UCSF

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.