Kelly Jones

Development of a short‐form Health Literacy Dental Scale (HeLD‐14)

OBJECTIVE To develop a short-form version of the 29-item Health Literacy in Dentistry (HeLD-29) instrument. METHODS Deriving the short-form version used data from a cross-sectional study of 400 indigenous Australians aged 18+ years in Port Augusta, South Australia, which was split to enable short-form testing (N = 191). Internal reliability analysis, factor analysis and regression analysis were undertaken to derive a subset (HeLD-14) questionnaire. Its validity was evaluated by assessing associations with socio-demographic and self-reported oral health variables. Internal consistency of the HeLD-14 was evaluated using Cronbachs coefficient α. A HeLD-14 scale was derived from regression analysis. RESULTS The HeLD-14 accounted for 94% of variance in the HeLD-29 mean scores; had high reliability (α = 0.88); contained questions from each of the seven conceptual dimensions of the HeLD-29; and had a good distribution of prevalence for individual questions. HeLD-14 scores and HeLD-29 scores displayed the same pattern of variation among socio-demographic groups of indigenous Australians. Cronbachs α for the HeLD-14 was 0.87. In a multivariable analysis, the same socio-demographic and self-reported oral health variables were associated (P < 0.05) with both the HeLD-29 and the HeLD-14. CONCLUSIONS The reliability, validity and precision of the short-form version (HeLD-14) were acceptable when tested in a sample of rural dwelling indigenous Australians. However, it will be important to replicate these findings in other populations before it can be used in health services research to determine the effects of interventions or programs aimed at improving oral health outcomes. This short form will be easy and efficient for use in research and clinical settings.

Does self-efficacy mediate the effect of oral health literacy on self-rated oral health in an Indigenous population?

OBJECTIVES Mediation analyses are critical to understanding why behavioral interventions work. Health literacy is a known mediator between socio-economic factors, health behavior and oral health outcomes in various populations, explaining gradients in oral health status and outcomes. We explore whether self-efficacy (SE) mediates the association between oral health literacy (OHL) and self-rated oral health (SROH) in an Indigenous population. METHODS Cross-sectional data collected from 278 rural-dwelling Indigenous Australians evaluated OHL, SE, SROH, socio-demographic and behavioral characteristics. OHL was measured using a validated OHL scale (HeLD-14), SE was measured using a validated SE scale and SROH was measured using a global, one-item statement. Theoretically-driven multivariable models, adjusted for age, sex, income, education, and dental service use estimated the prevalence ratios (PR) and 95 percent confidence intervals for poor SROH. RESULTS The overall prevalence of poor SROH was 78.8 percent. The prevalence of low OHL was 46.0 percent, while the prevalence of low SE was 56.8 percent. Analysis showed a significant main effect of SE (PR = 2.5, 95 percent CI 1.3-4.6). SE attenuated the effects of OHL on poor SROH (from PR = 2.4 to PR = 2.0), supporting its associated role in the Indigenous population under study. Sobel and bootstrap testing confirmed the significance of the mediating effect (z = 2.2, SE 0.30, P < 0.05) and 95 percent CI (0.11-0.07) (P < 0.05) respectively. CONCLUSIONS Given that SE is a construct amenable to change, our results suggest that interventions that aim to improve SE may have positive impacts on SROH among this vulnerable population.

The impact of health promotion on trachoma knowledge, attitudes and practice (KAP) of staff in three work settings in remote Indigenous communities in the Northern Territory

Background Globally, trachoma is the leading cause of infectious blindness and Australia is the only developed country with endemic trachoma. It is found in remote Indigenous communities burdened with poverty, overcrowding and poor hygiene. Lack of culturally appropriate health promotion, a small trachoma workforce and lack of awareness and support for trachoma elimination in general, were early barriers. Methods A cross-sectional pre-post study using a convenience sample, was conducted in clinics, schools and community work-settings from 63 of the 82 remote Aboriginal communities identified as being at risk of trachoma in the Northern Territory (NT). The study assessed the effect of a multi-component health promotion strategy aimed at increasing knowledge, attitude and practice amongst health, education and community support settings staff. Data were collected between 2010 and 2012. The health promotion initiatives were introduced in communities in staggered delivery over a one-year period; 272 participants were surveyed at baseline and 261 at follow-up. Results Trachoma related knowledge, attitudes and practice increased across all settings and for all primary outcome measures. Across all settings, there was a significant increase in the proportion of participants reporting the most important thing to do if a child has a ‘dirty’ face is to ‘wash it every time its dirty’ (61.6% cf 69.7%; X2p = 0.047), a significant reduction in the proportion of respondents answering ‘no’ to the question “Is it normal for kids to have dirty faces in your community’ (40.5% cf 29.6%; X2p = 0.009) and a significant increase in reported capacity to teach others about trachoma prevention (70.8% cf 83.3%; X2p <0.001). Conclusion Health promotion was associated with increased trachoma knowledge, attitude and practice amongst health, education and community support staff working with children and in remote NT communities. In the early stages of the trachoma health promotion program, this increased trachoma awareness and improved local workforce capacity and support for trachoma elimination in three health promotion settings in remote communities in the NT.

Factors Relating to Access to Dental Care for Indigenous South Australians

Objective. To explore and document self-reported factors contributing to Indigenous Australians’ attendance and non-attendance at South Australian public dental clinics. Methods. Semi-structured interviews were conducted with people (18 males and 26 females) referred for oral care through the Aboriginal Liaison Program of the South Australian Dental Service. Thematic analysis was performed on 44 transcribed conversations and a conceptual model developed. Results. Persons completing all recommended treatment reported high self-efficacy, health literacy, social cohesion and previous use of dental services and presence of a health advocate. Those completing some recommended treatment reported achieving desired oral health outcome of relief of pain or system-level barriers to completion. Those reporting accessing no dental treatment in contrast reported varied and complex barriers to dental care. Conclusion and implications. Differences in both individual and health service-related factors were evident. Individual-level factors related to health literacy, self-efficacy, and social control. Service factors related to availability of an advocate, service delivery, and culture. Practical service-level changes may alleviate the effects of individual-level factors.

An evaluation of the discriminant and predictive validity of relative social disadvantage as screening criteria for priority access to public general dental care, in Australia

BackgroundMost public dental care services provide preventive, general dental care on a chronological, first come – first served basis. There is concern about lack of transparency, equity and timeliness in access to public dental services across Australia. Using social determinants as screening criteria is a novel approach to triage in dental care and is relatively untested in the literature. The research evaluated the discriminant and predictive validity of relative social disadvantage in prioritising access to public general dental care.MethodsA consecutive sample of 615 adults seeking general dental care was selected. The validation measure used was clinical assessment of priority. Nine indicators of relative social disadvantage (RSD) were collected: Indigenous status; intellectual disability; physical disability; wheelchair usage; dwelling conditions; serious medical condition; serious medical condition and taking regular medication; hospitalised within 12 months; and, regular medical visits. At the first dental visit, dentists rated care as a priority if treatment was required ≤6 months (PriorityTx) and otherwise non-priority (non-PriorityTx). A standardised dental examination was conducted. Sensitivity, specificity, positive and negative predictive value and area under the ROC curve analyses of 1+ of RSD in predicting clinical priority were calculated.ResultsIn bivariate analyses, one or more indicators of relative social disadvantage status were significantly associated with PriorityTx (P < 0.001; χ2). In multivariate analyses, one or more indicators of relative social disadvantage persisted as an independent predictor of PriorityTx (OR 3.8, 95% CI = 2.6-5.6). Compared with clinicians’ classification of PriorityTx, one or more indicators of relative social disadvantage had a sensitivity of 77.1%, and specificity of 53.3%, together with a positive predictive value of 81.9% and negative predictive value of 46.0%. ROC curve analysis supported one or more indicators of relative social disadvantage as a predictor of greater priority for access to general dental care (0.66).ConclusionsConsiderable heterogeneity exists among persons seeking public general dental care in New South Wales. RSD performs as a valid predictor of priority for access to treatment and acts as valid screening criteria for triaging priority access to treatment. Such indicators may address issues of inequality in access to general public oral health services.