Addressing Oral Health Within a Women’s Homeless Community
Seven nursing students attending Seattle Pacific University (SPU) partnered with a women’s day center to serve population healthcare needs for a leadership project. In the first few weeks, we visited the agency site to get familiar with the population and have a deeper understanding of what our group should address. Our goal for this project is to identify an issue of concern and address the issue using the nursing process. The women’s day center is for women who are experiencing homelessness. Homelessness is unfortunately a big problem in the city of Seattle. This population has to constantly face barriers when it comes to basic self-care, oral care, and prevention of health issues. Our mission as a group was to identify the barriers and improve oral health within the homeless population at a women's day center. We helped them by providing resources, oral tooth kits, and education. We hope that our contribution has positively impacted them and we hope that others continue to help diminish the barriers when it comes to oral health.
This women’s day and overnight center is located in downtown Seattle. The overnight shelter is limited to some people due to the small capacity of the facility. However, any homeless women are welcome to come by during the day to use the agency’s drop-in services. However, drop-in services can only offer so much, “Individuals who are homeless… have higher mortality rates and experience the dual burdens of dental problems, chronic diseases compared to the general population due to structural and system-level barriers (e.g., lack of affordable housing… health services affordability, lack of accessibility to health and social services)...” (Mejia–Lancheros, et. al, 2020).
The homeless population faces many difficulties, and having access to good health care is one of them. One major problem that the homeless population faces is not having good oral health. This has been proven by our assessment of the population and literature about limited dental care. According to the National Institutes of Health (NIH), homeless people are half as likely to visit the dentist and more likely to have decaying teeth than the general population. The general population not going to dental services is 26.7% and 55.0% for the homeless population (Gelberg, 2023). This is due to the lack of supplies, access to resources, and the inability to perform oral care.
Activities with Rationale
At the women’s day center, we assessed, implemented several activities, and evaluated the outcomes over a span of seven weeks to promote the importance of oral health. During the second week of the quarter, the group performed a windshield survey to assess the three biggest concerns that the group should focus on. In the third week, we engaged with the population by providing hand massage and nail care to get to know the population. From a previous leadership project, three health concerns were identified, mental health, eye care, and oral care. We confirmed, by interviewing during the nail activity, that having good oral health and accessibility to dental services were the priorities of the population. We decided to focus on oral care and try to promote different resources that help with this issue. In weeks three and four, we created a pre-survey (Appendix A) and a brochure (Appendix C) to retrieve raw data about how knowledgeable the ladies were about dental care. According to Conte et al. (2006), there is evidence that access to dental care is limited among the homeless. Based on the feedback we got from the center, supplies were needed for preventative measures. Also, providing resource information and locations of nearby free dental clinics would be helpful.
In weeks five and six, our group implemented an incentivizing activity to promote population engagement. For this activity, our group chose to utilize a Jeopardy game that would implement learning and feedback from the brochure (Appendix C) we made for the center. Prizes were given as well as oral kit supplies (Appendix E) to signify the importance of preventative measures.The Jeopardy game and the brochure focused on how to brush teeth properly, oral myths/facts, resources to clinics, complications of poor dental care, and emergency clinics for tooth pain or any other immediate concerns (Appendix G). We found that many lack the motivation to use the resources given to the day center. This population attributes underutilization of social services due to mistrust of social service agencies (King and Gibson 2003). They also did not want to leave the center for safety concerns. We then pivoted alongside them in week eight to schedule the members of the population with dental appointments for an upcoming mobile dental van event within the same vicinity of downtown.
The goal of our project was to increase the utilization of resources related to improved oral health within our population through increased knowledge of oral care, increased accessibility of supplies, motivation to perform oral care, and the utilization of dental services in the population. When comparing the pre-teaching and post-surveys, we found that 13/22 of our participants reported their oral health as fair, good, or very good. After our teaching which included pamphlets and our jeopardy game, we found that 18/22 of individuals reported fair, good, or very good oral health showing a 23% increase. This data can be reflected as increased motivation to perform oral care due to the increased amount of knowledge after our teaching.
Our findings in the pre-survey helped us determine that the ladies need dental supply kits. We were generously donated 70 supply kits that each had a toothbrush, toothpaste, and dental floss. About 50% of the ladies showed interest in our pamphlets and we provided them with information on how to get free dental care, the location, phone number, and dates. When we were doing our Jeopardy games about 40% of the ladies were surprised about poor oral health being associated with heart problems. Last week there was a new population and about 10% of them learned about information on the dental clinics. We found the dental van resource and signed up 7/13 ladies, 54% of the population who participated during the signup promotion, for dental appointments.
Given the transient nature of the homeless population and the sample population altering each week, limiting factors such as lack of trust, supplies, and time impacted our findings and the efficacy of our interventions. Our population, specifically the short-term day visitors varied week to week, resulting in possibly skewed data collection on the effectiveness of our intervention. Gaining trust amongst our target population presented as an identified issue along with the constraints of time within ten weeks to assess and provide interventions.
Contrary to our belief, the population presented with a fairly good knowledge level about the importance of oral health, how to perform daily oral care, and resources that are available to them including nearby free dental clinics. The problem they were facing was not only the inability to pay for dental care but prioritizing their dental care over other things, safety and lack of dental supplies, and motivation to go out of their comfort zone to utilize dental services. It’s challenging to prioritize dental care when they are in survival mode of finding the next meal, a place to sleep, and a safety net. Being alongside them to get an appointment was the turning point of our intervention that produced tangible results. Improving the oral health of the population requires ongoing education, ensuring supply availability, and collaboration with other support service providers such as social services, community health nurses, nursing students, facility staff members, and volunteers to increase access to routine dental services.
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Hogan, Annika; Cadelina, Hannah; Kaur, Simran; DeCastro, Vannessa; Sano, Yoshiko Sano; Sonko, Fatou; and Urbick, Machaela, "Addressing Oral Health Within a Women's Homeless Community" (2023). Nursing Leadership in Community Engagement Projects. 39.
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