Health Education of School-Aged Children

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Health Education of School-Aged Children. Suzanne Marks, Director Albuquerque Area Dental Support Center. Overview. The effectiveness of oral health education Factors that help or hinder health messaging Resources that are readily available to support your efforts to educate your patients. - PowerPoint PPT Presentation

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Oral Health Promotion & Disease Prevention Head Start/Early Head Start

Health Education of School-Aged ChildrenSuzanne Marks, Director

Albuquerque Area Dental Support CenterGood morning,

Dr. Ricks asked me to talk about Health Education of School-Aged Children.

I feel a little like Im preaching to the choir but lets give it a go . . . 1OverviewThe effectiveness of oral health education

Factors that help or hinder health messaging

Resources that are readily available to support your efforts to educate your patientsIm hoping to look at Health Education in School Age Children from these angles:

2A rose by any other name . . . Health educationAnticipatory guidanceHealth communicationall refer to some aspect of the process of informing and influencing individual and/or community decisions intended to enhance health

As a health educator by training and by trade, I tend to use health education but youll hear all 3 during this presentation

So lets dive in . . . 3Health education can . . . Increase the intended audiences knowledge and awareness of a health issue, problem or solution Influence perceptions, beliefs or attitudes that may change social normsPrompt actionDemonstrate or illustrate healthy skills

In a perfect world . . . Health education can help you:4Health education can also . . . Reinforce knowledge, attitudes or behaviorShow the benefit of behavior changeAdvocate a position on a health issue or policyIncrease demand or support for health servicesRefute myths or misconceptionsDid I miss anything??5Health Education (by itself) cannot . . . Compensate for inadequate health care or access to health care servicesProduce sustained change in complex health behaviors without the support of a larger program for change Be equally effective in addressing all issues or relaying all messages

Bullet 3: maybe because the topic or suggested behavior change is complex, because the intended audience may have preconceptions about the topic or the message sender or because the topic is controversial

Because most of your programs are, in fact, challenged by access issues and because improving oral health IS a complex behavior . . .

Now it gets a little more dicey, doesnt it?6Is health education effective as a preventive strategy?What do think?

Well, everybodys pretty quiet and polite so far but Ive been running around with yall for the better part of 7 years and I learned early on that the preference seems to be for ACTION rather than education. Truth??

Well . . . lets have a look at a couple of examples of health educations effectiveness as part of a comprehensive preventive strategy . . . 7Efficacy of an oral health promotion intervention in the prevention of early childhood cariesIn a 2008 Australian study, Plutzer and Spencer tested the efficacy of an oral health promotion intervention in the prevention of ECC Conclusion: an oral health promotion programme based on repeated rounds of anticipatory guidance initiated during the mothers pregnancy was successful in reducing the incidence of ECC in very young children.A programme was developed around the provision of anticipatory guidance to nulliparous women (women expecting their first child) in Adelaide. Mothers in the test group received oral health promotion information during pregnancy, and later when the child reached 6 and 12months of age. After the second round of information the test group mothers were randomized again. The information was reinforced in one of the test subgroups through a telephone consultation. There was no contact with mothers in the control group after enrolment. At the age of 202.5months all test and control group children were examined by a dentist. The case definition of an incidence of S-ECC was one or more upper incisor teeth being carious at the level of a cavitated or noncavitated lesion. The differences in S-ECC incidence between the test and control groups, and the test subgroups were analysed.

Plutzer, K. and Spencer, A. J. (2008), Efficacy of an oral health promotion intervention in the prevention of early childhood caries. Community Dentistry and Oral Epidemiology, 36:335346. Plutzer, K. and Spencer, A. J. (2008), Efficacy of an oral health promotion intervention in the prevention of early childhood caries. Community Dentistry and Oral Epidemiology, 36:335346.8Oral health promotion for schoolchildrenIn a 2007 study Livny et al. evaluated the effect of a pragmatic education program on tooth brushing skills among young schoolchildrenConclusion: behavioral instruction emphasizing improvement of personal manual skills successfully increased the average number of dental areas brushed

Livny, A, Vered Y, Slouk L, Sgan-Cohen H: Oral health promotion for schoolchildren evaluation of a pragmatic approach with emphasis on improving brushing skills. BMC Oral Health 2008, 8:4 (31 January 2008)

BackgroundPreventive dentistry has traditionally emphasized improvement of oral hygiene. School-based programs, often delivered by dental hygienists or other health educators, are usually limited to dental knowledge provision. The present study focused on promotion of health behavior. The objectives were to evaluate the effect of a pragmatic educational program on tooth brushing skills of young schoolchildren.MethodsThe population consisted of 196 first grade children in Jerusalem. One dentist interviewed the children and evaluated base-line brushing skills, applying simple visual index, based on dividing the dentition to eight different segments. a trained hygienist then educated the children, emphasizing brushing skills. A simple "scrubbing" brushing method was taught for all dental surfaces. Four months later a second examination was conducted, applying same evaluation methods.ResultsAt base-line 92% of the children had brushed the labial surfaces of front teeth, but only 8% brushed the inner surfaces of posterior teeth. Only 32% brushed occlusal surfaces. These levels significantly increased after four months: 98% now brushed the labial surfaces; 43% brushed inner surfaces of posterior teeth, 87% brushed occlusal surfaces (p < 0.001). The average number of dental "areas" brushed had increased (among the eight areas recorded) from 2.8 to 5.7 (p < 0.0001).ConclusionThis method of behavioural instruction emphasized improvement of personal manual skills specifically for those areas of the dentition which demand most efforts in oral hygiene promotion. These results are of practical help in improving future health education programs by the health promotion team.9The Effectiveness of Evidence-Based Oral Hygiene Advice and Instruction Upon Patient Oral HygieneIn a 2006 randomized controlled trial, Clarkson et al. evaluated the effectiveness of providing evidence based oral hygiene advice and instructionPatients who received the evidence based oral hygiene advice and instruction were significantly more confident about their ability to toothbrush effectively and had significantly less plaque and gingival bleeding10Are these studies as revolutionary as those demonstrating the impact of community water fluoridation? Are these studies as compelling as those demonstrating the efficacy of fluoride varnish? Probably not

Doubtful11Cochran Database of Systematic ReviewsA recent Cochrane review looked at school-based interventions aimed at changing behavior related to tooth brushing habits and the frequency of consumption of cariogenic food and drink in children between the ages of 4 and 12 years.Actually released on June 3 12Randomized or cluster randomized controlled trials were included. Studies had to include behavioral interventions addressing both tooth brushing and consumption of cariogenic foods or drinks and have a primary school as a focus for delivery of the intervention. The primary outcomes were changes in caries or plaque levels.4 studies were reviewed involving 2,302 children . . . 1 study was at unclear risk of bias and 3 were at high risk of bias.Given the stated criteria, only 4 studies were included in the review.14Only 1 small study. . . with an unclear risk of bias, reported on caries. This found a prevented fraction of 0.65 in the intervention group. However, as this is a single study, reviewers encouraged caution be used with interpretation

153 studies found less plaque . . . in children receiving the program but they were not combined in a meta-analysis due to differences in study designs and in the details of the interventions.

Secondary outcome measures from one study reported that the intervention had a positive impact upon childrens oral health knowledge.

The reviewers concludedCurrently, there is insufficient evidence for the efficacy of primary school-based behavioral interventions for reducing caries. There is limited evidence for the effectiveness of these interventions on plaque outcomes and on childrens oral health knowledge acquisition. .None of the included interventions were reported as being based on or derived from behavioral theory. There is a need for further high quality research utilizing theory in the design and evaluation of interventions for changing oral health related behaviors in children and their parentsDoes health education still have a place in the comprehensive prevention and treatment of oral disease? ABSOLUTELY!!

So given all this . . .

And look who agrees . . .

20American Dental AssociationADA announced another new initiative, Action for Dental Health, designed to reduce the numbers of adults and children with untreated dental disease through ORAL HEALTH EDUCATION, prevention and treatment for those in need. . . In THAT order

21The American Academy of Pediatric DentistryAppropriate discussion and counseling should be an integral part of each visit.The American Academy of Pediatric Dentistry agrees . . . And is on record as saying . . . 22American Academy of PediatricsOral health anticipatory guidance can reduce dental expenditures. In light of this evidence, oral health anticipatory guidance should be integrated as a part of comprehensive counseling during well-child visits.The American Academy of Pediatrics agrees . . . AAP says23American Academy of Nurse PractitionersThe importance of . . . anticipatory guidance during well-child care visits cannot be overestimated.Even the American Academy of Nurse Practitioners says . . . 24Factors affecting health communicationsLets look at some factors affecting health communications . . . 25Factors that are likely outside the providers controlPovertySocioeconomic statusGeographyEducation levels

Factors such as poverty, socioeconomic status, geography and education levels are likely outside your control26Factors that can be accommodated by the providerInfluence of culture and familyDevelopmental learning stagesHealth literacy

But culture and family, developmental learning stages and health literacy are all factors that, if appropriately addressed, can increase the successful delivery of health education27The Influence of CultureIs there a difference?The Ortegas

The Tsosies

This is the Ortega Family and this is the Tsosie Family . . . Is there a difference?It would be foolish, insensitive and short-sighted to characterize individuals through general group definitions.This part of the discussion is not intended to limit your interpretation of what your patients are like.But rather as a door to greater understanding.The reality is there are 566 federally-recognized Indian tribes.Among any of those tribes and more specifically, among the people of those tribes there are varying degrees of acculturation from traditional to main stream and everything in between.

29How might culture express itself in health communications between provider and Native patient? May be more likely to regard concepts holistically and visually/symbolicallyIn patient/provider communication, there may be a strong tendency on the part of the provider to emphasize verbal over visual symbolic thinking and to approach situations analytically rather than holistically (Analytic thinking involves understanding a system by thinking about its parts and how they work together to produce larger-scale effects. Holistic thinking involves understanding a system by sensing its large-scale patterns and reacting to them.)However, integration of new information in many Native cultures is acquired in a holistic context (The holistic person tends to approach a subject by trying to understand its gist or general meaning)Neither is wrong, per se . . . But rather just different types of intelligence

30How might culture express itself in health communications between provider and Native patient? May be more likely to value "wait" timeWait time refers to the amount of time speakers are given to speak and respond Research has shown that wait time may be substantially longer in Native American culture than in European-American culture. In fact, interactions appear to be enhanced by extended wait time. Winterton (1976) studied the effect of extended wait time on Pueblo Indian children's conversations with teachers. Results indicated that extended wait time, especially when it followed students' responses, was significantly related to the length of students' responses and the amount of interaction. Verbal participation of less vocal students also increased, as did overall unsolicited but appropriate verbal responses. How might this have an application in your work??

31How might culture express itself in health communications between provider and Native patient? May be more likely to observe before acting or questioning

What about observing before acting or questioning? Navajo and European-American mothers were shown videotaped episodes of Navajo and European-American children participating in a classroom. The mothers were told to rate the children on a number of dimensions. Differences concerning one particular episode--a European-American boy engaged in high levels of verbal and physical activity--were especially striking.The Navajo mothers believed the high verbal and physical activity were negative attributes (and therefore rated the boy negatively), whereas the European-American mothers believed them to be positive.

32How might culture express itself in health communications between provider and Native patient? May be more likely to speak softly Another socio-linguistic variables that could influence health communications is the volume at which healthcare providers and patients speak to each other Native Americans tend to speak more softly (Darnell, 1979)

33How might culture express itself in health communications between provider and Native patient? May be more likely to avoid eye contact out of respect

and expectations regarding speaker- and listener-directed gaze (Native American patients might look down to express politeness when addressing someone of perceived authority like a healthcare provider).B...

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