Publication Date

Fall 12-11-2024

Item Type

Text

Executive Summary

Take Charge of Your Health: Start with Your Smile

Oral health is a fundamental component of overall health, yet it is often neglected-particularly among vulnerable populations like houseless individuals (Freitas et al., 2019). Houseless individuals face numerous barriers to accessing healthcare, with dental services being limited. This lack of access contributes to a higher prevalence of oral diseases, which if left untreated, can lead to severe complications. Poor oral health doesn’t just affect the mouth; it negatively impacts one’s overall systemic health, psychosocial well-being, and quality of life (Csikar et al., 2019).

As nursing students engaged in a Community Health Leadership Project, we partnered with a day center in Seattle, which provides shelter and supportive services to houseless women. Through this collaboration, we aimed to draw attention to the importance of oral health among shelter residents. By the end of the scheduled implementation day, our goal was to have at least one-third of the women we spoke to show a verbal increase in readiness to perform oral hygiene and report understanding of the care given by the mobile dental clinic that was scheduled to come to the center in the future.

Background

Through our evaluation and assessments, we discovered a stigma instilled among the population at the shelter regarding oral health services and participation in dental checkups. We conducted a survey to ask participants how they felt about oral cleaning and their interest in participating in the mobile dental van. Of the 15 women surveyed, 5 expressed fear around dental health services and did not show interest in participating in the dental van. The remainder of this group did not comment. Through intimate discussions, fears and barriers to receiving oral care, as well as personal attitudes were identified. Some ad traumatic experiences involving going into vehicles and having people put their hands in their mouths. Some verbalized they focused more on basic needs such as stable housing before giving attention and energy to specific attributes of higher health. Other women believed they did not need oral health or that the mobile dental van did not provide legitimate dental care. We were also informed that when the dental van last visited the agency, only eight out of 200 residents participated in a dental cleaning (Agency, personal communication, 2024).

The windshield survey reinforced the presence of both challenges and resources in the shelter’s environment. Strengths include access to transportation, pedestrian-friendly sidewalks, nearby green spaces, and food options such as restaurants and Pike Place Market. However, the area also exhibits high crime rates and substance use, creating additional barriers to health engagement. Mental health challenges, both within and outside the shelter, further impact the population’s ability to prioritize oral care.

Research has shown houseless individuals often view dental care as frightening, humiliating, and prohibitively expensive, with past negative experiences contributing to dental anxiety, discouraging treatment (Jennings et al., 2022). Government-provided dental care resources give limited access among houseless, leading to significant oral health issues such as tooth loss. In one study, over half of houseless participants were missing at least half of their teeth. Many reported experiencing oral pain that interfered with eating and sleeping, further impacting their quality of life. Many reported an inability to obtain dental care, and experienced oral pain within the past six months. This pain was linked to difficulties with eating and sleeping, further impacting their quality of life (Freitas, 2019).

Another aspect found in the literature that supports the importance of promoting oral hygiene is the prevention of diseases. In a study done in Beijing, China, researchers found poor oral hygiene practices were associated with a higher risk of chronic diseases, cardiovascular disease (CVD), and diabetes mellitus (DM) among middle-aged and older adults (Guo et.al., 2023). These findings highlight a critical link between oral health and systemic diseases. Lastly, bad oral hygiene can also lead to pneumonia, as germs in the mouth multiply rapidly and often trickle down into the lungs during sleep (Munro, 2019).

Rapport Building Activities

During our time at the women’s shelter, we carefully selected activities which stimulate engagement and educate the residents in a meaningful way-supporting the overall goal of increasing readiness to perform oral care and interest in participating in the mobile dental van. Each activity was designed to engage effective health promotion strategies while addressing the psychological, social, and educational needs of participants

One core activity, Bingo, is a widely accessible game that encourages participation and cooperation-which are crucial for creating a supportive and inclusive environment. Incorporating Bingo into the shelter program was not just a way to engage residents, but also a means of establishing trust, reducing anxiety, and fostering a sense of community. In addition, coloring pages have been shown to help reduce anxiety and promote feelings of well-being. A study found that coloring therapy has a positive impact on reducing anxiety and depression symptoms (Samuel et. al., 2022).

Implementation

After an environment and relationship were created where education could be effectively provided and receptive between the nursing students and the residents, an education session was performed. Extensive research was conducted to accumulate vital information that the population would benefit from surrounding oral health. A trifold board and pamphlets were created with topics such as symptoms of bad oral health, prevention strategies, diseases secondary to bad oral hygiene, barriers to dental care, and infographics on how to floss or brush. Donations from a local dentist were also provided to residents such as floss, high-quality toothpaste, and toothbrushes since a barrier to oral health was a lack of adequate resources. Lastly, we provided a virtual database that pairs an individual to dentists depending on their geographical area and insurance provider (Medicaid or no insurance).

Outcomes

Our goal was for one-third of the women to verbalize an increase in readiness to perform oral hygiene after our education and improved comprehension of the care given by the dental van. We used post-education surveys to quantify how many women planned on performing daily oral hygiene and their interest in attending the dental van. Although some women refused to fill out surveys or expressed disinterest, one-third of the women who did reported readiness to participate in oral hygiene and interest in attending the dental van. We determined that our goal was met using the teach-back method to assess comprehension. After educating the women, they accurately reported a proficient understanding of the dental van services.

Conclusion

Through establishing rapport with the women at the day center, we fostered motivation and readiness to engage in oral care and anticipation of the dental van visit in February. Women then completed post-education surveys to determine readiness to perform oral care and interest in utilizing the dental van. Our goal was met, as at least one-third of women verbalized increased readiness to perform oral hygiene. We left extra educational pamphlets and our trifold board at the agency for the women to read. These materials promote a sustained impact despite participant turnover and provide a reminder of the dental van. We anticipate the winter quarter will follow up and fellow students will continue this project and further participation.

References

Bond, M., Goh, L. K., & Soong, K. H. (2017). Building rapport and trust in health care: A framework for engagement. Journal of Health Communication, 22(2), 160-167. https://doi.org/10.1080/10810730.2017.1280193

Csikar, J., Vinall-Collier, K., Richemond, J. M., Talbot, J., Serban, S. T., & Douglas, G. V. A. (2019). Identifying the barriers and facilitators for homeless people to achieve good oral health. Community Dental Health, 36(2), 137-142. file:///C:/Users/maddy/Downloads/CDH4488-Csikar_web.pdf

Freitas, D. J., Kaplan, L. M., Tieu, L., Ponath, C., Guzman, D., & Kushel, M. (2019). Oral health and access to dental care among older homeless adults: results from the HOPE HOME study. Journal of public health dentistry, 79(1), 3–9. https://doi.org/10.1111/jphd.12288

Guo, D., Shi, Z., Luo, Y., Ding, R., & He, P. (2023). Association between oral health behavior and chronic diseases among middle-aged and older adults in Beijing, China. BMC oral health, 23(1), 97. https://doi.org/10.1186/s12903-023-02764-y

Jennings, B. M., Lem, M., Kilborn, S., Donnelly, B., & Acker, A. (2021). Improving oral health care accessibility for homeless and vulnerably housed pet-owning populations. Journal of Public Health Dentistry, 81(4), 381–386. https://doi.org/10.1111/jphd.12461

Mago, A., MacEntee, M. I., Brondani, M., & Frankish, J. (2018). Anxiety and anger of homeless people coping with dental care. Community dentistry and oral epidemiology, 46(3), 225–230. https://doi.org/10.1111/cdoe.12363

Munro, S. (2019). Oral Hygiene to Fight Pneumonia.U.S. Department of Veteran Affairs, Office of Research and Development. https://www.research.va.gov/research_in_action/Oral-hygiene-to-fight-pneumonia.cfm#:~:text=Germs%20in%20the%20mouth%20multiply,can%20therefore%20help%20prevent%20pneumonia.

Samuel, B.,Wang, H., Shi, C., Pan, Y., Yu, Y., Zhu, W., & Jing, Z. (2002). The effects of coloring therapy on patient with generalized anxiety disorder. Animal Models and Experimental Medicine, 5(6). https://doi.org/10.1002/ame2.12256

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