Improving Oral Health in Rural Communities Charla J. Lautar Elaine T. Jurkowski Southern Illinois University Carbondale Carbondale, Illinois A presentation to the American Public Health Association, Oral Health Section, October 29,

Presenter Disclosures (1)The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: Charla J. Lautar No relationships to disclose

Background O What is oral health literacy? O Healthy People 2020 objectives O Why worry about oral health literacy in rural communities? 2

Health Literacy…. O Is defined as the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions”. (U.S. Department of Health and Human Services, Office Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy. Washington, DC: Author. )

What is oral health literacy? 3

Oral health literacy suggests… O “People need information they can understand and use to make informed decisions and take actions that protect and promote their teeth”. (U.S. Department of Health and Human Services, Office Disease Prevention and Health Promotion. (2010). National Action Plan to Improve Health Literacy. Washington, DC: Author. )

Healthy People 2010… O Identified limited health literacy as a public health problem and set national objectives for its improvement. O Adults over the age of 65 are more likely to experience limited oral health literacy.

Healthy People 2020 Objectives O Some of the Healthy People 2020 Objectives include: O Reduce the proportion of older adults aged 65 to 74 years with untreated coronal caries. Reduce the proportion of older adults aged 65 to 74 years with untreated coronal caries O Reduce the proportion of older adults aged 65 to 74 years who have lost all of their natural teeth. Reduce the proportion of older adults aged 65 to 74 years who have lost all of their natural teeth O Reduce the proportion of older adults aged 75 years and older with untreated root surface caries Reduce the proportion of older adults aged 75 years and older with untreated root surface caries 4

Why worry about health literacy in rural communities? 5 6

Greater barriers exist in rural communities. O Greater barriers to accessing care exist in rural communities. O Limited opportunities for regular oral health and specialty care for a Medicare and Medicaid population base. O Medicare does not cover oral health care and Medicaid reimbursed oral health services have been curtailed in the state.

What was the issue? O Health disparities, according to Healthy People 2010 and the Centers for Disease Control and Prevention are greater among older adults, when compared to urban communities. O We tried to examine health literacy levels among older adults (n=190) who lived in rural and frontier communities in the Midwest from the aspects of behavioral and oral health. 7

Goals for our intervention: O To make older women aware of the relationship between oral health and general health. O To educate social service providers working with older adults on the role that aging plays in one’s oral health. O To promote health literacy among older women (55+) in the Southern Illinois Delta area. O To reduce oral health disparities among rural women, especially women of color or living below the poverty level. 8 9

The Delta Region 10

What did we do? O Received a grant from the Regional Office of Women’s Health, Department of Health and Human Services. O Developed an educational intervention which provided information to older adults about oral health and behavioral health issues (this presentation will focus on oral health). O Delivered the presentation to Senior Nutrition Sites, and collected post test information regarding myths to care and services. 11

What did we do (continued)… O One page fact sheets related to oral health issues. O Pen and paper questions/responses to assess the impact after the presentation. O Incentive toothbrushes and toothpaste. O Folders with educational information. O Brochures on specific subjects related to oral health literacy. Topics included: O Oral cancer; O Dry mouth and O Smoking cessation. 12

Where did this take place? O Four Senior Meal Sites located in three county areas with distinctly different demographics. O (Jackson County (Carbondale and Murphysburo, IL), Williamson County (Marion & Carterville, IL.), Perry County(DuQuoin, IL). 13

Demographics Demographic Area % Below Poverty % Older than 60 years % Female% White Jackson Williamson Perry State of IL

When did this take place? O Conducted during the summer months (May to July), which may have had an impact on attendance. O Older adults may not have attended meal sites due to warm weather conditions, visiting with family members or away on vacations

Who participated? Consumers (n=190) Demographics: O Gender: O 71.3% Women O 27.5% Males O 1.2% Not known O Ethnicity O 83.3% Caucasian O 3.8% African American/Black O 1.3% Asian O 6.4% did not disclose

Relationship between our target population and the general population in a rural community. O Rural O White, this does not match with the goals. O Limited access to care 20 21

How?..... O How to establish linkages in the community: 22

Built upon existing relationships… O Educators and social service providers collaborated to identify a list of senior nutrition sites in the geographic area. O The lead agency promoted the training opportunities about oral health literacy to their provider agencies. O Educators agreed to provide feedback on needs to help with community needs assessment.

How….did we utilize students O Dental hygiene student: O Recent graduate from the dental hygiene program volunteered to help with presentations and data collection. O Social work student: O An MSW student participated in both the educational intervention and data collection

Benefits… O Students gain valuable service learning experiences. O Older adults are invigorated by the energy of youth. O Students gain cross-disciplinary experience. O Training opportunities for students helped them to build clear communication channels.

How…. O Did we put the materials together and build an educational intervention? O Selected specific information from brochures. O Attempted to provide information without overloading the participants. 25

How did this impact oral health literacy? O Created awareness of oral health issues. O Provided a forum for information exchange and dialogue about oral health issues among participants. O Sensitized social service providers to specific oral health issues with older adult consumers. O People who did not attend sessions still wanted giveaway items such as toothbrushes and toothpaste, which led to further discussion and interaction. 26

Strategies to improve oral health literacy O Pair social work with dental health professionals/students. O Utilize senior meal sites. O Build upon established relationships. O Advertise when you plan to deliver a program through menu advertisement, newsletters and calendars. O Utilize the Area Agency on Aging and Healthy Communities Coalitions for promotion and letters of support. 27

Take home lessons O Older adults are oriented to time at the meal sites – at serving time, they want “food” not information! O Call ahead to assure that the program remembers that you are coming (change in staffing, or schedules could be problematic). O Use existing relationships which have been previously established with Area Agencies on Aging and Senior Nutrition Sites. O Need for constant communication with the meal sites regarding the timing, scheduling and location. O Be mindful of competing priorities (i.e.,lunch) which may impact one’s attention span.

Take home lessons (cont.) O Although we did not reach a diverse population, we could integrate some new strategies which may reach difficult to reach and diverse elders through: O Church and faith based organizations. O Migrant field workers. O Grandparents raising grandchildren can be reached through children’s intergenerational programs.

Areas for development Three or six month follow up. Large print (14 – 16 point fonts) Follow-up to examine behavior changes and the retention of information. Follow-up to see how people utilized information in brochures. 28

Areas for development (cont.) O Implement a “STEPP” approach to intervention management: O S – Sharing O T- Use technology being mindful of digital divide O E-Evaluate across different population groups. O P-Create partnerships O P- Participation through community engagement.

Where do we need to go from here? O Affordable Care Act: Is there any inclusion of Oral Health for Older Adults? O Medicaid in many states have devolved services for oral health care with recipients (i.e., Illinois will no longer cover restorative services, but only extractions). 29

Acknowledgements O Region V, Regional Office of Women’s Health, Health and Human Services (Federal Level) who provided financial support for folders, and travel expenses. O Egyptian Area Agency on Aging O Senior Nutrition Meal Sites (pamphlets, toothbrushes and toothpaste sponsors)

Questions 30

Contact information O Charla J. Lautar, RDH, PhD O School of Allied Health O Southern Illinois University Carbondale O MC 6615 O Carbondale, Illinois O

O Elaine T. Jurkowski, MSW, PhD O School of Social Work O Southern Illinois University Carbondale O M/C 4329 O Carbondale, Illinois O

Picture Citations O 1. O 2. of-stains-on-false-teeth// O 3. O 4. O 5. restaurants/ O 6. O 7. improvement.cdd.nhs.uk/index.cfm?Articleid=13048 O 8. O 9. dentistry/porcelain-veneers-and-crowns/example-5.aspx O 10.

Picture Citations Cont… O oralhealthpromotion.php O id=591&authorid=107 O senior-meal-sites-in-lawrence-could-/ O in-the-hot-summer-sun/ O O O O a11-b91f-0480d13ca3ad&style=charities O O commissioner-for-older-people

Picture Citations Cont… O home-care O O Feasibility_of_Dental_Hygiene_Students_in_Long-Term_Care_Facilities _Studied_in_Pilot_Program/ O O O O /Pages/0910/Nursing-Home-Specialty-Services-A-Crucial- Component-Of-Quality-Care.aspx O about-on-coast/article_b311fcd4-cc55-11e1-95cb-0019bb2963f4.html O parent.html O 30.