CULTURAL BARRIERS TO ORAL HEALTH CARE IN CHILDREN

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CULTURAL BARRIERS TO ORAL HEALTH CARE IN CHILDREN

• Principal Investigator
• Patricia E. Evans, MD, MPH
• Medical Director, Maternal and Child Health
• San Francisco Department of Public Health

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San Francisco Department of Public Health
Co-Investigators Samantha Stephen, RDH, MS Irene
V. Hilton, DDS, MPH
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SUB-CONTRACTOR
Polaris Research and Development
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SPECIFIC AIM

• To identify barriers to accessing preventive oral
  health care among African American, Chinese,
  Filipino and Hispanic caregivers of children
  between 1-5 years of age, including those related
  to culture as measured by knowledge, attitudes
  and behaviors

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HYPOTHESIS

• African American (AA), Chinese, Filipino and
  Hispanic caregivers will access or not access
  preventive oral health care for children between
  1-5 years of age based on cultural influences

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RESEARCH DESIGN AND METHODS

• Focus Groups
• Identification of key informants to participate
  on a Community Advisory Board (CAB) for each
  racial/ethnic group

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Purposes of CAB

• Providing input on the screening and demographic
  questionnaires
• Providing input on the efficacy and translations
  of the research questions
• Providing expertise on recruitment in the
  community
• Receive and disseminate results of research

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Focus Group Interview Guide Development

• Re-review literature
• Develop interview guide and screening
  questionnaire for potential subjects
• Field test with CAB (including translations)

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Examples of Questions

• When you were a child, who made dental care
  decisions (e.g. when to go to the dentist) in
  your family?
• What is the purpose of the first set of teeth?
• Are there things that you know of that can
  prevent your child from getting cavities?
• When do you feel is the best time to take your
  youngest child to the dentist?

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INCLUSION CRITERIA

• Caregivers who provide daily care to a child
  between 1-5 years of age
• Younger caregivers defined as lt 44 years and
  older caregivers as gt 44 years
• Less acculturated defined as non-US born and more
  acculturated as US-born
• Participants self identify as AA, Chinese,
  Filipino or Hispanic

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FOCUS GROUPS
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LOGISTICS OFFOCUS GROUPS

• Held in the community
• Conducted by language-specific trained
  facilitators, audio-taped
• Logistics assistant, note taker, PI
• Refreshments, child care
• Consent, demographic, screening questionnaires
  completed
• Incentive provided upon completion
• Listing of local dentists provided

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DATA ANALYSIS

• Transcript/translation made of each focus group
  and reviewed by facilitator
• Research team develops coding scheme
• Consultants review transcripts/tapes and code
  according to scheme
• Coding results analyzed by research team across
  ethnic/racial groups, age/acculturation strata
• Conclusions drawn

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TIMELINE FOR YEAR ONE

• Planning, review of literature
• Development of AA and Hispanic CABs
• Conduct AA and Hispanic focus groups
• Code/analyze data of AA and Hispanic groups
• Initiate CABs for Filipino and Chinese Communities

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TIMELINE FOR YEAR TWO

• Conduct Chinese and Filipino focus groups
• Code/analyze data of Chinese and Filipino groups
• Conduct cross analysis of all racial/ethnic
  groups, other strata
• Report results to all CABS
• Disseminate information through reports,
  presentations, articles etc.

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LIMITATIONS OF STUDY

• Generalizations cannot be made from the data
  generated because of the nature of focus groups
• There is no quantitative method associated with
  this project to confirm data obtained through
  this qualitative methodology

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CHALLENGES DURING STUDY

• Responses to issues raised by grant review
  process
• Selecting a theoretical framework
• PEN-III Model
• Defining acculturation
• Defining older/younger caregiver

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CHALLENGES DURING STUDY

• Difficulty in recruiting certain demographic
  groups
• US-born caregivers over 44 years old in Hispanic,
  Chinese Filipino groups
• Had to eliminate from study (6 FG)

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FOCUS GROUPS COMPLETED
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CHALLENGES DURING STUDY

• Pilot coding of African-American focus groups
  revealed significant variation in interpreting
  the coding scheme (between the two coders)
• Requires much more detailed and structured coding
  manual

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CHALLENGES DURING STUDY

• The sudden untimely passing of our PI Dr.
  Patricia E. Evans

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CURRENT CHALLENGEComplete Coding Analysis

• Administrative
• Arrange extension to finance coding and analysis
  of focus group transcripts

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CURRENT CHALLENGESComplete Coding Analysis

• Research issues
• Maintain or modify original plan (number
  ethnicity of coders)
• Revise coding scheme/manual
• Complete coding
• Analyze coding results and produce information
  that can be used to continue research and/or
  develop programs