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UBC Theses and Dissertations

Evaluating the effectiveness of the Healthiest Babies Possible dental program Lin, Diana Louise


Objectives: A community dental public health program in Vancouver has been providing clinical hygiene services and oral health counseling to a limited number of high-risk, low income pregnant women for over 20 years. To enable future program decision-making, a program evaluation was undertaken with the following objectives: 1) to describe program, clients, and their oral health needs; 2) to determine whether program activities have been implemented as intended; and 3) to assess program's effectiveness in improving oral health status of clients and in improving their knowledge and behavior in relation to their own health and those of their children. Methods: The evaluation, undertaken by the resident dental hygienist, had two phases. Phase 1: Evaluability assessment, descriptive and process evaluation (retrospective and concurrent chart reviews, semi-structured interviews, appointment monitoring, and field observations). Phase 2: A short- and medium-term outcome evaluation with a convenience sample who attended over a 1-year period. Data, collected by questionnaires, interviews, clinical indices, chart review, field observations, and appointment statistics, was analyzed with a combination of univariate and bivariate analyses. Results: Phase 1: Stakeholders' goals were identified; a logic model and organizational flowchart were developed. Chart review (N=123) revealed mean client age of 27 years; 28% Canadian-born; 48% had other children; 78% were concerned about "bleeding gums"; and 63% had visible tooth decay. 28% of women referred to the program never attended. Unfamiliarity of clients with the dental "experience", language barriers, and clinic operation and time restraints affected implementation of program's activities. Phase 2: Outcomes in clients (N=61) demonstrated significant improvements (P<0.05) in clinical indices, oral health knowledge and tooth brushing skills, and dental care for clients' children. A positive program experience was reported from all the women. However, 79% (48/61) of clients never obtained the "outside" dental services that they needed. Conclusions: Evaluation revealed positive changes, extending into the postnatal period in knowledge, behaviors and clinical outcomes despite language barriers, insufficient resources, and ill-defined program goals. Identified program limitations need to be addressed to further improve outcomes of this promising intervention. Research was partially supported by a grant from the British Columbia Dental Hygienists Association.

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