Evaluate,assess, treat: development and evaluation of the EAT framework to increase effective communication regarding sensitive oral‐systemic health issues

Oral healthcare providers are likely to encounter a number of sensitive oral/systemic health issues whilst interacting with patients. The purpose of the current study was to develop and evaluate a framework aimed at oral healthcare providers to engage in active secondary prevention of eating disorders (i.e. early detection of oral manifestations of disordered eating behaviours, patient approach and communication, patient‐specific oral treatment, and referral to care) for patients presenting with signs of disordered eating behaviours. The EAT Framework was developed based on the Brief Motivational Interviewing (B‐MI) conceptual framework and comprises three continuous steps: Evaluating, Assessing, and Treating. Using a group‐randomized control design, 11 dental hygiene (DH) and seven dental (D) classes from eight institutions were randomized to either the intervention or control conditions. Both groups completed pre‐ and post‐intervention assessments. Hierarchical linear models were conducted to measure the effects of the intervention whilst controlling for baseline levels. Statistically significant improvements from pre‐ to post‐intervention were observed in the Intervention group compared with the Control group on knowledge of eating disorders and oral findings, skills‐based knowledge, and self‐efficacy (all P < 0.01). Effect sizes ranged from 0.57 to 0.95. No statistically significant differences in outcomes were observed by type of student. Although the EAT Framework was developed as part of a larger study on secondary prevention of eating disorders, the procedures and skills presented can be applied to other sensitive oral/systemic health issues. Because the EAT Framework was developed by translating B‐MI principles and procedures, the framework can be easily adopted as a non‐confrontational method for patient communication.     

The invisible barrier: literacy and its relationship with oral health. A report of a workgroup sponsored by the National Institute of Dental and Craniofacial Research, National Institute of Health, U.S. Public Health Service, Department of Health and Human Services

Although oral health in the United States has improved significantly over time, preventable and treatable oral diseases remain common, especially among the poor and underserved. Limited literacy skills among adults are hypothesized to be one of many barriers to better oral health outcomes. Adults must be able to understand, interpret, and act on health information, whether it is communicated in spoken or in written form, to maintain their oral health and manage disease. While the body of health literacy research has grown in recent years, little is known about oral health literacy. Research is needed to build an understanding of oral health literacy and its impact on a variety of outcomes, including adoption of effective disease prevention regimens and actions, adherence to treatment regimens, effectiveness of caregivers and ultimately, improved oral health status. In addition, the effect of oral health literacy on the validity of clinical research such as response to surveys and adherence to research protocols is another area that is important to investigate.
This paper defines oral health literacy and offers a framework for studying relationships between oral health literacy and other points of intervention for improving health outcomes. Findings of existing health literacy research are summarized, and a research plan for oral health literacy is proposed. A broad-based collaborative effort will be required to develop a detailed agenda for research, one that is aimed at reducing literacy barriers to oral health and ensuring that the information and insights emanating from new oral health research are more widely adopted.     

Development and validation of an instrument to assess oral health literacy in Norwegian adult dental patients

Abstract

Objective. To develop and validate an interview instrument to assess oral health literacy in Norwegian adult dental patients. Materials and methods. The instrument, Adult Health Literacy Instrument for Dentistry (AHLID), was based on an OECD instrument used to assess general literacy in adults. One hundred and thirty Norwegian adults (mean age = 48 years; 57% women) participated. AHLID included a selection of oral health-related printed texts that ranged from 1–5 with respect to difficulty. A questionnaire regarding socio-demographic variables and knowledge of risk factors for oral disease was used. DMFT, stimulated salivary flow rate and streptococcus mutans and lactobacillus in saliva was also examined. Results. The Cronbach’s alpha values of AHLID were 0.98 for internal consistency reliability (p < 0.01) and 0.81 for test–re-test reliability (p < 0.05). AHLID score 3 was most frequent while very few fulfilled the criteria for score 1 and 5. Linear multiple regression analysis showed that lactobacillus in saliva and knowledge of risk factors for periodontitis and caries were predictor variables of AHLID score. Conclusions. AHLID appears to be reliable and valid to assess oral health literacy in Norwegian adults and suggests a method for country-specific health literacy instruments.     

Evaluation of a word recognition instrument to test health literacy in dentistry: the REALD-99

OBJECTIVE: This study aims to evaluate a dental health literacy word recognition instrument. METHODS: Based on a reading recognition test used in medicine, the Rapid Estimate of Adult Literacy in Medicine (REALM), we developed the Rapid Estimate of Adult Literacy in Dentistry (REALD-99). Parents of pediatric dental patients were recruited from local dental clinics and asked to read aloud words in both REALM and REALD-99. REALD-99 scores had a possible range of 0 (low literacy) to 99 (high literacy); REALM scores ranged from 0 to 66. Outcome measures included parents' perceived oral health for themselves and of their children, and oral health-related quality of life of the parent as measured by the short-form Oral Health Impact Profile (OHIP-14). To determine the validity, we tested bivariate correlations between REALM and REALD-99, REALM and perceived dental outcomes, and REALD-99 and perceived dental outcomes. We used ordinary least squares regression and logit models to further examine the relationship between REALD-99 and dental outcomes. We determined internal reliability using Cronbach's alpha. RESULTS: One hundred two parents of children were interviewed. The average REALD-99 and REALM-66 scores were high (84 and 62, respectively). REALD-99 was positively correlated with REALM (PCC = 0.80). REALM was not related to dental outcomes. REALD-99 was associated with parents' OHIP-14 score in multivariate analysis. REALD-99 had good reliability (Cronbach's alpha = 0.86). CONCLUSIONS: REALD-99 has promise for measuring dental health literacy because it demonstrated good reliability and is quick and easy to administer. Additional studies are needed to examine the validity of REALD-99 using objective clinical oral health measures and more proximal outcomes such as behavior and compliance to specific health instructions.     

Screening for oral health literacy in an urban dental clinic

Objective: Studies show that the average person fails to understand and use health care related materials to their full potential. The goal of this study was to evaluate a health literacy instrument based on the Rapid Estimate of Adult Literacy in Medicine (REALM) that incorporates dental and medical terms into one 84‐item Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM‐D) measure and determine its association with patient characteristics of a culturally diverse dental clinic population. Methods: An 84‐item dental/medical health literacy word list and a 48‐item health beliefs and attitudes survey was provided to a sample of 200 adult patients seeking treatment for the first time at an oral diagnosis clinic located in a large urban medical center in Los Angeles, California. Results: Of the total sample, 154 participants read all of list 1 correctly, 141 read list 2 correctly, and only 38 read list 3 correctly. Nonwhite participants had significantly lower REALM‐D scores at each level of difficulty as well as the total scale score compared to white participants. Participants who reported English as not their main language had significantly lower REALM‐D scores. REALM‐D scores also varied significantly by level of education among participants where as level of education increased, oral health literacy increased. At a bivariate level, race, education, and English as a main language remain predictive of health literacy in a regression model. An interaction between education and English as a main language was significant. Conclusions: The REALM‐D is an effective instrument for use by medical and dental clinicians in detecting differences among people of different backgrounds and for whom English was not their primary language.