Community health worker intervention to improve tooth brushing in young children: Results from a cluster randomized controlled trial

Abstract

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 selfreported. 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.

Oral community health worker-led interventions in households with average levels of psychosocial factors

“…Nearly a quarter of participants in the intervention arm received all four visits (23.7%); 12.8% received three visits; 21.3% received two visits; 23.2% received one visit; and 19.0% of participants in the intervention arm received no visits during the study period [ 6 ]. CHW visits ranged in duration from 9 to 195 min, with a mean duration of 63.7 (SD 21.8) min [ 6 ]. After a CHW visit was completed, a follow-up call was attempted.…”

“…We conducted per-protocol analyses to determine if more or less receipt of CHW visits was associated with psychosocial factors and behaviors but outcomes did not vary by CHW dose. Although the dose of 4 CHW visits was carefully chosen based on effective doses with other studies [ 6 ], the dose and intensity may ultimately have been insufficient to influence participant psychosocial factors and other outcomes. The main trial was powered to show changes in oral health behaviors, and therefore power may not be adequate for this secondary analysis.…”

“…CHW-led intervention included up to four visits over 1 year. There was social proximity between the CHWs and the study participants [ 6 ]. CO-OP's Spanish speaking families were paired with a Spanish-speaking CHW.…”

“…The primary outcomes of the clinical trial were children's tooth brushing, measured using self-reported frequency and observed plaque score. The intervention, delivered by CHWs mainly in homes, was not associated with a difference in brushing when compared to brushing in a wait-list control group [ 6 ]. This result was different than expected and did not align with other CHW research.…”

“…CO-OP's CHW intervention was based upon Bandura's Social Cognitive Theory [ 17 ]. We hypothesized that tooth brushing behaviors could be influenced by immediate feedback from CHWs that are external to the family but aligned with the participant's social network [ 6 ]. Tooth brushing behaviors, including parental supervision, have been linked to self-efficacy [ 18 , 19 ].…”