Developing Educational Oral Health Resources for the Maternal Infant Health Program

Transcription

1 Capstone Project Proposal Developing Educational Oral Health Resources for the Maternal Infant Health Program Jennifer Smits, RDH, AAS University of Michigan Degree Completion Program HYGDCE 489

2 Table of Contents Project Statement/Description 2 Review of the Literature 3 I. Introduction to MIHP 3 II. Developing Oral Health Resources 4 III. Management/Intervention 5 IV. Prevention/Education 7 V. Conclusion 9 Project Rationale 9 Project Objectives 10 Project Design 10 Project Methods 11 Project Evaluation 12 Project Timeline 14 References 16 1

3 PROJECT TITLE Developing Educational Oral Health Resources for the Maternal Infant Health Program PROJECT STATEMENT/DESCRIPTION: The focus of this Capstone Project is the development of educational oral health resources. These resources will support increasing awareness about oral health for non-dental personnel as well as mothers/children who participate in the Michigan Department of Community Health s (MDCH) Maternal and Infant Health Program (MIHP). This project will involve t he development of resources for two audiences that include mothers in the MIHP as well as the non-dental professionals who make home visits. These resources will serve to improve oral health knowledge and provide early childhood caries prevention strategies. Three specific resources are to be developed. One will address infant oral health. It will be designed at a second/third grade reading level and will be distributed to the participating mothers of the MIHP. Secondly, a quick reference card will be developed with step-by-step directions for conducting a knee-to-knee exam. This card will be helpful for professionals to use with oral screenings in the home MIHP visits. These non-dental professionals may include nurses, social workers or other healthcare personnel. Lastly, an existing MDCH educational resource about fluoride varnish will be redesigned from a fifth grade reading level to a second/third grade reading level in order to best suit the MIHP population being served. A literature review will be performed to discover information about the MIHP, oral disparities among those involved in the MIHP, knee-to-knee examinations, infant oral health & early childhood caries (ECC) information, and health literacy. Professional association websites may provide already published educational tools and this project can discover ways to adapt 2

4 these for the MIHP. Providing oral health educational resources will benefit non-dental professionals involved in the health care field, women who are pregnant, and children who are at high risk for ECC in the MIHP. Project Advisors include Christine Farrell, RDH, BSDH, MPA, the MDCH Oral Health Director, and Susan Deming, RDH, BS, also from the MDCH. The Faculty Advisor is Anne Gwozdek, RDH, BA, MA, University of Michigan Dental Hygiene Degree Completion E-Learning Program Director. The project advisors support our on-site involvement with the capstone project and shares experience, content, and expertise. The Faculty Advisor helps to refine topics, define methods to approach these topics, and polish our work along the way. This project will also be done in collaboration with E-Learning student, Lindsey VandenBerg. Review of the Literature Introduction and Overview of MIHP The Maternal Infant Health Program (MIHP) is part of the Michigan Department of Community Health ( MDCH). This program offers support for mothers and infants with Medicaid health insurance by promoting healthy pregnancies, good delivery outcomes, and healthy infants. 1 MIHP s are scattered throughout the state of Michigan at federally qualified health centers, private providers offices, and local health departments. It is through this program that women and infants can receive health assessments by nurses, social workers, or nutritionists. 1 The Michigan Department of Community Health Oral Health Program is collaborating with the MIHP to increase oral health knowledge among non-dental providers and mothers in the program. 3

5 Generally, the population enrolled in the MIHP are low income, black non-hispanics, have less than high school education, with Medicaid as the primary source of health care. 2 A total of 912,000 Michigan Medicaid enrollee s are infants and children. 3 Children who come from low-income families are twice as likely to suffer from decay and this is more likely to be left untreated. 4 Along with low socio-economic status, frequency of sugar consumption, enamel defects, presence of current decay, how often teeth are brushed, level of parental education, children who live in poverty, and children of color are also relevant determinants in caries risk. 5,6,7 Oral health education for this community can be supported by professional training so that providers who work at MIHP s can inform, motivate, and help mother and infant participants adopt and maintain healthy practices and lifestyles. 2,3 Developing Oral Health Resources Developing educational resources will support Michigan s Oral Health Plan goal of providing education opportunities for non-dental health care providers on topics such as the relationship between oral and maternal health, screening and referral for early signs of decay in infants/children. The Michigan s Oral Health Plan is also associated with the goal of partnering with community organizations to provide resources to support comprehensive and culturally sensitive oral health education and prevention activities. 3 These two examples identify how the MIHP oral health initiatives fits in with the state s plan. Having these resources available for non-dental health care providers provides an opportunity for them to present anticipatory guidance for parents and caregivers. Anticipatory guidance is defined as providing recognition (screening) and intervention for those who are at high risk for dental caries and to provide referrals to a dental home for those in need of further 4

6 dental care. 3 These professionals see women and children at their well-child visits on a more regular basis than visiting dental personnel, therefore offering them the opportunity to offer oral-health information. 4,8 Primary health care providers can be a significant asset when providing dental caries prevention information, intervention, and diet education to help aid in reducing preventable ECC. 4 In a national survey that included 862 pediatricians, over 90% of the respondents noted that they play a significant role in early detection of dental decay and provide anticipatory guidance for oral-health related topics to parents and caregivers. 4 With adequate oral health risk assessment training child healthcare professionals have the ability to screen children for decay, apply preventive fluoride varnish, and give referrals to dental professionals for further treatment. 4 It will be important for these educational resources to be understood by the general population. Basic vocabulary at a second to third grade reading level will be most effective. There is a need to simplify written health education information for patients with limited literacy, as over one quarter of the U.S. population has a second-grade reading level. 9 Those with restricted health literacy are linked to lower levels of personal health, minimal use of preventive care and higher risks of hospitilzation. 9 Members of minority groups and those of low socioeconomic status are more likely to have a lower health literacy level. 10 Management/Intervention Dental caries is five times more likely to occur in children than asthma and seven times more likely than hay fever making it the single most common chronic, preventable disease that affects 28% of children in the U.S. 4,6,9 ECC is a dieto-bacterial disease that results from interactions between the host (child), cariogenic (decay causing) bacteria (Streptococcus 5

7 mutans, Streptococcus sobrinus), and diets that are high in cariogenic foods. 9 This disease, when left untreated, can have such consequences as: pain, bacteremia, speech disorders, high treatment cost (emergency room visits), compromised chewing resulting in lack of adequate nutrition, low self-esteem, and reduced growth development. 4 All of these are negative side effects from a disease that is preventable. One way to check for early signs of disease and provide prevention education is the knee-to-knee screening. Knee-to-knee screening technique is technique for health care professionals and caregivers to thoroughly inspect the oral cavity of infants and determine risk for ECC. The rationale for performing this screening is to examine the child before potential dental problems are given the chance to become apparent, which in turn can become more costly and difficult to treat. 6 Most importantly having these screening visits with the caregivers allows time for the health care professional to provide education and oral health prevention strategies. 6 The knee-to-knee technique for this screening is simple yet effective. There are guidelines for the provider to use in this screening. First, tooth surfaces, especially near gum tissues, for smooth, white, dull areas, generally on the facial surface of the tooth should be checked. 4 These are areas of demineralization (tooth mineral loss), commonly caused from a sticky biofilm (plaque) which supports an acid attack on the teeth whenever fermentable carbohydrates are consumed. 4 These white spot lesions are also commonly caused when the infant is put to bed with a bottle filled with liquids other than water. Sweetened liquids such as juice, soda, formula and milk also promote acid attacks on the teeth and promote ECC. 6 Infants who also have an increased frequency of consuming liquids and snacks during the day have an increased risk for these lesions to appear. 9 Another symptom to 6

8 look for is an abscessed tooth. This infection could also be caused by severe ECC. 6 Finally, the gingival tissues, checking for redness, swelling, and bleeding, which are all common signs of gum disease should be thoroughly evaluated. It is here during this screening that the health care professional is given the opportunity to dialogue with the parent/caregiver and child, expressing areas of concern and reinforcing healthy behaviors. 4 Prevention & Education Prevention by ways of early intervention helps to reduce the risk of possible dental diseases such as decay. 6 Fluoride varnish is one example of a cost effective product that can be used for prevention. Fluoride varnish is a concentrated topical fluoride with a resin or synthetic base, allowing it to adhere to the tooth surface in the presence of saliva. 6 According to the American Academy of Pediatric Dentistry, studies have shown if infants are provided fluoride varnish four times a year prior to ever having any dental decay their caries risk is reduced by 40%. 8 Not only can fluoride varnish help prevent decay from forming, it can also remineralize areas where early lesions have already started. 10 Moreover, topical fluoride is more effective than systemic fluoride when it comes to decay prevention. 4 This results in a strengthened tooth surface that is more resistant to acid caused by cariogenic bacteria. 7 In addition to fluoride varnish, oral health education for both non-dental personnel and parents/caregivers offers great potential for caries risk prevention. Once health care professionals are trained and educated they are then able to pass along this wealth of information to the families they provide services for. By educating caregivers, health care professionals can help manage factors that contribute to this disease as well as help parents identify early signs of high risk infants so they can get a referral to a dental home for further 7

9 evaluation. 4 Caregivers/parents may also be unaware that they could possibly be contributing to ECC in their children from the transmission of saliva via sharing utensils such as spoons and pacifiers. 4,6 The work of non-dental health care providers and caregivers can only go so far, however. It is important to establish a relationship with a pediatric or general dentist by the time the child is one year of age for regular preventive visits, especially if they are at high risk for decay. 4 It is here that further anticipatory guidance, diet education, prevention strategies, and risk assessments can be provided. The American Academy of Pediatric Dentistry recommends bi-yearly visits to the dentist starting from the first year of life to five years of age to provide risk assessments, diet evaluations, surveys on parental knowledge and dental health, and behavioral surveys/analysis. 6 These visits to the dentist, establishing the dental home(a place where a patient can continuously count on going to when needed), will help to establish a relationship with the dentist/dental hygienist and parents as well as building a positive connection with the infant. 6 Conclusion Non-dental health care professionals are ideal persons for providing oral health education and disease prevention strategies. However, limited knowledge of oral health and caries risk assessment are barriers that keep them from performing assessment and education prevention techniques for infants. Becoming educated professionals through training and obtaining appropriate educational resources will give them oral health prevention strategies to use to educate caregivers. Non-dental health care providers can serve as advocates for infant 8

10 oral health and can provide screening, share information with parents, and, ultimately may help to reduce ECC. Project Rationale Dental decay is a common, chronic, yet preventable disease. Early childhood caries (ECC) can cause pain, infection, minimize nutrient intake, and costly emergency room visits. Caries experience is closely associated with those with low socioeconomic status. Those involved with the MIHP fall under this category. If education on oral hygiene recommendations, fluoride information, basic screening techniques, and how to address nutrition are provided at an appropriate reading level, ECC and its needless pain, costly medical bills, and malnutrition could be reduced. Educational resources are needed to support this effort. Three educational resources will be developed. One involves the revision of a fluoride brochure to a second grade reading level, a level needed for those involved with the MIHP. Secondly, a quick reference card will be developed for the non-dental professionals for conducting a knee-to-knee screening. The development of an infant health brochure is the final resource. These three educational resources will benefit non-dental professionals, the patients whom are seen, and employees involved with the MIHP. Developing these educational resources will support increasing awareness about oral health for non-dental personnel as well as mothers/children who participate in the Michigan Department of Community Health s (MDCH) Maternal and Infant Health Program (MIHP). Developing resources that are culturally appropriate and at a literacy level where information can be easily understood will help provide oral disease prevention education for years to come. 9

11 Project Objectives OBJECTIVES By the end of the project a quick reference card will be developed for the non-dental professionals to use when conducting a kneeto-knee screening. By the end of the project revisions of a fluoride varnish brochure to an appropriate reading level will be completed. By the end of the program the development of the infant oral health brochure will be provided for caregivers and staff. EVALUATION METHODS An evaluation form will be developed and Susan Deming and participating non-dental health care providers will be completing this form. MDCH education coordinator will fill out an evaluation form for feedback to assess the information (including appropriate reading level, format, etc). The staff/caregivers will be able to discuss factors that contribute to both dental health and disparities such as decay and its causes. Project Design This project will entail the development of educational oral health resources to support the Maternal Infant Health Program (MIHP) program. The topics include knee-to-knee screening, fluoride varnish benefits, and infant oral health. The focus of the project will center around the development of two educational resources and the revision of one that is existing. The first will be the development of an index (reference) card for knee-to-knee screening. The second will be the development of an oral health informational brochures for mothers and children. Some of the topics of discussion that will be included in this brochure include caries risk, nutrition, and infant oral health. Finally, a revision of an existing fluoride varnish related brochure from the Michigan Department of Community Health (MDCH) will be converted from a 5 th grade reading to a 2 nd grade reading level. 10

12 Project Methods Contacting Susan Deming, RDH, BS, Education and Fluoridation Coordinator from the MDCH, Christine Farrell, RDH, BSDH, MPA, the MDCH Oral Health Director, and Anne Gwozdek RDH, BA, MA, University of Michigan Dental Hygiene Degree Completion E-Learning Program Director will be the first necessary step of the project. Contacting these three key persons will allow detailed conversation to take place to discuss a plan of action. Susan and Chris, the onsite project advisors will educate those developing the project on necessary information to include and the most effective ways to format the educational resources for index cards and brochure form. The three educational resources each have their own purpose and audience. It will be important to have them all be visually appealing and at an education level where those reading will have full understanding of the material. Once determined, researching evidence based information via PubMed, Google Scholar, and peer-reviewed journals will be necessary to gain information that will be used in these resources. Anne, our faculty advisor, will aid in refining topics and polish our project along the way. Initial drafts of these resources will be sent to Susan Deming for preliminary review. Evaluation forms will be developed to address content, format, and literacy level for each resource. Project advisor Susan Deming and faculty advisor Anne Gwozdek will review these forms prior to their distribution. Based on the feedback given, the resources will be revised. Project Evaluation 11

13 Evaluation forms for each educational resource will be developed and will be filled out by the project advisors or other stakeholders identified by Susan Deming, once the final brochure and reference cards are complete. Their feedback analyzes these resources and gives the strengths/weaknesses and leaves space to comment. Format, reading level, and visually appealing resources are priority criteria. All evaluation forms will be reviewed by both Susan and Anne prior to their use. Upon receiving this feedback, revisions will be made to all three educational resources prior to dissemination. The knee-to-knee screening reference cards will be evaluated by non-dental providers in the MIHP program. A review of these cards will be done during an MIHP presentation given by Susan Deming on March 24 th, During break, a rough draft of the knee-to-knee screening index (reference) card will be given to random volunteers along with an evaluation form. Once filled out, this evaluation form will give feedback on the structure of the index cards. Information that will be included on this form will include whether or not the card was an appropriate size and layout, was visually appealing, had comprehensive and sequenced information, and was easy to follow. Once filled out, Susan will collect the forms at the end of her presentation and send the results via to those developing the project.the revised fluoride related brochure and infant oral health brochure will both be evaluated by Susan and Chris. After evaluation, any final revisions will be made for the final version. 12

14 PROJECT TIMELINE Tasks Activities Start Finish Resources Development of Project Idea Contact Susan Deming, set up meeting Jan 20 (meeting Jan 29) Jan 29 Susan Deming, education & fluoridation coordinator of MDCH Research Phase Develop letter of MOU Jan 29 Jan 29 Indentify Resources People: 1. Susan Deming 2. Chris Farrell 3. Anne Gwozdek Jan 29 Project and Faculty advisors (Anne Gwozdek, Chris Farrell, and Susan Deming) Reading Materials: PubMed, Google Scholar Define Project Design Phase Choose Design Developing educational resources for those involved in the MIHP. Brochure 1. Infant oral health 2. Revised fluoride varnish related brochure Jan 29 Rough draft (RD) by: March 1st Jan 29 March 26 Susan Deming, Chris Farrell, Anne Gwozdek Reference cards 1. Knee-to-knee Jan 29 April 8 Obtain EB information for brochure content Develop resources Those with low SES affected. Jan 29 Mar 23 PubMed, Google Scholar, Peer-reviewed journals 1. Index card a. Knee-to-knee screening 2. Infant oral health brochure (rough draft) 3. Revised fluoride varnish related brochure (rough draft) Feb 1 st Jan 29 th Jan 29th Rough draft: March 1 st for index card April 23 rd May 1 st Susan Deming, Anne Gwozdek, Chris Farrell Develop Evaluation forms March 19 Marchindex cards May- Susan Deming, volunteer evaluators from MIHP meeting 13

15 Evaluation Phase Administer Evaluation Forms Disperse Index Card 1. Evaluation form Mar 24 th meeting Brochure Apr 10 th Feedback via evaluation forms Mar 24 th Apr 10 th Brochure 1. Infant oral health a. Evaluation form 2. Revised fluoride related brochure a. Evaluation form April 30 th June 1 st Analyze Results May 10th May 15th Random volunteers from March 24 th seminar held by Susan Deming Revision Phase Implementation Phase Revise all educational resources according to evaluation forms and feedback Post-project resources: implemented through MDCH Complete Capstone Project Report Apr 10 May 2011 June 1 June 26 14

16 References 1. Michigan.gov [Internet] Michigan Department of Community Health: maternal infant health program. C [cited 2011 March 20]. Available from: _4911_ ,00.html 2. Michigan Department of Community Health Oral Health Program: Oral Health Plan. 2010; Kagihara L, Niederhauser V, Stark M. Assessment, management, and prevention of early childhood caries. J Am Acad of Nurse Pract. 2009;21: Ramos-Gomez F, Jue B, Bonta CY. Implementing an infant oral care program. J Calif Dent Assoc. 2002;30;10: Center for Disease Control [Internet]. Atlanta: Recommendations for using fluoride to prevent and control dental caries in the United States. c Aug 11 [cited 2011 Mar 20]. Available from: 6. Palmer CA, Kent R, Loo CY, Hughes CV, Stutius E, Pradhan N, Dahlan et al. Diet and caries-associated bacteria is severe early childhood caries. J Dent Res. 2010;89;11: American Academy of Pediatrics: Fluoride varnish [Internet]. Illnois: c2001. [cited 2011 Mar 20]. Available from: 8. Deming S. Maternal & Infant health program coordinator meeting. Presented at: Crown Plaza Hotel, MIHP meeting; 2011 Mar 24. Grand Rapids, MI. 9. Roter D. Oral literacy demand of health care communication: challenges and solutions. Nurs outlook. 2011;59: Jackson R. Parental health literacy and children s dental health: implications for the future. Pediatr Dent. 2006;28: