Long-term effects of a lay health advisor intervention on immigrant children's dental caries and maternal preventive behaviour: A randomized controlled trial

A Systematic Review and Meta-Analysis of Interventions Targeted to Parents for Improving the Oral Health of Children from Culturally and Linguistically Diverse (CALD) Backgrounds

A high prevalence of dental caries is a significant health problem, especially in the pediatric population. Low-income minority groups, including the refugee and immigrant populations, are at higher risk of compromised oral health. It has been suggested that migrant parents do not have enough understanding of oral health, risk factors associated with dental caries, or the progress of dental decay. This systematic review aims to study quantitative literature on oral health interventions, health promotion programs, or behaviour change interventions targeting the parents/ caregivers of culturally and linguistically diverse (CALD) children. A systematic search of electronic databases, including MEDLINE, EMBASE, PUBMED, CINAHL, SCOPUS, WEB OF SCIENCE, COCHRANE, and PROQUEST, was conducted until August 2023. Randomised (RCT) or non-randomised controlled trials (NRCTs) were included. Two reviewers independently assessed the quality of the included studies using the Cochrane Risk of Bias (RoB) 2.0 and ROBINS-I tools. Meta-analysis was performed as appropriate. The initial search from the databases retrieved 2073 articles. After the removal of duplicates, 1683 articles remained. Finally, 69 articles were reviewed in full text, and 15 articles were considered eligible in this review. The RoB assessment for RCTs rated three as low-risk and three as high-risk. The serious RoB in these NRCTs mostly pertained to measurement bias based on self-reporting oral health behaviours. The meta-analysis pooling of results (for RCTs and NRCTs) favoured interventions for CALD parents' oral health knowledge [0.73 (95% CI, 0.08 to 1.38) for RCTs, 1.73 (95% CI; 1.45 to 2.02) for NRCTs] and attitudes [0.86 (95% CI, 0.31 to 1.42)]. Relatively high heterogeneity was observed. Oral health educational interventions can be effective in improving the oral health literacy of CALD parents' oral health knowledge and attitudes, especially when facilitated by lay health advisors. However, the low quality of evidence due to high heterogeneity and high RoB further highlighted the need for well-designed RCTs targeting CALD parents.

Impact of Oral Health Chatbot With and Without Toothbrushing Training on Childhood Caries

OBJECTIVES

Standalone oral health chatbots targeting young children's oral health are rare. The aim of this research was to compare the effectiveness of a standalone chatbot and a combination chatbot with in-person toothbrushing training for caregivers in improving young children's oral health.

METHODS

A randomised, parallel, 2-group pretest-posttest design was employed with 320 caregiver-child pairs (aged 6-42 months). Group I (160 pairs) used the 21-Day FunDee (modified) chatbot along with in-person toothbrushing training, whilst Group II (160 pairs) used only the 21-Day FunDee Plus chatbot. Oral examination assessed plaque levels and caries, whilst a self-administered questionnaire evaluated oral hygiene care, dietary practices, and oral health perceptions based on the protection motivation theory (PMT). Data were analysed using 2-way repeated-measures analysis of variance, a t test, and chi-square measures for group comparisons.

RESULTS

The majority of caregivers were Muslim mothers. No significant differences were observed between groups at the baseline, 3-month, and 6-month follow-ups in mean dmft (Group I: 4.16, 4.64, and 5.30 vs Group II: 4.30, 5.54, and 5.82), mean plaque scores (Group I: 0.72, 0.53, and 0.55 vs Group II (0.84, 0.52, and 0.59), and most dietary habits. However, significant improvements were found within groups from baseline to follow-ups in plaque reduction, toothbrushing practices, overall knowledge score, PMT perceptions, proper tooth brushing, fluoride toothpaste usage, and dietary behaviours (frequency of bottle feeding, frequency of nocturnal bottle feeding, proportion of children who went to bed without consuming anything after cleaning their teeth before bedtime). The significant differences between groups were found in self-efficacy at all time points, but only at the 6-month evaluation for percentage of fluoride toothpaste and overall PMT perceptions.

CONCLUSIONS

Both interventions were comparable in preventing caries, reducing plaque, improving feeding practices, increasing parental involvement in tooth brushing, and enhancing knowledge. The standalone chatbot 21-Day FunDee Plus presents a viable alternative for promoting oral health in young children.

Every bite counts to achieve oral health: a scoping review on diet and oral health preventive practices

OBJECTIVE

To examine the landscape of preventive strategies and interventions directed to achieve oral health equity, with particular emphasis on the interplay between dental caries prevention, individual behaviors, and population-level strategies across various demographic and geographic regions.

METHODS

This scoping review was guided by Peters et al.'s framework, which incorporates four key concepts aimed at reducing caries: education for individuals and healthcare providers, behavioral modifications, addressing broader social determinants of health, and extending oral health education programs beyond traditional dental settings. A systematic search was conducted across five databases, from 2011 to 2022.

RESULTS

This review identified 107 studies highlighting three main themes: behavioral practices (N = 33), which focused on reducing the prevalence of caries, improving oral hygiene practices, and enhancing overall oral health knowledge; educational interventions (N = 39), which explored strategies to integrate oral health with broader public health initiatives; and dietary interventions (N = 35), which emphasized the critical relationship between diet and oral health.

CONCLUSION

This SR highlights the critical need for comprehensive multilevel approaches that address the complex interplay between nutrition, oral health, and sociodemographic factors, while emphasizing the critical relationship between societal factors and individual health behaviors. Multifaceted interventions that include behavioral change, education, and dietary modifications are crucial for improving oral and overall health outcomes across diverse populations. Comprehensive strategies should prioritize medical-dental integration and data-driven approaches to effectively reduce oral health disparities for vulnerable populations, promoting long-term health equity.

Approaches to Reach Trustworthy Patient Education: A Narrative Review

BACKGROUND

Patient education is a cornerstone of modern healthcare. Health literacy improves health-related quality of life and health outcomes of patients, enhanced by effective patient education. Inadequate competency of patient education in healthcare providers triggered this review to summarize common approaches and recent advancements.

METHODS

This narrative review summarizes common approaches and recent advancements in patient education with their relations to health literacy, their strengths, limitations, and practical issues.

RESULTS

This review highlighted the multifaceted approaches to patient education, emphasizing the importance of tailoring methods to meet the diverse needs of patients. By integrating various strategies, including intrapersonal, interpersonal, and societal/community-level interventions, healthcare providers can create a more comprehensive educational experience that addresses the complexities of patient needs, meanwhile improving the health literacy of patients. With the rise of digital media and artificial intelligence, there is an increasing need for innovative educational resources that can effectively reach and engage patients. Ongoing research and collaboration among healthcare professionals and policymakers will be essential to refine educational strategies and adapt to emerging challenges. It is essential to remain vigilant about potential conflicts of interest that may compromise the integrity of educational content.

CONCLUSION

Effective patient education empowers individuals and their contributions to a healthier society by fostering informed decision-making and encouraging proactive health management.

Effectiveness of the lay health advisor program on oral function and quality of life in aboriginal older adults: A randomized controlled trial

BACKGROUND

Aboriginal older adults residing in remote areas have poor oral function due to inadequate access to healthcare services. Lay health advisor (LHA) strategies can fill capacity shortages of healthcare professionals in rural communities and increase population acceptance of health care or healthy behaviours.

OBJECTIVE(S)

To evaluate the effectiveness the LHA program on oral function and oral health-related quality of life (OHRQoL) among older adults in aboriginal community.

METHODS

Participants were randomly assigned to an experimental group (EG; n = 122) and a control group (CG; n = 118). All participants performed oral exercises, and the EG received additional one-on-one 30-min lessons by an LHA over 4 weeks. Data were collected through face-to-face interview and oral examination. The generalized estimating equation model was used to analyse changes in outcomes over time.

RESULTS

The EG exhibited significantly greater improvement in swallowing (β = .63) at the 6-month follow-up and in masticatory performance (β = .52) and pronunciation of the syllable/pa/ (β = 2.65) at the 2-week follow-up than the CG did. The EG had a significantly lower plaque control record (β = -.14) and plaque index (β = -.30) at the 3-month follow-up than the CG did. Moreover, the OHRQoL was significantly increased at 6-months follow-up in the EG (p = .010).

CONCLUSION

The LHA program had positive effects on chewing, swallowing and plaque control in aboriginal older adults. LHA group also experienced positive long-term effect on OHRQoL after intervention.

Barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools: a systematic review

Background

Untreated dental caries negatively impacts a child's quality of life including overall health and wellbeing, growth and development, social interaction ability, and school attendance. School-based toothbrushing programs have been recognised as an effective intervention to reduce the burden of dental caries. However, limited information is available to understand the real-world enablers and challenges in the implementation and sustainability of toothbrushing programs. This review aims to understand the barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings and primary schools.

Methods

Five electronic databases [i.e., CINAHL (EBSCO), Medline (EBSCO), EMBASE (Ovid), Web of Science, and PsycINFO] and backward citation chasing were performed. The last updated databases searches were conducted in May 2022. Studies reporting on barriers and enablers in the implementation and sustainability of toothbrushing programs in early childhood settings or primary schools were included in the review. The methodological quality of included studies was assessed by using Joanna Briggs Institute [JBI] and mixed methods appraisal tool [MMAT] critical appraisal tools and results were reported in accordance with PRISMA guidelines.

Results

A total of six studies met the eligibility criteria and were included in the review. Toothbrushing programs in early childhood settings and primary schools were mostly implemented under the supervision of staff and teachers. A positive attitude of the staff, the flexibility of toothbrushing sessions, involvement of community volunteers and parents were a few of the identified enablers. However, the timing of the communication of the program, inadequate transfer of information among staff, frequent staffing turnover, lack of parental support, and staff feeling overburdened while acting as pseudo parents were frequently reported as barriers.

Conclusion

The results of this systematic review identify key enablers and barriers for toothbrushing programs in early childhood settings and primary schools which need to be considered for developing oral health promotion initiatives.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02270-7.