The study design called for two interventions. The AMI was a face to face 30 minutes to one hour long intervention with participants, tailored to their intervention needs as determined by their scores below an established cutoff point on each of the study mediators. The Oral Health Fair / Campaign was a three session oral health fair, conducted in each building in collaboration with residents who formed a building based steering committee of people who were not eligible for participation in the project but wanted to contribute. The interventions are described in detail below.
Adapted Motivational Interview
A tailored individual-level intervention to meet the specific oral health needs of individual residents who volunteer for the intervention.
The approximately 90-minute tailored individual-level intervention takes place within two weeks of administering the baseline survey and clinical assessment. It is administered by trained project staff. Interventionists make appointments with residents who have completed the baseline assessment, review assessment materials and construct the intervention checklist specific to that individual. They conduct the intervention either in the privacy of the resident’s apartment or in a private location within the building.
The individual level intervention uses the Adapted Motivational Interviewing-Practice to Mastery (AMI-PM) approach. This approach is geared toward emphasizing internal locus of control, improving self-efficacy, addressing knowledge gaps, shaping intentions, and improving skills required to conduct oral hygiene behaviors regularly and appropriately, and should be highly effective in addressing core components of MI. The Oral Health AMI-PM intervention follows the adapted motivation protocol by shaping the tailored intervention in relation to a checklist derived from cognitive scale items and reported oral health behaviors. Tailoring is based on:
- each participant’s specific gaps in the survey (inaccurate responses and incorrect oral health behavior or insufficient or inadequate oral health behavior)
- oral health problems identified in the clinical assessments at baseline
- brief conversations with each participant about his or her oral health problems
From these sources the interventionist generates a list of participant specific cognitive and behavioral elements to be addressed and modified through the AMI-PM intervention. For example, the clinical examination produces information on gingivitis and locations demonstrating accumulation of plaque. The survey produces information that indicates incorrect beliefs, gaps in knowledge, gaps in self efficacy and limitations in intentions to practice and gaps in reported skills and specific oral hygiene practices. Staff reviews these data and generate the individual participant’s checklist prior to the scheduled session.
Implementation of the Oral Health AMI-PM intervention includes the following steps:
- identifying the respondent’s checklist of focal points for tailored intervention from survey and clinical results
- building rapport with the participant through a 15-minute discussion of personal oral health, oral health problems, concerns and fears, practices and intentions, and probing of explanations underlying items on the checklist
- completing the personalized (tailored) intervention checklist as a guide for the intervention
- addressing each of the items on the checklist with the participant through dialogue to correct misunderstandings expand knowledge, and explore barriers to intention (knowledge, beliefs, attitudes, intention
- demonstrate requisite oral hygiene skills that are not practiced or may be practiced insufficiently (skills improvement)
- observe respondent practice individualized skills to mastery on a model (practice to mastery, self-efficacy)
- revisiting skills and behavioral intentions (self-efficacy)
- building a behavioral plan (intentions)
- revisiting myths, fears, doubts and other gaps (reflection)
Oral Health Campaign
A building-level intervention involving residents as volunteers to implement two 4-hour standardized and scripted pro oral health campaigns, one after completion of the individual-level intervention, and the second after the 3-month survey
Training and Preparation of Pro-GOH Campaign Volunteers.
Toward the end of the first year, approximately ten residents of the intervention building are recruited by study intervention staff to meet four times over a four-week period to receive training for the implementation of two pro-oral health campaigns and an additional four times to create a Pro-GOH film. The committee includes role models who are broadly representative of the composition of the building by age, ethnicity, gender and ability.
The specific role of the volunteers includes:
- learning about oral health and good oral health hygiene
- raising and addressing any concerns they might have about oral health promotion
- agreeing to recruit residents to campaign events using the GOH flip chart
- organizing others’ or presenting their own oral health practice testimonials
- working with intervention staff on an oral health movie
- staffing information tables and game and poster contest activities at oral health fairs
- and helping to set up food and entertainment.
The four training sessions include:
- Session 1: committee roles and responsibilities and introduction to core theoretical concepts guiding the intervention (knowledge, beliefs, fears, self efficacy, intentions, and oral health hygiene behavior.)
- Session 2: oral health and oral health self management behavior including exposure to demonstration and volunteer practice
- Session 3: Review of the standard components of the Pro-GOH campaign
- Session 4: Creation of a campaign plan
Standardized Oral Health Campaign Components. Core components standardize the pro-oral health campaign, ensure inclusion of theoretical principles, and prepare for fidelity of implementation.
- Campaign Materials: will include Frequently Asked Questions (FAQs), pro-oral health messages, flip books, posters and the Pro-GOH movie.
- Campaign recruitment: Resident volunteers will recruit residents to the campaign events using a plan that they devise to reach all residents in the building. For assistance they will carry the 4 x 6 flip chart that contains FAQs, messages and images to which they can refer when answering questions about the event and about oral health.
- Pro-GOH Campaign Activity Guide and checklist. The campaign guide and checklist outlines the major required components of a Pro-GOH campaign event as follows:
- Preparatory Activities:
- A recruitment strategy to reach all residents (e.g. by floor, network, public spaces, elevators, etc.)
- Posting posters with Pro-GOH messages invited residents to events.
- Creating a campaign event program with detailed guidelines, for use by building volunteers;
- Developing an introductory script for building volunteers for introducing each of 2 campaign events.
- Defining specific roles designated for volunteers (recruitment, management of Campaign activities);
- Campaign activities with associated theoretical concepts
- Norms/Intentions: Pro-GOH testimony from building residents
- Self Efficacy: Games repeating Pro-GOH Messages by challenging residents to answer faqs (goh puzzle));
- Knowledge: competition challenging residents to reflect on and produce the best representation of one or more of the core Pro-GOH messages (e.g. poster competition) (knowledge);
- Knowledge/Fears: “Meet An Expert” informal question and answer period with a GOH expert from UCHC (knowledge/beliefs; oral health fears);
- Norms: screening of the building-specific Pro-GOH Movie with interactive discussion (norms);
- Skills Building information table with educational skills building and oral hygiene practice opportunities using toothbrushes, flossing equipment and models.
- different materials (at least 4 different types of materials in English and Spanish)
- multiple channels (oral group, written)
- multiple exposure times (each message is presented a minimum of four times during each event) interactivity for learning reinforcement and role
- modeling by building volunteers and though testimonials