Oral Health Intervention for Low-Income African American Men in Atlanta, Georgia

摘要

Objectives. To describe the Minority Men’s Oral Health Dental Access Program (MOHDAP) intervention and report participants’ outcomes and satisfaction. Methods. MOHDAP was designed to increase the oral health knowledge of low-income, African American men in Atlanta, GA, in 2013. A community-based participatory approach and needs assessment guided the intervention development, which consisted of 3 educational modules delivered over a 2-day period. All participants (n?=?45; mean age?=?50 years) were African American men. We assessed changes in oral health knowledge and attitudes at baseline and postintervention via survey. Results. After the intervention, the percentage of correct responses to questions about gingivitis increased by 24.2% ( P =?.01), about use of a hard (instead of a soft) toothbrush increased by 42.2% ( P ?.01), and knowledge of ways to prevent gum diseases increased by 16.0% ( P =?.03). The percentage agreeing with erroneous statements decreased 11.3% ( P =?.02) regarding oral health–related fatalism and oral health self-care and 17.4% ( P =?.05) regarding saving front versus back teeth. Conclusions. Community-based oral health educational interventions designed for African American men may reduce oral health disparities among this population. Oral health is one of the leading indicators in the Healthy People 2020 initiative; however, there has been a decline in the percentage of adults annually visiting a dentist. 1 Racial and ethnic disparities in oral health, access, and service utilization are well documented. 2–5 Specifically, African American men are among the most disadvantaged populations with respect to oral health care and access by both gender and race. 5 African American men experience untreated tooth decay nearly twice as often as White men, and compared with African American women and adults from other racial/ethnic groups, they have the highest incidence rate of oral cavity and pharyngeal cancers in the country. 6–8 Furthermore, although oral cancer incidence rates are steadily declining for all races, mortality rates for oral cancer are increasing among African American men. 9,10 Concurrent with poor oral health is limited or inaccurate oral health knowledge. 11,12 Many educational interventions have been implemented to modify the dental care knowledge, attitudes, and habits that directly affect oral health. 13–18 Studies measuring the effect of oral health literacy and self-care interventions on oral health outcomes also identified significant improvements in knowledge and oral health status. 16,17 Despite the well-documented positive impact of educational interventions, no identified studies have focused on oral health intervention strategies designed specifically for African American men. Culturally appropriate health education that improves oral health knowledge is an essential component of interventions designed to increase awareness and risk perception associated with promoting improved oral self-care. Effective approaches have been characterized as multifaceted, culturally sensitive, promoting participant self-efficacy, and including both group-based and individual activities. 15 Although community-based participatory research (CBPR) approaches are being used broadly in research focused on prevention of a variety of health issues, its use in oral health research has been limited, and only a few recent studies have reported community-based approaches to be a priority in the development of oral health interventions. 19–21 Community partnerships can play a central role in improving access to care and utilization of services through approaches that position community residents as senior partners. These partnerships facilitate relationships central to intervention implementation, increase community research capacities, and result in interventions that are owned and sustained because of cultural and contextual relevance and responsiveness. 22–26 We established the Minority Men’s Oral Health Dental Access Program (MOHDAP) in Atlanta, Georgia, in February 2013 as a pilot CBPR intervention led by a community-based organization in partnership with an academic medical institution, thus reversing academia’s typical role of serving as the project lead. In response to the relevance of CBPR, we also conducted a needs assessment, which is detailed elsewhere, 27 and identified the cultural and community contexts of this underrepresented group using a formative CBPR process. Given the lack of evidence about oral health interventions for African American men, our aim was to fill that gap and evaluate the pilot MOHDAP intervention toward strengthening subsequent intervention delivery.