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Open Access Publications from the University of California

Scholarly Works (16 results)

  • Thesis
  • Peer Reviewed
UC San Francisco Electronic Theses and Dissertations (2023)

INTRODUCTION: The high prevalence of dental caries in children, especially those from disadvantaged backgrounds such as immigrant and refugee children, is well recognized. There are multifactorial causes for these disparities. One of the fastest-growing groups of immigrants to the United States and other countries in recent years has been immigrants from Afghanistan. The objective of this qualitative study was to assess the oral health knowledge, beliefs, and practices of immigrant Afghan parents of preschool-aged children.

METHODS: Recruitment flyers in English and Farsi were posted in mosques and Afghan supermarkets in the California Bay Area. Inclusion criteria were parents of healthy children 6 years or younger who immigrated to the United States within the last 10 years. Interviews were completed in Farsi using an interview guide consisting of questions about the knowledge of caries, parental oral hygiene practices, and barriers to access dental care. Interviews were audio-recorded, translated to English and transcribed. Thematic qualitative analyses were completed.

RESULTS: A total of 10 interviews were completed in Farsi, 8 by videoconference, and 2 in person. The knowledge of Afghan immigrant parents about children’s oral health and oral hygiene practices ranged widely. In addition to poor oral hygiene, participants described the etiology of caries as including lack of breastfeeding, feeding children formula, the weather and water conditions in the United States, mothers' complicated pregnancy and high consumption of sugar in the children’s daily diet. Participants described language and cultural differences, financial difficulties, and resettlement issues as the main barriers to accessing dental care for their children.

CONCLUSION: This study provides information that can contribute to improving patient experience and oral health knowledge for Afghan immigrant families in the dental setting. There is a need for dental providers to increase their understanding of Afghan culture and values when providing care to the Afghan immigrant population. There is also a need for more and improved translation services in dental offices for Afghan families with language barriers

    Cover page: Assessment of the oral health knowledge, beliefs, and practices of parents of Afghan preschoolaged children in the California Bay Area
    • Thesis
    • Peer Reviewed
    UC San Francisco Electronic Theses and Dissertations (2016)

    Tooth decay is the most prevalent chronic infectious condition experienced by children in the United States, disproportionately affecting children in low-income Latino families. A theory-based, promotora-led curriculum, Contra Caries Oral Health Education Program (CCOHEP), was developed to improve low-income Spanish-speaking parents’ oral hygiene behaviors for their young children. The objective of this dissertation was to evaluate CCOHEP for acceptability, feasibility, effectiveness, and the utility of Social Cognitive Theory constructs for improving parental knowledge and behavior around their children’s oral health. Acceptability was assessed through qualitative analysis of twelve Spanish-language focus groups (n=51). Feasibility was assessed through implementation data including attendance and attrition. Effectiveness and theoretical constructs were assessed through a questionnaire verbally administered before, immediately after, and 3 months after attendance at CCOHEP. And within-person change was measured between timepoints. Overall, 105 caregivers participated in CCOHEP (n= 105 pretest, n=95 posttest, n=79 second posttest). At baseline, all parents self-reported doing at least one aspect of toothbrushing correctly, but only 13% reported performing all five aspects according to professional guidelines. At posttest, 44% of parents reported completing all aspects of tooth brushing according to professional guidelines (p<.001). Knowledge was high at baseline (mean 12.8 of 16), but 6 knowledge items improved significantly between pretest and posttest. Social Cognitive Theory constructs of outcome expectations and situation were found to be significantly associated with a caregiver brushing their child’s teeth twice a day at baseline and with improvements in that behavior after CCOHEP. Self-efficacy to brush child’s teeth with fluoridated toothpaste, outcome expectation, and environment were all significantly associated with caregivers brushing child’s teeth with fluoridated toothpaste at baseline and with improvements in that behavior after CCOHEP. Eight of the 10 measured SCT constructs improved after attendance at CCOHEP, and were maintained or further improved 3 months after. CCOHEP was acceptable to and improved low-income Spanish-speaking parents’ oral hygiene knowledge and self-reported behaviors for their young children, and change was sustained 3 months after the end of the intervention. Five social cognitive theory constructs were associated with baseline behaviors and improvements in behavior. Further study of CCOHEP is warranted.

      Cover page: Parental preventive behaviors and oral health in Latino children
      • Article
      • Peer Reviewed
      UC San Francisco Previously Published Works (2021)
      BACKGROUND: Care coordination is a key strategy used to improve health outcomes and efficiency, yet there are limited examples in dentistry. A large dental accountable care organization piloted care coordination by retraining existing administrative staff to coordinate the care of high-risk patients. Following the pilots success, a formal dental care advocate (DCA) role was integrated system-wide. The goal of this new role is to improve care, patient engagement, and health outcomes while integrating staff into the clinical care team. We aim to describe the process of DCA role implementation and assess staff and clinician perceptions about the role pre- and post-implementation. METHODS: Guided by the Consolidated Framework for Implementation Research, semi-structured interviews with clinical and operational administrative staff and observation at the company-wide training session were combined with pre- and post-implementation electronic surveys. Descriptive statistics and mean scores were tested for significance between each survey sample (t-tests), and qualitative data were thematically analyzed. RESULTS: With preliminary evidence from the pilot and strong executive support, a dedicated leadership team executed a stepwise rollout of the DCA role over 6 months. Success was facilitated by an organizational culture of frequent interventions deployed rapidly through a centralized system, along with supportive buy-in from managerial teams and high staff acceptance and enthusiasm for the DCA role before implementation. Following implementation, significant changes in attitudes and beliefs about the role were measured, though managers held stronger positive impressions than DCAs. DCAs reported high confidence in new skills and dental knowledge post-implementation, including motivational interviewing and the ability to confidently answer patients questions about their oral health. Overall, the fast-paced implementation of this new role was well received, although consistent and significant differences in mean attitudes between managers and DCAs indicate more work to fine-tune the role is needed. CONCLUSIONS: Successful implementation of the new DCA role was facilitated by a strong organizational commitment to team-based dentistry and positive impressions of care coordination among staff and managers. Upskilling existing administrative staff with the necessary training to manage some high-risk patient needs is one method that can be used to implement care coordination efforts in dentistry.
        Cover page: Implementing care coordination in a large dental care organization in the United States by upskilling front office personnel.Creative Commons 'BY' version 4.0 license
        • Article
        • Peer Reviewed
        Berkeley Research Impact Initiative (BRII) (2017)
        In lower middle-income economies (LMIE), the nutrition transition from traditional diets to sugary foods and beverages has contributed to widespread early childhood dental caries. This qualitative study explores perceived risk and protective factors, and overall experiences of early childhood nutrition and oral health in indigenous Ecuadorian families participating in a community-based oral health and nutrition intervention. Dental exams of 698 children age 6 months through 6 years determined each child’s caries burden. A convenience sample of 18 “outlier” families was identified: low-caries children with ≤2 carious teeth vs. high-caries children with ≥10 carious teeth. Semi-structured in-depth interviews with parents/caregivers explored the child’s diet, dental habits, and family factors related to nutrition and oral health. Interviews were transcribed and thematically analyzed using grounded theory. In the high-caries families, proximity to highway and stores, consumption of processed-food, and low parental monitoring of child behavior were identified as risk factors for ECC (early childhood caries). In the low-caries families, protective factors included harvesting and consuming food from the family farm, remote geography, and greater parental monitoring of child behavior. The study results suggest that maintaining traditional family farms and authoritative parenting to avoid processed foods/drinks and ensure tooth brushing could improve early childhood nutrition and oral health.
          • Article
          • Peer Reviewed
          UC San Francisco Previously Published Works (2016)
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2018)
            Latino children are more likely to be obese than non-Hispanic white children, and feeding patterns that begin in infancy may contribute to this disparity. The objective of this study was to elucidate beliefs and practices related to the introduction of solids and solid food feeding in the first year of life among low-income Latino parents residing in Northern California. We conducted 26 semi-structured interviews that explored the timing of introduction of solids, selection of foods to serve to infants, feeding strategies, sources of information on solid food feeding and concerns about infant weight. We found that most parents relied on traditional practices in selecting first foods for infants and had a strong preference for homemade food, which was often chicken soup with vegetables. Parents generally described responsive feeding practices; however a minority used pressuring practices to encourage infants to eat more. Very few parents practiced repeated gentle introduction of unfamiliar food to increase acceptance. High calorie low nutrient foods were typically introduced at around 12 months of age and parents struggled to limit such foods once children were old enough to ask for them. Parents were concerned about the possibility of infants becoming overweight and considered health care providers to be an important source of information on infant weight status. The results of this study can be used to inform the development of interventions to prevent obesity in Latino children with similar demographics to our study population.
              Cover page: Beliefs and practices regarding solid food introduction among Latino parents in Northern California
              • Article
              • Peer Reviewed
              UC San Francisco Previously Published Works (2015)

              Background

              Prevalence of high blood pressure has been increasing in U.S. children, with implications for long term health consequences. Sodium consumption, a modifiable risk factor for high blood pressure, is above recommended limits and increasing. Very little is known about Latino caregiver beliefs and behaviors around their children's salt consumption.

              Methods

              In California's Central Valley, qualitative interviews in Spanish investigated low-income caregivers' views and understandings of their children's dietary salt consumption. Thirty individual interviews and 5 focus groups were conducted (N=61). Interview transcripts were translated and transcribed, coded and thematically analyzed.

              Results

              Seven primary topic areas around children's salt intake and its impact on health were identified: children's favorite foods, children's dietary salt sources, superiority of home-cooked foods, salty and sweet foods, managing salt for health, developing children's tastes, and adding salt added at the table. Parents recognize common sources of sodium such as "junk food" and processed food and made efforts to limit their children's consumption of these foods, but may overlook other significant sodium sources, particularly bread, cheese, prepared soups and sports drinks. Caregivers recognize excess salt as unhealthy for children, but don't believe health problems (like high blood pressure) can occur in young children. Nevertheless, they made efforts to limit how much salt their children consumed through a variety of strategies; school meals were a source of high sodium that they felt were outside of their control.

              Conclusion

              Latino caregivers are concerned about their children's salt intake and attempt to limit consumption, but some common sources of sodium are under-recognized.
                Cover page: Rural Latino caregivers' beliefs and behaviors around their children's salt consumption
                • Article
                • Peer Reviewed
                UCSF Open Access Publishing Fund (2020)
                  • Article
                  • Peer Reviewed
                  UCSF Open Access Publishing Fund (2016)
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2014)
                    The objective of this article is to investigate parental understanding of tooth discoloration and decay and their related care seeking for young, Mexican-American children. The research design entailed semi-structured, face-to-face interviews conducted in Spanish with a convenience sample of 37 Mexican immigrant mothers of young children in a low-income urban neighborhood. Five major color terms - white, off-white, yellow, brown, and black - were used to describe tooth discoloration, the causes of which were mainly unrecognized or attributed to poor oral hygiene and exposure to sweet substances. Mothers also described three major levels of deterioration of the structural integrity of teeth due to caries, from stains to decayed portions to entirely rotten. A trend was observed between use of darker discoloration terms and extensive carious lesions. Teeth described as both dark in color and structurally damaged resulted in seeking of professional care. The paper concludes with the finding that Spanish terms used to describe tooth discoloration and carious lesions are broad and complex. Mexican immigrant mothers' interpretations of tooth discoloration and decay may differ from dental professionals' and result in late care seeking. Increased understanding between dental practitioners and caregivers is needed to create educational messages about the early signs of tooth decay.
                      Cover page: Shades of Decay: The Meanings of Tooth Discoloration and Deterioration to Mexican Immigrant Caregivers of Young Children
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