Health professional schools and licensing bodies can teach evidence-based and culturally competent communication.
Prevention Strategy: Types of Prevention
Health care professionals and provider organizations must recognize and address literacy, culture, and native language in their health literacy efforts. HHS can sponsor, conduct, and disseminate research on interventions to improve communication for patients with low health literacy, since few techniques have been rigorously evaluated. The education system is where most individuals develop both basic literacy skills and health knowledge, and therefore it plays a critical role in developing health literacy. Students learn health knowledge through health education programs provided in elementary, middle, and high schools.
See Chapter 4 for more on the role of public education in improving health literacy. Knowledge about health care topics is sometimes included in the definition of health literacy IOM, , and sometimes it is regarded as a resource that facilitates literacy Baker, In either case, correct, evidence-based knowledge about health topics allows individuals and health care professionals to make informed health care decisions and recommendations, and to interact more effectively in health care contexts. Health literacy is important because it can affect health care use, patient outcomes, and overall health care costs.
Adults with limited health literacy have less knowledge of disease management and of health-promoting behaviors, report poorer health status, and are less likely to use preventive services Arnold et al. People with low health literacy have adverse health outcomes DeWalt et al. In addition, parents with low literacy make health care decisions that are less advantageous to their children, and their children have poorer health outcomes DeWalt and Hink, ; Miller et al. Currently, there is little consensus about the best ways to improve health outcomes for people with low health literacy Pignone et al.
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- Good Oral Health and Diet.
- What Parents and Caregivers Can Do!
- What Do You Do When Something Wants To Eat You?;
Medical errors can occur when patients do not understand instructions provided by a doctor. In fact, one study found that nearly half of all pediatricians surveyed reported being aware of a communication-related. Poor health literacy is also expensive; it contributes significantly to both overall health care costs and individual expenditures Eichler et al.
Not enough is known specifically about oral health literacy. Progress has been slow; researchers have developed instruments to measure oral health literacy, although more work must be done to assess their validity Atchison et al. In , the National Assessment of Adult Literacy assessed the health literacy of adult Americans on a large scale for the first time.
It determined that only 12 percent of adults had proficient health literacy Kutner et al. One study that specifically investigated the oral health literacy of patients in a clinical setting found poor oral health literacy was strongly associated with self-reported poor oral health status and lower dental knowledge Jones et al.
Infant and Children's Oral Health
The public has little knowledge about the best ways to prevent oral diseases. Fluoride and dental sealants for children have long been acknowledged as the most effective ways to prevent dental caries, yet the public consistently answers that toothbrushing and flossing are more effective Ahovuo-Saloranta et al.
- Oral health knowledge, attitudes and practice in year-old schoolchildren.
- Educational outcomes of a new curriculum on interproximal oral prophylaxis for dental students.
- Keeping Your Child's Teeth Healthy.
- Good Oral Health and Diet.
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When asked to choose the best way to prevent tooth decay from five options, only 7 percent of respondents to the National Health Interview Survey correctly answered using fluoride, while 70 percent answered that brushing and flossing were most effective Gift et al.
Further, only 23 percent of respondents knew the purpose of dental sealants. Other studies show that the public remains generally unaware of the transmissible, infectious nature of dental caries, including that the bacteria involved in the etiology of the disease can be passed from caretaker to child through the sharing of food and utensils and by kissing Gussy et al. While 85 percent of respondents to a telephone survey had heard of oral cancer, only 23 percent of those could name one early symptom Horowitz et al.
Many people also could not identify common risk factors for oral cancer. Although 67 percent of adults responding to the National Health Interview Survey knew that tobacco use is a risk factor for oral cancer, very few respondents knew about any other risk factors Horowitz et al. All health care professionals can facilitate literacy by communicating clearly and accurately. This requires them to have good communication skills and knowledge related to oral health.
Recognizing literacy as an important issue in oral health, the ADA recently developed a strategic action plan that provides guidance but not requirements on principles, goals, and strategies to improve health literacy in dentistry ADA, Strategies include facilitating the development, testing, distribution, and evaluation of a health literacy training program for dentists and other members of the oral health team, investigating the feasibility of a systematic review of the health literacy literature, and encouraging oral health education in schools ADA, However, health care professionals are generally not trained in how to perform such an assessment and do not account for the low health literacy of patients when communicating health information.
Practitioners often use medical jargon, provide too much information at once, and fail to confirm that the patient understood the information provided Williams et al. This study aimed to determine the techniques that are used by dentists and dental team members to communicate effectively with their patients; examine variation in the use of these techniques; and explore the different variables that might be targeted in the future to improve communication and dental practices.
Findings included a high amount of variation in the type and number of communication techniques used, and the use of more techniques by older dentists, by dentists from racial and ethnic populations, and by dentists who are specialists e. Routine use of communication techniques is low among dentists, especially some techniques such as the teach-back method, thought to be most effective with patients with low literacy.
Nearly two-thirds of the dentists said they did not have training in health literacy and clear communication. Improving the communication skills of oral health care professionals may require curricular changes in both health professional schools and continuing dental education programs. Despite these standards, few schools have adopted a competency exam for communication Cannick et al. Continuing education courses can also improve the communication skills of providers Barth and Lannen, ; Levinson and Roter, , yet at least one state does not allow continuing education credit for courses taken in communication.
As patients of all ages often visit primary care professionals more frequently than they visit dentists, these practitioners are in a good position to provide basic oral health education. For example, plus percent of practicing pediatricians think they play an important role in identifying oral health problems and counseling parents about the importance of oral health Lewis et al. Even more dramatically, nearly all 99 per-. Despite this, pediatricians lack the necessary knowledge about basic oral health to educate patients about oral health issues or screen for oral disease.
Thirty-five percent of pediatric residents receive no oral health training during their residency, and 73 percent of those who do receive training spend less than 3 hours on oral health Caspary et al.
Graduating residents with more than 3 hours of oral health training were significantly more likely to feel confident performing oral health education and assessments Caspary et al. Additionally, osteopathic medical students who received 2 days of oral health education showed dramatically improved oral health knowledge Skelton et al. The education and training of health care professionals in oral health is discussed further in Chapter 3. Similar patterns are seen in other types of health care professionals as well as for other oral diseases.
For example, one study of internal medicine trainees showed that only 34 percent correctly answered all five general knowledge questions on periodontal disease; 90 percent of the trainees stated they did not receive any training regarding periodontal disease during medical school Quijano et al. In a study by Applebaum et al. In a survey of nurse practitioners, only 35 percent identified sun exposure as a risk for lip cancer, and only 19 percent thought their knowledge of oral cancers was current Siriphant et al.
The few surveys that have investigated the oral health knowledge of dentists and hygienists have found it lacking. In a national survey, fewer than 50 percent of dental hygienists knew that dental caries was a chronic infectious disease, and many did not recognize the value of fluoride in preventing dental caries Forrest et al. In a survey about knowledge of oral cancer risk factors, dentists averaged 8. When asked about oral cancer diagnostic procedures; dentists averaged six correct answers out of nine, but more than one-third answered four or fewer answers correctly Yellowitz et al.
In the above-cited study by Applebaum et al. Although 98 percent of dental hygienists responded that adults over age 40 should receive an oral cancer examination annually, only 66 percent report providing the exam all of the time, and an additional 10 percent report doing so some of the time Forrest et al.
While a full examination of the evidence base and approaches for behavior change is beyond the scope of this report, it is important to note that improving health literacy is just the beginning of the behavioral change process.
A number of factors make behavior change very difficult, including cultural norms, individual preferences, economic factors, and the role of the larger society Glanz and Bishop, ; IOM, ; McLeroy et al. A IOM report on social and behavioral research stated:. To prevent disease, we increasingly ask people to do things that they have not done previously, to stop doing things they have been doing for years, and to do more of some things and less of other things.
Although there certainly are examples of successful programs to change behavior, it is clear that behavior change is a difficult and complex challenge. It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change.
In oral health care, behavior change requires attention to individuals e. This is illustrated graphically in Figure Despite the difficulties in influencing health behaviors, there are promising behavioral change models. Motivational interviewing has been shown to improve a variety of health behaviors and conditions, including smoking cessation and dental caries Freudenthal and Bowen, ; Lai et al. Reproduced with permission from Pediatrics , Vol. Oral health care professionals need to be be trained in effective communication and cultural competence.
Guidelines for diagnostic imaging during pregnancy. Obstetrics and Gynecology 3 Cancer facts and figures Professionally applied topical fluoride: Evidence-based clinical recommendations. Journal of the American Dental Association 8 Health literacy in dentistry action plan Competencies for the new general dentist. Journal of Dental Education 73 7 Ahovuo-Saloranta, A. Hiiri, A. Nordblad, H. Worthington, and M.
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Pit and fissure sealants for preventing dental decay in the permanent teeth of children and adolescents. Al Habashneh, R. Guthmiller, S. Levy, G. Johnson, C. Squier, D.
Dawson, and Q. Factors related to utilization of dental services during pregnancy. Journal of Clinical Periodontology 32 7 Al-Hashimi, I. Journal of the American Dental Association 10 Albert, D. Severson, J. Gordon, A. Ward, J. Andrews, and D. Tobacco attitudes, practices, and behaviors: A survey of dentists participating in managed care.
Nicotine and Tobacco Research 7 Supp. Severson, and J. Tobacco use by adolescents: The role of the oral health professional in evidence-based cessation programs. Pediatric Dentistry 28 2 Begg, H. Andrews, S. Williams, A. Ward, M.