UCSF

Authors: Alexandra Malebranche, Jing Cheng, Pamela Den Besten, Karen-Sokal-Gutierrez, Arup Roy-Burman, and Ling Zhan

Purpose: To evaluate feasibility and barriers for implementation of a novel oral-health and fluoride-varnish program for 0-5 year old children in vaccination clinics in Roatán, Honduras.

Methods: Administrators, physicians, nurses, and dentists involved in the oral-health and fluoride-varnish programs in vaccination clinics in Roatán were recruited for a mixed survey and interview study. Information regarding staff demographics, knowledge, confidence, attitudes and behavior, implementation barriers, as well as, suggestive solutions in providing oral health services in the vaccination clinic were collected.) The data were analyzed using SPSS Statistics 22.

Results: Twenty-five subjects were enrolled. The time that non-dental providers spent learning oral health education was between 2.5-5.3 hours. Of these individuals, more than 68% of the subjects correctly identified the frequency and method for application of fluoride-varnish, and cariogenicity of candy and soda. However only 32% subjects identified juice as cariogenic and the correct timing of fluoride-varnish application in children. Nine of the 25 subjects were confident that they could effectively provide fluoride-varnish and oral-health education. All subjects requested more training on oral-health with preference for hands-on-training and reading-material with pictures. Most subjects supported to providing basic oral health services during vaccination visits, such an oral exam (78-100%), nutrition counseling (71-88%), applying fluoride varnish (88-100%), or demonstrating brushing technique (100%). The most commonly reported barriers of the program were lack of supplies, family interest, staff time, and staff interest. Increased government support and improved training were common suggestions for program improvement.

Conclusions: The administration of fluoride varnish in vaccination clinics in Roatán, Honduras was largely supported by staff. Barriers to success were inadequate training in oral health, lack of interest by staff and families and inadequate supplies. Improving training and increased government support were identified as key elements to improve the program's effectiveness.