemented as soon as possible.

Community Link

Based on research, there is currently one program that offers dental health programs to

the public in Bulloch County. Originally developed in 1989, by Dr. Ted Holloway, the Bulloch

Wellness Center offers the public a variety of services which include those ranging from HIV

counseling and testing, adherence-based treatment plans, substance abuse services, to oral health

services. According to the State of Georgia Rural Health Plan, “although Georgia may face an

overall shortage of dentists in the near future, oral health experts agree that the state’s current

dental workforce shortage is largely a distribution problem, particularly in rural areas” (DCH,

2007, p.33). Implementing a program on how to maintain good dental health would both be new

and beneficial to those at the Hearts and Hands Clinic of Bulloch County. This program will

also be complementary to the program offered by the Bulloch Wellness Center. Once the

programmers implement a program on how to maintain and sustain good dental/oral health, we

hope that those with dental health complications will obtain the knowledge to improve their

conditions as well as their lifestyle.

Methods

Participants

A sample of approximately 10 dental patients from the Hearts and Hands Clinic ranging

from 21-60 years of age will be obtain after the program planners received prior IRB approval.

Information will be given to participants in an informed consent, explaining the information that

will the survey is going to entail. The questions were geared towards demographics, personal

oral hygiene practices, how often participants visit their dental facility, and basic oral hygiene

techniques.

Intervention

Participants will attend a one time workshop on the 2nd of October, 2015, on how to

maintain proper oral care. This workshop will consist of a PowerPoint presentation providing

information on proper and safe oral hygiene techniques, abscessed teeth prevention strategies, as

well as demonstrations on how to care for people’s teeth. There will also be hands-on activities

for participants to engage in as well as a Jeopardy game to test their knowledge on oral health

topics. Following program implementation, participants will receive incentives such as

toothbrushes, toothpastes, floss, and brochures about oral health and proper dental hygiene

techniques. Participants will also engage in a final discussion for several minutes about new

knowledge they have obtained while present at the workshop.

Measures

This program is designed to measure oral health behaviors of the participants. For the

program, the measurement is determined by using pretests and posttests. The pretest and posttest

will consist of the same 10 question, which are knowledge based, as well as a Jeopardy game to

see what the participants learned after the program is implemented. The pretest contains closed -

ended questions to see how often people should brush and floss, what they knew before, and

what they learned after the presentation (how often you brushed your teeth, do you use floss, do

you understand the proper way to brush your teeth?). The pretests and posttest are going to be

confidential so no one will identity their names on the paper or out loud. Along with the

powerpoint presentation, there will be an activity, the Jeopardy game that the participants will do

to make sure they understand how to properly take care of their teeth to help prevent future oral

health problems and have a better knowledge for the posttest.

Data Analysis

Program planners will conduct their data analysis through SPSS Software. The

relationships and correlations between demographics and personal oral health rankings/standings

will be assessed and placed in a data statistics chart. To help analyze the program, a statistical

analysis will be conducted on this study, to compare participates before and after knowledge

from the pre- and post-tests.

Results

A total of 6 participants (n=6) attended the “Maintain Your Smile” program, hosted by

Georgia Southern Public Health Students, at the Hearts and Hands Clinic of Bulloch County in

Statesboro, GA. A wide variety of demographics were in attendance to “Maintain Your Smile”;

both male (n=2) and female (n=4) and those of Caucasian (n=1) and African-American race

(n=5). Those who attended were given a consent form which stated they will be given a pre- and

post- test throughout the duration of the program.Table 1 below shows the mean knowledge on

oral health from the participants and patients who completed the pre- and post-tests. The

common average for the pretest was 6.6 while the average for the post-test was 8.6. Results

conclude that there was a small increase in knowledge following the completion of the program.

Overall the results show that although the program had minimal significance, it resulted in a

positive impact on the knowledge of those in attendance, and the program objectives were met.

Table 1. Mean of knowledge on oral health from participants and patients from the Hearts

and Hands Clinic.

Variable n x2 SD t df

Significance

Group -3.354 10 0.134

Pre-test 6 6.6667 1.36626

Post-test 6 8.6667 0.51640

Budget

Place

Bulloch County Hearts and Hands Clinic;

(127 North College Street Statesboro, GA 30458)

$0

Equipment

Water (10 pack) $1 per bottle

Veggie Tray $10

Meat Tray $10

Plates (10 pack) 10 cents per plate

Napkins $3

Personal Equipment

Laptop (Apple) $1300

Projector $300

Projector Screen $120

Jeopardy Game $40

Supplies

Educational Brochures $30

Flyers $15

Travel

GA Southern to Hearts and Hands Clinic (4.2miles there&back) $10 per planner

People

Program Planners ($4,800 per person) $19,200

Urkovia Andrews, DrPH(c); Executive Director $200

GRAND TOTAL $21,278

Budget Justification

Place

The Hearts and Hands Clinic of Bulloch County

The Hearts and Hands Clinic is a clinic in which citizens in Bulloch County who

have an income under 200% of the Federal Poverty Line and who are medically uninsured, can

receive free medical attention.

Equipment

Water

The water will be provided as a compliment to the various snacks we will be providing as

well as a beverage to participants. It is also a healthy, sugar-free alternative to any sodas or

juices.

Veggie Tray/ Meat Tray

Due to the program being held during normal lunch times, meat and veggie trays will be

provided as both an incentive for attending the program as well as a healthy snack.

Plates

Gives participants a serving tray for their various snacks to rest upon.

Napkins

In case of a spill or if participants have a mess on their hands, napkins will be provided to

clean up.

Personal Equipment

Laptop (Apple)

This device will house the presentation for the program being implemented at the Hearts and

Hands Clinic.

Projector/ Projector Screen

The projector will be connected to the laptop in order to show the presentation to the

participants while the projector screen will be used as a background for the presentation.

Leopardy Game

This fun activity, along with a pre and post test, will be used in order to measure how

much the participants learned from the presentation.

Supplies

Brochures

The brochures will provide participants with different educational services and techniques on

oral awareness.

Flyers

The flyers will provide the potential participants with the information about our program

such as the subject, place, time, and date.

Travel

Personal Vehicle

Program planners will be traveling from Georgia Southern University campus to the

Hearts and Hands Clinic in order to plan and deliver their program.

People

Urkovia Andrews, Dr. P.H.; Executive Director

Dr. Andrews is the Executive Director at the Hearts and Hands Clinic. She will serve as

the overseer of our program that we will implement at her facility on the 2nd of October.

Program Planners

The program planners were the individual’s who created and implemented the ‘Maintain

Your Smile’ program focused on oral care and dental hygiene. These planners served as

overseers to ensure that the program ran smoothly and that the presentation adhered to the

agenda. They gathered all of the statistics and information displayed in the PowerPoint and

created their own version of Jeopardy for the activity. They recruited all of the participants using

various strategies and provided the attendees with a variety of incentives. All of the testing and

research was also completed by the program planners.

Maintain Your Smile Intervention

Lesson Plan w/Activity

Georgia Southern

University

Prepared by: Tiffani Carter, Morgan Chance, Aykel Haynes,

Jordan Fordham

Objectives

1. Increase participants’ knowledge on oral health, by at least 30%

among completion of the program.

2. At least 50% of attendees will be able to identify at least 2 new

skills on what they have learned about dental care by completing a

post-test.

Materials:

Incentives (toothbrush, floss, toothpaste, veggie and meat tray), Chairs, Projector,

Screen, Laptop, Hand-outs, Pencils, Candles, Walmart gift cards

Time: Type Action

10

min

Introduction

& Pre-test

Introduce the members of the group and the purpose of the

program. Administer a pretest to test the participants’

knowledge on oral health before the program begins.

Present the PowerPoint lecture on the basic information,

20

min

10

min

20

min

Lecture

Post Test

Jeopardy

Game

statistics, and benefits of proper oral hygiene. This time will

also be for the tutorial videos that we will be showing on the

proper ways to brush and floss.

Give post-test to test the knowledge on oral health after the

program is over.

Conduct a game to test knowledge on oral health. Pass out

incentives (toothbrush, toothpaste, floss) and take-home

brochures.

Mission

It is the mission of our program to increase knowledge on proper dental hygiene care in

order to reduce and prevent further oral complications.

Goals

1. To offer an educational program that promotes oral health in lower income families at the

Hearts and Hands Clinic.

2. To promote healthy oral hygiene and care in the Bulloch County Community

Objectives

1. Increase participants’ knowledge on oral health, by at least 30% among completion of the

program.

2. At least 50% of attendees will be able to identify at least 2 new skills on what they have

learned about dental care by completing a post-test.

Framework

The Hearts and Hands Clinic of Bulloch County provides free primary health services for

individuals who are uninsured and are 200% below the federal poverty line

(http://theheartsandhandsclinic.org/). The priority population for the dental health program will

be the patients receiving services from the Hearts and Hands Clinic. Executive Director of the

Hearts and Hands Clinic, Urkovia Andrews, stated that the patients were in need of additional

knowledge concerning the importance of proper dental care and upkeep. She proceeded to say

that the top medical issue that was presented at the clinic on a daily basis was dental issues,

mainly abscessed teeth and tooth decay. Based on this information, the purpose of program is to

increase knowledge on proper dental hygiene care to reduce and prevent further oral

complications.

The theory that best fits the program’s aim is the Information-Motivation-Behavioral skills

model. IMB focuses on preventive behavior. The fundamental determinants of this model consist

of information, motivation, and behavioral skills (McKenzie, Neiger, Thackeray, 2013). All three

of these constructs are essential in the preventive behavioral process. Although some individuals

are well informed on certain health issues and their associated risks, they may not possess the

motivation to improve their actions. Motivation is driven by two different sources, personal and

social (McKenzie, Neiger, & Thackeray, 2013). Personal motivation is one’s attitude toward a

specific behavior while social is the support for the preventive behavior (McKenzie, Neiger,

Thackeray, 2013). The combination of these two motivation types is essential for action and

change to occur. After information and motivation, behavioral skills need to be considered. This

includes an individual’s objective ability and self-efficacy to perform the preventive behavior

(McKenzie, Neiger, Thackeray, 2013).

The program will begin by giving the participants information on oral health, such as statistics

and information that shows the individuals how crucial proper dental care truly is and the

different ways it can affect overall health. Approved videos, filmed by dental professionals, will

be shown during the presentation to ensure that the participants know the correct ways to brush

and floss. Overall, the program will focus on the proper oral hygiene techniques, how to reduce

their chances of further complication oral health issues, as well as increasing motivation to

change their current oral habits.

While information is crucial, the programmers believe motivation is the most important

component of the Information-Motivation-Behavioral skill model because it is essential for a

behavioral change to occur. If an individual is well informed on a particular health issue and its

associated risks but lacks the motivation to change, behavior change will not occur. The planners

are providing incentives such as toothpaste, toothbrushes, and dental floss to increase motivation

in the participants. Since the patients at the Hearts and Hands Clinic are also from a low-income

socioeconomic status, some of these patients may not possess the items essential for proper

dental care. By the end of the presentation, the program’s expectations are not only to increase

the participants’ knowledge on oral health, but to also improve their motivation and build their

confidence level to continue practicing proper dental care long after the program is over.

Information-motivation-behavioral skills model

Discussion

The purpose of this study was to improve participants’ knowledge of proper dental

hygiene and to promote an overall healthier lifestyle in relation to oral health. The Maintain Your

Smile program was used to increase awareness on the importance of proper dental hygiene. The

program was knowledge-based and started off with a pretest and an educational PowerPoint that

discussed various topics such as the basic statistics related to oral health and even certain food

groups that can help maintain a healthy smile. Following the PowerPoint, two instructional video

demonstrations were shown on the proper ways to both brush and floss teeth. Participants also

took part in a jeopardy game at the conclusion of the program to test their knowledge on what

they had learned during the presentation.

A total of six participants (n=6) took part in the program. The participants included a

diverse group of demographics such as males, females, Caucasians and African-Americans were

all in attendance. Every participant were given a pre-test to test their knowledge on oral health

before the presentation started. When the presentation was over the same participants were given

a post test to measure their knowledge after the program was implemented. The test ask various

questions such as; what kind of toothbrush should you use and how many times a day should you

floss. For several questions, prior to the program, four out of the six participants were not able to

identify the correct type. However afterward the program, all six participants were able to answer

the question correctly. Although the results for the program had no statically significant change,

the results did show that there was an increase in knowledge among the participants by 2 points.

Due to the participants increase in knowledge the programmers were able to meet part of their

goal to achieve and have participants walked away with a better understanding of proper dental

hygiene and oral healthcare in general.

While reviewing the literature, the programmers found that there was a lack of articles

that discussed problems related to their target audience about oral health care targeted towards

middle-aged individuals living below the federal poverty line. However, there were a few articles

that related to the program’s aims. One article in particular stressed the importance of purchasing

toothpaste with fluoride and participating in regular flossing and dental care check ups with a

provider at least twice a year (McMullen, 2013). During the program we informed participants

how important fluoride products and that flossing regularly were to their oral health and how it

could benefit their oral care. We also explain seeing the dentists every six months will also help

improve their oral care. A survey was also conducted in Wisconsin that showed that 58.8 percent

of citizens could not afford dental insurance and 44.9 percent of the total population lacked

health and dental insurance combined (Malecki, 2015). This article related to the program

because the programmers work with some people who lived below the federal poverty line.

Another article focuses on why oral health is still a problem in the older population. Researchers

have found that demographics, socioeconomic status, and even food intake can play an important

role in the state of one’s oral health (Singh, 2014). They have many risk factors that can cause

poor oral health, which may lead to future problems such as infections, diseases, and other

serious, more chronic illnesses (Singh, 2014). During the presentation the programmers informed

the participants how different foods and drinks can or cannot be beneficial towards their oral

health. We also explained how oral health could lead to different chronic illness. Since dental

care is so expensive, most individuals without insurance would rather wait until the pain is

unbearable and the disease is advanced to seek professional help (Sanders, 2012). It is at this

point when people go to the emergency room for relief because that is there only option

(Sanders, 2012). Before people come to the Hearts and Hands Clinic, they relieve the pain from

mouth on their own by using items like wrench, screwdrivers, and more. Since the program was

targeted towards people who did not have medical or dental insurance and who already had poor

oral heal care, a majority of this information is essential to the program because the information

is related towards the target audience. When speaking to Ms. Andrews, the executive director of

the clinic, she informed the program planners that the majority of the dental patients procedures’

consists solely of dental extractions. It was with great intentions that the program focus solely on

educating the patients on how to properly care for their teeth in order to maintain or even

improve their oral state to prevent these many extractions.

There were several limitations to the program. One limitation was the program’s small

sample size. Many individuals did not have the transportation or could not find a ride to attend

the program, which cause many people not to attend the program and impacted the number of

participants. Another obstacle the study faced was recruitment. Insufficient planning and

strategizing on recruiting individuals to attend the program also affected the sample size.

Recruitment needs to be started earlier next time and program planners’ must be more persistent

instead of only conducting one round of calls. Administering only one program was another

limitation. Administering two or three different programs with the same participants would have

been more effective in testing their knowledge since all of the information and testing would not

be packed into a single session. Lastly, the time that the program was conducted also proved to

be a limitation. The Hearts and Hands Clinic has a designated time each week for patients to

attend educational sessions. However, since this program was dental based, Mrs. Andrews asked

if the program could be implemented during the dental appointment time on Friday mornings. If

held during the normal educational session time, the number of participants would have probably

been higher since the clinic was not even open to the general public during the time of

implementation

With more time in the future, the program planners feel that this program could be

improved. In the future, the program should not only focus on knowledge but on behavior as

well. The program should monitor how participants are changing their dental habits throughout a

specific time frame. By adding the behavior change, the pretest and posttest should not only

measure the participants’ knowledge but their behavior as well. To help improve the program,

multiple sessions of this program should be conducted instead of conducting everything in one

shot. Since this program is targeted towards people who are living below the federal poverty line

it is a good idea to make sure every session has a way to measure growth. Lastly, to expand the

participation numbers of the program, there needs to be more promotion. Start as early as

possible promoting the program call people at least three times to remind them of the program.

Recruiting and reminding people about the program are essential for the overall success of the

program. Hanging flyers everywhere in Statesboro, compared to just the clinic’s lobby, and

advertising on social media are also a few ways to improve promotion.

Due to the increase in knowledge, with minor adjustments in the program structure,

practitioners will be able to use Maintain Your Smile as an effective way to teach dental patients

the proper techniques to caring for their teeth. This program can be used for all ages due to its

interactive components, visual demonstrations, and easy to follow dialogue. It is feasible to

introduce this program to the younger population who are beginning to understand the basics of

oral care. With the lessons learned from the program, this program can also be used for

individuals that need extra guidance on the proper ways to take care of their teeth and the

importance of doing so. All populations will be able to take away useful information and

therefore benefit from this program overall.

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