Participating in Community Programs

 

1: Participating in Community Programs

Case 1Participating in Community Programs

CASE STORY

The dental hygienists from the local component were contacted after Palomar Hospital was awarded a grant to assess the oral health needs and plan an education program for the senior population who regularly visit the health education center (see Figure 12.1.1A). The hospital has many different programs for health education and disease prevention that are targeted at the senior population. The health education director informed the dental hygienists that the patients would like to know more about oral health. It was assumed the needs of the target population would be more education in denture care. The dental hygienists conducted a needs assessment survey (see Figure 12.1.1B). They developed a questionnaire utilizing closed‐ended questions with a Likert scale response with only two open‐ended questions for a more in‐depth discussion. To ensure collection of detailed information and a wide range of respondents that would represent the target population, it was decided to conduct the survey as a face‐to‐face interview (see Figure 12.1.1C). The results from the survey revealed a strong interest in information about the prevention of xerostomia and more education about implant care. The seniors also reported that holding small groups rather than a large lecture would be the preferred method in delivering the information on oral health promotion. The dental hygienists developed a plan to meet the needs of the targeted senior population.

Figure 12.1.1: (A) Hospital setting. (B) Patient completing needs assessment. (C) Dental hygienist conducting face to face interview. (D) Dental hygiene process of care. (E) Dental hygiene program planning paradigm.

PROBLEM‐BASED LEARNING GOALS AND OBJECTIVES

• Explain the structure and steps of the Dental Hygiene Program Paradigm
• Distinguish appropriate data collection survey methods in assessing community needs
• Differentiate between closed‐ and open‐ended questions

Discussion

Note the dental hygiene process of care and dental hygiene program planning paradigm are similar in that they are both a structured process for dental hygienists to follow when caring for an individual or group. Both consist of steps that include: assessment of the situation, formulation of a dental hygiene diagnosis, planning the program, putting the plan into action, and evaluation (see Figure 12.1.1D and E, and Table 12.1.1).

Table 12.1.1: Patient care vs. community health programs.

Source: Adapted from Darby and Walsh (2015); Nathe (2017).

Stage	Patient Care	Community Health Programs
Assessment	Conducts a health assessment and comprehensive oral examination of individual patient to identify oral and general health status based on patient problems, needs, and strengths	Conducts a needs assessment of target population to analyze needs, interests, abilities, and resources
Dental hygiene diagnosis	Formulate conclusions about the patient’s dental hygiene needs based on all available assessment data and evidence in the literature	Formulate findings from assessment and prioritize needs
Planning	Develop a dental hygiene care plan with realistic goals and outcomes based on patient needs, expectations, values, and current scientific evidence to plan dental hygiene interventionsSelect appropriate interventions to implement plan	Develop a program based on the analysis of needs assessment data, priorities, and alternatives; community interaction; and resources available for which measureable assessment mechanisms are usedSelect appropriate resources to implement program
Implementation	Implement dental hygiene care plan while minimizing risk and optimizing oral health	Implement self‐generated treatment plan effectively
Evaluation	Review and assess outcomes of dental hygiene care via dental, gingival, and periodontal evaluations, modifying plan when necessary	Review and assess program outcomes via index and community evaluations, modifying plan when necessary
Documentation	Document all collected data, interventions planned and provided, recommendations, and other information relevant to patient care and treatment	Document all data gathered throughout all stages

Data collection is the gathering of information that the community can use to make decisions and set priorities. Different types of data are necessary to make certain that a complete assessment accurately describes the factors influencing the health of the community. Community health assessment efforts can evaluate determinants of health needs, assess needs, and assets, quantify disparities, and inequalities among population groups, measure preventable disease, injury, disability, and death (Geurink 2012, p. 64).

Assumptions should not be made of a population’s needs. A need is a gap between what the current condition is and what it should be. It can be defined as a judgment based on professional knowledge, skill, and experience as to the amount and kind of health‐care services required to attain or maintain health (Nathe 2017, p. 41). A needs assessment is required to provide the evidence that will guide the development of appropriate program planning. It provides a systematic method to determine needs, identify related cause(s), and priorities for future interventions. A needs assessment has the ability to identify health‐care situations regarded as unwelcome or harmful and needing to be dealt with and overcome within the community. The assessment provides information not only about the issues but about the community (Geurink 2012). Assessment is a core public health function and dental hygienists involved in public health practice must be proficient in the various aspects of oral health assessment. This is an integral component of a community oral health improvement process. Information gained form a community assessment can be used to plan, implement, and evaluate oral health improvement strategies.

A survey is a method of collecting information to determine the views of the target group. The assessment survey to evaluate community needs may be conducted in a variety of forms, such as interviews, questionnaires, or indices. The method chosen depends on the scope of the intention and available resources. Methods include: face‐to‐face interviews, phone interviews, direct mailers, email questionnaire, focus groups, indices, and multiple methods of distribution. The appropriate data collection survey approach should be determined. Interviews and questionnaires provide measurement of knowledge, attitudes, and values related to health and disease (Nathe 2017, p. 200). Interviews involve direct verbal questioning of participants and questionnaires are simple to administer when a large amount of data is needed. Interviews may be more time consuming than questionnaires, but assures more adequate responses. A dental index is a standardized quantitative method for measuring, scoring, and analyzing oral conditions in individuals and groups (Nathe 2017, p. 166).

Closed‐ended questions are those that may be answered with a single word or a short phrase, while open‐ended questions are those that require more thought and a longer answer. Closed‐ended questions may be dichotomous, multiple choice, or scaled questions. The Likert scale is the most widely used rating scale to measure responses and survey research. It is an ordered scale from which respondents choose one option that best aligns with their views. A typical scale might be “Strongly agree, Agree, Neutral, Disagree, Strongly disagree” (CDC 2012). Open‐ended questions have no predefined options or categories.

After the needs assessment is completed and the data has been evaluated, the dental hygienists began the planning by determining the goals and objectives for the program. A plan for community‐based interventions consists of strategies that will be implemented. Planning is an organized response to a community’s established need to reduce or eliminate one or more problems. A course of action is developed from the diagnosis. Developing goals, objectives, and program activities is part of the planning process. During this stage, it is essential to have community involvement and participation by community leaders, stakeholders, health group representatives, foundation leaders, government agencies, and all dental hygiene and dental associations (Geurink 2012).

Implementation is the step defined as the process of putting the plan and activities into action (Beatty 2017). Personnel, equipment, resources, supplies, and preliminary progress toward program goals are monitored. Many community oral health programs commence on a smaller scale – short term. This is referred to as a pilot testing or a pilot program. This provides information and allows for future decisions to be made that would work in practice.

Evaluation is continuous and measurements of the program’s intended outcomes determine if the population’s needs were met or if revisions are needed. A successful program meets its goals and objectives. Evaluation is a mandatory phase of all types of community programs. Although it is the final step of the program or community health improvement plan, formal, and informal evaluation results are reported regularly as this phase is ongoing and involves constant feedback and interaction. Program evaluation is a systematic method for collecting, analyzing, and using information to answer questions about community health programs. During this stage of the process, the results of the program are measured against the goals and objectives developed during planning. This is summative evaluation (Beatty 2017). Formative evaluation or process evaluation takes place before or during a project’s implementation with the goal of improving the project (Beatty 2017).This type of evaluation allows for better understanding of the process of change or continual improvement. The dental hygienist can improve future design and implementation.

Take‐Home Hints

1. If you are unfamiliar with the target population, always begin with a needs assessment.
2. Closed‐ended questions are time‐efficient, but make sure to not ask for simplistic responses to a complex issue when an open‐ended question is more appropriate.