1. Oral Health Literacy: A Pathway to Reducing Oral Health Disparities in Maryland 2011 Maryland Oral Health Summit: Pathways to Common Ground and Action October 20, 2011 Alice M. Horowitz, PhD Dushanka V. Kleinman, DDS, MScD SCHOOL OF PUBLIC HEALTH

2. Remember Efforts to improve quality, reduce costs and reduce oral health disparities cannot succeed without simultaneous improvements: In oral health literacy of the public, health care providers and policy makers; and Ensuring the user friendliness of our dental facilities.

3. Health Literacy is: the interaction between skills of individuals and demands of the healthcare system(s) IOM Report 2004

4. Oral Health Literacy - Defined “The degree to which individuals have the capacity to obtain, process and understand basic oral health information and services needed to make appropriate health decisions.” Healthy People 2010

5. Importance of Literacy Skills Literacy influences one’s ability to access information and to navigate the highly literate environments of today’s society. influences

6. Oral Health Literacy is Associated With: Knowledge and understanding of preventive measures Frequency of dental visits Severity of dental caries Oral health and quality of life

7. What’s the Problem? Health literacy varies by race, ethnicity, level of education, and poverty level. The lower the health literacy the more likely the individual will have poor health, use fewer preventive procedures and use costly ER services. Less likely to manage chronic health conditions. National Assessment of Adult Literacy 2003

8. Maryland’s Approaches to Meet This Challenge Establish state needs Determine what the public knows and does regarding caries prevention & early detection Determine the public’s perceptions of providers communication skills Determine what health providers know and practice regarding caries prevention & early detection Determine communication techniques of healthcare providers

9. Health Literacy Fits in the Oral Health Plan A major topic in Maryland’s oral health plan is oral health literacy & education

10. What We Have Done to Date: Phone survey of MD adults 18 years of age and older. KOP’s about caries prevention & their perception of dental staff communication skills. Focus groups of MD adults 18 years & older [4 in English; 2 in Spanish] Surveyed physicians, dentists, dental hygienists and nurse practitioners. KOP’s about caries prevention & use of communication techniques.

11. What We Have Done (Con’t) Focus groups/interviews of all four provider groups

12. MD Adults’ Understanding of Caries Prevention 97.9% said they had heard of fluoride Only 58% knew the purpose of fluoride 64.9 % had heard of dental sealants Of those, only 46% knew their purpose Only 23% could identify an early sign of tooth decay

13. Perceptions of Communication Skills of Dentist & Staff Perceptions of Communication Skills of Dentist & Staff AA were significantly more likely to express lower satisfaction with the amount of time DDS spent with them than Caucasians, and AA were more than twice as likely to report they were treated unfairly due to race, ethnicity, or education Those with private dental insurance were significantly more likely than those with Medicaid to report favorably about providers listening practices.

14. Use of Tap Water Adults with high school education or less were significantly less likely to: Know if their tap water was fluoridated Drink tap water Give it to their child Medicaid recipients were less likely to drink tap water than non-Medicaid.

15. Demands of Our Healthcare Syst em Health literacy is dependent on the demands of the healthcare and public health systems. Individuals need to: Know how to locate and navigate a health facility Read, understand, and complete many kinds of forms to receive treatment and payment reimbursement Articulate their signs and symptoms Know about various types of health professionals and what services they provide and how to access those services Trust us Know how and when to ask questions or ask for clarification when they do not understand

16. What We Are Working On….. Determining user friendliness of dental clinics in community health settings Surveying Head Start & WIC personnel regarding their KOP’s about caries prevention Conducting focus groups of Head Start and WIC personnel

17. Remember Efforts to improve quality, reduce costs and reduce oral health disparities cannot succeed without simultaneous improvements: In oral health literacy of the public, health care providers and policy makers; and Ensuring the user friendliness of our dental facilities.

18. Improving Oral Health Literacy Of the public, health providers and policy makers is one essential pathway to eliminating disparities among Marylanders.

19. Healthy People 2020 Plain Language Act Oral Health Literacy Workshop 2011 IOM Reports Surgeon General Reports Health Literacy Call to Action Evidence-based Protocols State, County & Local Agencies and Professional Organizations Research and Development State Oral Health Plan and State Oral Health Policies Program Evaluation and Refinement Education and Practice Increased Health Increased Disease Prevention Programs & Services Increased Healthcare Delivery Drivers   Assessment  Policy Development  Assurance Maryland Oral Health Literacy Model: Moving Science into Action

20. THANK YOU!