Evaluation Design

All eligible participants who enrolled in the pilot study agreed to take the study surveys in either English or Spanish which were conducted approximately 3 months apart. The subset of participants who agreed to participate in the face to face intervention also underwent a clinical assessment before and after the AMI to assess changes in gingival index and plaque scores.

Outcome Measures

Gingival Status: The Gingival Index (GI) (Loe & Silness, 1963) was used to assess the presence of gingival inflammation around six surfaces of each tooth.  The GI was described as: 0=no visual signs of inflammation; 1=slight change in color and texture of the gingiva but no bleeding; 2=visual sign of inflammation and bleeding upon swiping; 3=overt inflammation and spontaneous bleeding.  A mean GI was calculated per participant. 

Plaque Score: We used the O’Leary plaque control record (O’Leary, Drake, Naylor, 1972), which was developed as a dichotomous measure for plaque on the gingival third of each tooth surface. The supragingival bacterial plaque was assessed with the use of erythrosine disclosing solution on six surfaces of each tooth and calculated based on the number of surfaces stained positive for plaque divided by the total number of surfaces.

Oral Health Related Quality of Life (OHRQoL): We used the General Oral Health Assessment Inventory (GOHAI), a commonly used 12-item measure initially developed for older adults that has been used with low income, populations (Atchison & Dolan, 1990). The GOHAI was translated into Spanish and back translated for the pilot study and was found to be acceptable by across the racial/ethnic spectrum.  

Clinical assessments were administered at baseline and four to five months after the initial assessment. They were conducted in an apartment that the building management allocated to the study. Participants sat in an upright chair with arms and tilted their heads back for the assessment. Head lamps and disposable sterile instruments were used. A clean work environment was maintained using hospital grade surface disinfectant and clean paper drapes. Universal precautions were observed and disposable instruments were removed via sharps containers. Participants first received a soft tissue exam, evaluation of prostheses and the presence or absence of teeth. This was followed by the gingival assessment and then the plaque index. The clinical assessment took about 15 minutes to complete. Dentists (dental residents) doing the evaluations were instructed to not give any advice or input regarding participants questions about oral hygiene.

Survey Self-Reported Mediators

The survey included data on demographic, health insurance, dental care and cognitive variables/domains as follows:

  1. ADLS Activities of Daily Living (ADL index): a widely used measure of the functional status of an individual.  The scale consists of 8 behaviors that indicate ability to take care of personal basic needs 
  2. Oral health knowledge:  Oral health knowledge is a 7-item true/false test based on previously developed knowledge test used with low income older African Americans.
  3. Oral health beliefs/norms (2 domains): The Dental Coping Beliefs Scale [135-137] is a 26-item scale consisting of four subscales, Oral Health Beliefs, Internal Locus of Control, External Locus of Control, and Self-Efficacy.   The scales were adapted in the pilot study and used to measure locus of control, and self-efficacy, key domains in the study model (Alpha = .61). 
  4. Oral Health Norms. We measured social norms with a scale that assessed the perceived importance of oral hygiene behavior (Alpha =.68 with 1 item deleted).
  5. Oral Health Social Support. One question asking how many people they can get health information from in the building: none, 1-2 people, 3-4 people, 5 or more people.
  6. Oral hygiene behaviors: A measure consisting of questions that assess oral health self-management behavior including frequency and timing of brushing and flossing teeth.
  7. Oral health self-management fears and worries (2 domains). A scale was developed from formative data collected through our prior studies and evaluated during the pilot. The scales consisted of items identified by residents in focus group sessions related to worries and fears about conducting oral hygiene behaviors. Dental Worries Sacel (23 items) Alpha=.90; Dental Dears (4 items) Alpha=.75.
  8. Oral Health Self-Management Intentionality.  Intention to perform the oral health self-management behaviors, a critical component of the IM model, was assessed using the protocol described by Ajzen and Fishbein and Tedesco and adapted based on formative data.  Participants rated their intention to brush and floss daily using a five item four point Likert scale Alpha=.81.
  9. Dry Mouth.  Xerostomia was assessed through self-report measure developed by Fox and colleagues (1987).  It consists of 8 items with yes/ no responses to symptoms.  Scores on this variable are calculated by counting the number of yes responses to each item.  (Alpha = 0.58).
  10. Dietary sugar intake was assessed with a five-item scale on frequency of eating cakes, candies and sugary drinks.  (Alpha = 0.61 with one item deleted)
  11. Clinical Assessment: results of the clinical assessment of plaque and gingival inflammation (see details of the clinical assessment below) were discussed with each participant using the clinical dental chart.
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