Introduction to the problem and statement of need of an intervention program
Dental caries constitutes one of the prevalent and critical oral health challenges among adults across the world. For example, in the US, Dye et al. (2015) quantify the significance of the problem stating that 91% of 20-64 years old adults have decayed permanent teeth. The prevalence level varies according to demographic factors, including age, ethnicity, and socio-economic status. For example, 35-64-age adults have prevalence levels of 94-97% compared to those aged 20-34 with an occurrence level of 82% (Dye et al., 2015). For the 20-64 age group, 85% of Hispanics, 86% non-Hispanic Black, and 94% non-Hispanic White reported cases of dental caries between 2011 and 2012 (Dye et al., 2015). According to Costa et al. (2013), untreated caries in the permanent teeth is highly prevalent among persons in low SES. This situation arises from their poor access to dental health care, which is amplified by pitiable education on dental care. Consequently, there is a need for the development and implementation of dental caries intervention program among low SES adults aged 20-64 years.
Dental caries is an important health aspect that is of primary interest to Healthy People 2020. A rich body of scholarly research indicates that dental caries is leading disease in the United States and across the globe. For example, Dye et al. (2015) put its prevalence level in the US at 91%, although it varies depending on age, socio-economic status, and ethnic differences among other demographic characteristics.
Costa, Vasconcelos, and Abreu (2013) studied the relationship between dental caries and SES, the number of visits in search of dental care, and the deployment of community benefits among Brazilian adults. Using focus groups (low severity and high severity), the researchers found a direct correlation between the intensity of dental caries and socio-economic status. Indeed, low-income earners had a chance of 2.2 of developing dental caries compared to the higher income earners (Costa et al., 2013). The research concluded that dental caries correlates positively with SES and that it increases with a decrease in social cohesion.
Costa et al. (2012) studied the variation of levels of dental caries with various socio-economic factors, including income levels and educational background of their research participants. Using multivariate analysis, the hypothesis that less schooling resulted in high level of dental caries received support since the p-value exceeded the 0.5 mark (p>0.5). Using a similar analysis approach, the researchers also found p-value greater than 0.5 after testing the hypothesis that low levels of income had the effect of increasing the prevalence of tooth decay (Costa et al., 2012).
Dye, Li, and Thornton-Evans’ (2012) research provides a clearer connection between dental caries and poverty level or income levels. The primary focus of the work of the authors is to offer an analysis of Healthy People 2020 statistical data in an attempt to provide a comprehensible understanding of its objectives in the reduction of the problem of teeth decay. Indeed, Dye et al. (2012) assert that teeth retention or maintenance constitutes one of the important factors that call for an intervention. Their research noted that adults who live in poverty retained 38% of their teeth compared to 45% in case of high-income earners.
Complete teeth retention was at 15% for adults living below the federal poverty level compared to 32% in case of adults living above the national poverty level (Dye et al., 2012). In a bid to promote good dental health, it is important to incorporate teeth retention in the Healthy People 2020 objectives. This claim also sets out a rationale for developing and implementing dental caries intervention program among the risky population segments. From the work of Costa et al. (2012) and Costa et al. (2013), these segments comprise low socio-economic status adults aged between 20 and 64 years.
The selected geographical region is Louisville, Kentucky. Louisville residents earn bellow $25,000 annually on average. This situation makes it one of the poorest cities in the US. Louisville also has the highest rate of Edentulism in Kentucky. This prevalence may be explained by factors such as engagement in risky behaviors, for instance, smoking, low frequencies of dental visits, chronic ailments, including asthma, and low socio-economic status among the adult population. Consequently, Louisville is a good choice for implementing an intervention program that focuses on awareness and education on dental caries.
Goals and Objectives
Deploying the SMART approach, the project has the following objectives:
- Identifying three scholarly articles and statistics that classify factors contributing to dental caries among low SES adults by August 2016
This objective has already been achieved. It ensures the intervention program is evidence-based.
- Constructing a sample of 20 participants randomly selected from the target population following the criteria of low income, educational background, and low SES
Semi-structured interviews are then administered to the sample. The aim here is to acquire information about the awareness and frequency of dental visits related to seeking treatment for dental caries. This objective is due by the end of October 2016.
- Developing and implementing an awareness and educational intervention program for dental caries among the target population by November 2016 The aim is to increase the awareness of dental caries with the expected outcome of increasing dental care visits for treatment, including gathering information on the prevention of dental caries by 25% above to values measured in objective ii
- Conducting a post-test study to determine the effectiveness of the intervention by determining the actual or intended increase in dental visits above values measured in objective ii by December 2016.
Strategies need to be in line with the targeted goals and objectives of any intervention program (Issel, 2013). This plan increases the probability of the proposed interventions to achieve objectives established using the SMART criterion. Creating dental caries awareness receives support from scientific research on the prevalence of the dental problem. For example, Costa et al. (2012) revealed poor healthcare awareness as a major determining factor for high prevalence levels of dental caries in any population. Therefore, an intervention program that focuses on providing awareness and education services on dental caries has a likelihood of yielding positive outcomes. However, such a program can only be implemented after a successful evaluation of the 5W (where, what, when, who, and why) and the ‘How’ aspect of an intervention program.
The ‘Where’ aspect defines the place of implementation (Louisville, Kentucky) of the intervention coupled with the channel used in the actualization process of the project. Creating awareness and providing educational services on dental caries require a channel that reaches more people and/or one that is most cost-effective due to monetary resource constraints. Social media platforms meet this requirement. Facebook page called ‘Louisville dental caries’ will be established. To initiate awareness on the Facebook page, the plan is to seek an opportunity with local radio stations through which the project will be launched. The audience will be requested to ‘like’ the page and even share it with their friends in other social networks such as Twitter. The detailed version of the information with a visual, animated, and textual description of the process of full development of dental caries will be incorporated in a separate web page. The page is called ‘Louisville dental caries.’ It is accessible through a link provided in the Facebook page, which can also be shared with other social media platforms users.
The page will be opened by the beginning of November 2016, 2 days before the radio show is held. The website will be forwarded to the web server host at the time of opening of the Facebook page.
The purpose of the radio show is to communicate the purpose and objective of the intervention campaign. Risk factors to dental caries, its detection (signs and symptoms), treatment, and awareness of local organizations within Louisville that seek to reduce the problem constitute part of the information that will be disseminated during the show. An emphasis is placed on the audience to use fluoride products, flossing, and food products to avoid the disease and the need for seeking proficient medical attention (National Health Services, 2016). This information is also incorporated in the Facebook page.
The intervention program targets Louisville adults aged 20-64 years. However, there is a possibility of having other people outside Louisville sharing the information. Some people in Louisville, but outside the targeted age group, may also share the information. This case presents a major problem in using Facebook page ‘likes’ counts in providing empirical data necessary for the evaluation process. Indeed, this concern forms the main rationale for incorporating a web page link. Upon clicking the link, before full access to the page is granted, one is requested to input data such as age, the current place of residence, and the number of time he or she has made dental caries treatment visits.
The ‘Who’ aspect also incorporates people who provide information on social media platforms, including the website. Volunteering dentist partners collaborate and/or share their knowledge through the forum on a regular basis. The dentists also provide competent specialized consultation services in an online platform through the Facebook page or the website discursive forum. The primary concern here is to increase awareness, including making any necessary clarification to the audience.
The element of ‘Why’ has already been covered in the literature review section. It is also captured in the discussion of the goals and objectives. Therefore, a repeat of the same here is not warranted.
During the radio show, the audience is requested to ‘like’ and share with friends in Louisville the Facebook page. The radio show is the strategy for initiating conversations in the social media platform. A link on the Facebook page directs the audience to the web page for further explanation and detailed information about dental caries.
Partners in a project tackle difficult issues. They solicit for project funding together. They must work willingly together towards achieving project objectives and goals (Brandstetter et al., 2006). Partnership commitment with the American Association for Community Dental Programs and American Dental Association has already been secured. I have also secured partnerships with Dr. Navnoor Gill, a practicing expert dentist. He is the immediate person to whom all questions on dental caries are addressed. As a partner, the County Health Department in Dayton provides guidance on dental and oral health practices and policies. The Department also provides linkages with other stakeholders in the dental care practices such as dental associations who can voluntarily supply the necessary dental caries educational and awareness information. The principal partner is Dr. Sarabjit Thind. He will house the project. His clinic is located at 8340 Yankee Street, Centerville, Ohio.
- Professional expertise
No cost is incurred in paying for the professional services. Any dental caries awareness educational information provided by experts through the Facebook page or website is offered voluntarily.
- Internet connectivity
The resource is required in the process of disseminating information and tracking the progress of the project. It is impossible to access conversation over the Facebook profile and the web page without it
- Personal computer
The resource can be easily purchased through Amazon.com or any other dealer through a physical store or online e-commerce platform.
- Monetary resources
The required monetary resource to fund the dental caries intervention program will be sourced from non-government organizations focusing on promoting oral health in the United States.
Funding and Budgets
The American Association for Community Dental Programs and American Dental Association are the financiers of the project. The American Association for Community Dental Programs offers to fund 70% of the total cost of the project while the American Dental Association will fund the remaining portion. However, the organizations have also requested for incorporation of links to their websites in the intervention program’s website for the traffic to be redirected to them for further information on dental health and hygiene. The two organizations are non-governmental having charitable assistance as a major portion of their funds (ADA Foundation, 2016).
The organizations are flexible due to the short funding cycles of up to one year. They also fund outstanding ideas since they have less bureaucratic procedures compared to government programs. The budget for the intervention is shown in Table 1.
Table 1: Budget for Dental Caries Community-based Intervention Program
|Item||Cost in US $ per year|
|Ongoing website maintenance||1250|
|Content management||13, 000|
|Website design/theme creation||350 (payable once)|
|Search engine optimization||3600|
|Logistics, including the cost of sample data collection and analysis||12,750|
|Miscellaneous expenses, including refreshments and allowances during semi-structured interview||7000|
The evaluation phase focuses on aligning the intervention implementation with goals and objectives. Evaluation data is collected as the audience interacts with the website. At the end of the web page, four pairs of dynamic buttons are provided. Each pair has the labels YES or NO. The buttons offer a response to the four main questions:
- You are a resident of Louisville. Please click YES or NO
- You lie in the age bracket of 20-64 (the age entered previously before access was granted, which is automatically retrieved). Please confirm by clicking YES or NO
- Do you think you have the signs of dental caries from the information you have read on this page? Click YES or NO
- Do you now consider seeking professional help for the condition? Please respond by clicking YES or NO
The pairs of buttons are programmed in a manner that by clicking YES in response to question (i), the next pair of questions pops up. The phrase ‘thank you for paying attention to this dental menace’ pops up when NO is clicked. The same cycle of events occurs when YES or NO for (ii) and (iii) is clicked. However, clicking YES or NO for (iv) yields the phrase ‘thank you for paying attention to this dental menace.’
The system keeps count of the clicks for each button. This case makes it possible to have cumulative data on the number of users using the website who are from Louisville, falling in the 20-64 age group, and having signs of dental caries. This data is provided by the number of clicks for the YES button in question (iii). The number of clicks for NO in (iii) provides data for those living in Louisville, falling in the 20-64 age group, and do not have signs of dental caries. The result of the number of clicks for YES in (iv) divided by sum of clicks for YES in (iv), NO in (iii) and NO in (iv) and on multiplying the quotient by 100 may be 25% more than the percentage of the sample size of 20 frequently visiting dentists for dental caries checkups. The implication here is that the outcome of the intervention meets its objective. Hence, it is effective.
Barriers to Success
- Allocation of airtime in a local radio station
Almost all local stations provide airtime slots for community-focused healthcare promotion interventions as part of their corporate social responsibility. Consequently, this plan is not anticipated to be a major barrier to success since I have already been allocated a time slot on 04/11/2016.
- Monetary resources
The resources are required for web development, its hosting, and maintenance. Nevertheless, this challenge is not significant since funds already provided by the sponsor are adequate.
- Time resources
Time is required to build conversation over the social media. This resource remains a major impediment since it depends on the capacity of the communications to become viral.
- Attracting people who are not from the target population
The web page is dynamic. Hence, it provides a track of users to ensure they fall in the intervention program targeted population.
- Internet connectivity level among the target population
Today’s inexpensive mobile phones are internet enabled. Therefore, the majority of the target population can afford mobile phone web browsing, despite their low SES.
Conclusion of Plan
The target population characteristics meet the criterion of the prevalence of dental caries established in the literature review. Therefore, implementing the community-based dental caries awareness and educational intervention program in Louisville is feasible. The project can be implemented within the limits of the available monetary resources (as shown in Table 1).
ADA Foundation. (2016). Charitable assistance. Web.
Brandstetter, R., Brujin, H., Byrne, M., Deslauriers, H., Forschner, M., Machacova, J., Scoppetta, A. (2006). Successful partnerships: A guide. Web.
Costa, S., Martins, C., Bonfim, M., Zina, L., Paiva, S., Pordeus, I., & Abreu, M. (2012). A systematic review of socioeconomic indicators and dental caries in adults. International Journal of Environmental Research and Public Health, 9(10), 3540-3574.
Costa, S., Vasconcelos, M., & Abreu, M. (2013). High dental caries among adults aged 35-44 years: Case control study of distal and proximal factors. International Journal of Environmental Research and Public Health, 10(6), 2401-2411.
Dye, B., Li, X., Thornton-Evans, G. (2012). Oral health disparities as determined by Selected Healthy People 2020 oral health objectives for the United States, 2009-2010. National Center for Health Statistics, 104(1), 1-8.
Dye, B., Thornton-Evans, G., Li, X., & Iafolla, T. (2015). Dental caries and tooth loss in adults in the United States, 2011-2012. Web.
Issel, M. (2013). Health program planning and evaluation: A practical, systematic approach for community health. Burlington, MA: Jones and Bartlett.
National Health Services. (2016). Tooth decay. Web.