Changing Oral Health Norms and Hygiene Practices among Vulnerable Older Adults Project GOH!: Good Oral Health
Between 2011 and 2014 the Institute for Community Research and the University of Connecticut School of Dental Medicine conducted a pilot intervention through NIDCR clinical trial planning grant # 5R34DE22271, Changing Oral Health Norms and Hygiene Practices among Vulnerable Older Adults (9/15/2011-2/28/2014). With the ARRA infrastructure grant as a base for multilevel infrastructure to support oral health research among older adults we were able to develop and evaluate a bilevel intervention with older adults in subsidized senior housing. The goals of the pilot intervention referred to as Good Oral Health (GOH!), were:
- Do formative research to build, modify and refine a theoretically driven intervention, together with residents in a single large building in a downtown area of a small urban center in Central Connecticut
- Test the intervention for feasibility and acceptability
- Use the experience to develop a larger study in more buildings as a clinical trial.
The intervention was based on the Integrated Model (IM) of Behavioral Prediction, which emphasizes contextual, social norms and social influence, beliefs and attitudes, and intentionality factors as having an impact on health outcomes. We also added a self-efficacy component based on Bandura’s social psychology/social learning approach to prevention, and the notion of practice to mastery of oral health skills, also from Bandura. The intervention used two delivery mechanisms, both engaged, participatory and tailored based on the IM/self efficacy theoretical model.
One of the interventions was a face to face hour long exploration of volunteer participants’ concerns about oral health, and instructions on brushing teeth, flossing and cleaning dentures, with practice on a mouth model to mastery. This intervention used an adapted motivational interviewing (AMI) approach that was semi-scripted and tailored to the domains in the theoretical model (link to theoretical model). Participants who scored below the domain median or other indicators were offered a discussion on that domain based on the scripts that were developed for that domain. Participants were also shown videos and demonstrations on proper brushing, flossing and denture cleaning and practiced until they could no longer improve further, practice to mastery or PM.
The second intervention was a series of oral health fairs, managed by a building resident committee with help from the research staff, that featured messages and games generated by residents based on the domains from the theoretical model. All building residents were invited to participate. They rotated around tables that reflected messages related to each domain, staffed by other residents from the “campaign” committee, and research staff. Two campaigns events were conducted in the study building about one month apart. Each campaign event lasted about three hours and included oral health messages constructed by the five committee members who planned the campaign with research staff facilitation. The event included oral health information booths staffed by residents, Q and A from a dental provider, a Practice to Mastery (PM) table staffed by building residents and a dentist, a poster contest using campaign messages, and oral health games.
The primary outcomes were changes in gingivitis measured by the Ginigival Index, brushing quality measured by Plaque Scores and oral health related quality of life measured by the General Oral Health Assessment Index.