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Published on: February 2, 2020
Community health worker intervention to improve tooth brushing in young children: Results from a cluster randomized
Molly A Martin1, David Avenetti1, Helen H Lee1
1University of Illinois Chicago, Chicago, Illinois, USA.
Insights
Community health worker (CHW) home visits did not improve tooth brushing in young children. Parent involvement in brushing was key for better oral health outcomes. More effective interventions are needed for families.
Area of Science:
- Public Health
- Pediatric Oral Health
- Health Behavior Interventions
Background:
- Low-income children often have poor oral hygiene, increasing risk for dental caries.
- Community Health Worker (CHW) interventions show promise for improving health behaviors in underserved populations.
- The Coordinated Oral Health Promotion (CO-OP) Chicago trial evaluated a CHW intervention for young children's tooth brushing.
Purpose of the Study:
- To test the efficacy of a CHW intervention to improve tooth brushing frequency and reduce plaque scores in low-income children under three years old.
- To identify factors associated with improved brushing behaviors and oral health outcomes in this population.
Main Methods:
- A cluster randomized controlled trial involving 420 children (mean age 21.5 months) across 20 sites in Chicago.
- Intervention group received up to four CHW home visits over one year; control group did not.
- Tooth brushing frequency was self-reported, and plaque scores were assessed from home-collected images.
Main Results:
- No significant improvement in brushing frequency or plaque scores was observed in the CHW intervention arm.
- Child brushing frequency improved over time, associated with various child and caregiver factors.
- Parental involvement in brushing was the only factor linked to reduced plaque scores.
Conclusions:
- Oral-health-specific CHW services did not effectively improve tooth brushing behaviors in this cohort of young children.
- Caregiver involvement in brushing is crucial for enhancing the quality of oral hygiene practices.
- Future interventions should focus on more robust strategies to support families during early childhood development for better oral health.
Objectives:
Coordinated Oral health Promotion (CO-OP) Chicago is a cluster randomized controlled trial testing the efficacy of a community health worker (CHW) intervention to improve tooth brushing in low-income children.
Methods:
Four hundred twenty children under 3 years old (mean 21.5 months) were recruited from 20 sites in or near Chicago, IL. Children were identified mainly as Black race (41.9%) or Hispanic ethnicity (53.8%) and most (85.2%) had Medicaid. Intervention families were offered four CHW home visits over 1 year. Brushing frequency was self-reported. Plaque score was determined from images collected in homes using disclosing solution. Analyses used GEE logistic models with variable selection at p < .05.
Results:
At enrolment, 45.0% of families reported twice a day or more child brushing frequency, and child plaque scores were poor (mean of 1.9, SD: 0.6). Data were obtained from 87.1% of children at 6 months and 86.2% at 12 months. In the CHW intervention arm (10 sites, N = 211), 23.7% received 4 visits, 12.8% 3 visits, 21.3% 2 visits, 23.2% 1 visit and 19% no visits from CHWs. No intervention effect was seen for brushing frequency or plaque score. Child brushing frequency improvement over time was associated with a range of child and caregiver factors. The only factor associated with a change in plaque score over time was parent involvement in brushing.
Conclusions:
Oral-health-specific CHW services were not associated with improved brushing behaviours in these young children. However, caregiver involvement with brushing supported more quality brushing. More robust interventions are needed to support families during this critical developmental period.
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