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      Framing Young Childrens Oral Health: A Participatory Action Research Project

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          Abstract

          Background and Objectives

          Despite the widespread acknowledgement of the importance of childhood oral health, little progress has been made in preventing early childhood caries. Limited information exists regarding specific daily-life and community-related factors that impede optimal oral hygiene, diet, care, and ultimately oral health for children. We sought to understand what parents of young children consider important and potentially modifiable factors and resources influencing their children’s oral health, within the contexts of the family and the community.

          Methods

          This qualitative study employed Photovoice among 10 English-speaking parents of infants and toddlers who were clients of an urban WIC clinic in North Carolina. The primary research question was: “What do you consider as important behaviors, as well as family and community resources to prevent cavities among young children?” Five group sessions were conducted and they were recorded, transcribed verbatim and analyzed using qualitative research methodology. Inductive analyses were based on analytical summaries, double-coding, and summary matrices and were done using Atlas.ti.7.5.9 software.

          Findings

          Good oral health was associated with avoidance of problems or restorations for the participants. Financial constraints affected healthy food and beverage choices, as well as access to oral health care. Time constraints and occasional frustration related to children’s oral hygiene emerged as additional barriers. Establishment of rules/routines and commitment to them was a successful strategy to promote their children’s oral health, as well as modeling of older siblings, cooperation among caregivers and peer support. Community programs and organizations, social hubs including playgrounds, grocery stores and social media emerged as promising avenues for gaining support and sharing resources.

          Conclusions

          Low-income parents of young children are faced with daily life struggles that interfere with oral health and care. Financial constraints are pervasive, but parents identified several strategies involving home care and community agents that can be helpful. Future interventions aimed to improve children’s oral health must take into consideration the role of families and the communities in which they live.

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          Most cited references49

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          Photovoice: a participatory action research strategy applied to women's health.

          Photovoice is a participatory action research strategy that may offer unique contributions to women's health. It is a process by which people can identify, represent, and enhance their community through a specific photographic technique. Photovoice has three main goals: to enable people (1) to record and reflect their community's strengths and concerns, (2) to promote critical dialogue and knowledge about personal and community issues through large and small group discussion of their photographs, and (3) to reach policymakers. This report gives an overview of the origins, key concepts, methods, and uses of photovoice as a strategy to enhance women's health.
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            From victim blaming to upstream action: tackling the social determinants of oral health inequalities.

            The persistent and universal nature of oral health inequalities presents a significant challenge to oral health policy makers. Inequalities in oral health mirror those in general health. The universal social gradient in both general and oral health highlights the underlying influence of psychosocial, economic, environmental and political determinants. The dominant preventive approach in dentistry, i.e. narrowly focusing on changing the behaviours of high-risk individuals, has failed to effectively reduce oral health inequalities, and may indeed have increased the oral health equity gap. A conceptual shift is needed away from this biomedical/behavioural 'downstream' approach, to one addressing the 'upstream' underlying social determinants of population oral health. Failure to change our preventive approach is a dereliction of ethical and scientific integrity. A range of complementary public health actions may be implemented at local, national and international levels to promote sustainable oral health improvements and reduce inequalities. The aim of this article is to stimulate discussion and debate on the future development of oral health improvement strategies.
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              Photovoice: concept, methodology, and use for participatory needs assessment.

              Photovoice is a process by which people can identify, represent, and enhance their community through a specific photographic technique. As a practice based in the production of knowledge, photovoice has three main goals: (1) to enable people to record and reflect their community's strengths and concerns, (2) to promote critical dialogue and knowledge about important issues through large and small group discussion of photographs, and (3) to reach policymakers. Applying photovoice to public health promotion, the authors describe the methodology and analyze its value for participatory needs assessment. They discuss the development of the photovoice concept, advantages and disadvantages, key elements, participatory analysis, materials and resources, and implications for practice.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                22 August 2016
                2016
                : 11
                : 8
                : e0161728
                Affiliations
                [1 ]Department of Dental Ecology, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
                [2 ]Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
                [3 ]Oral and Craniofacial Health Sciences, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
                [4 ]Department of Pediatric Dentistry, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
                [5 ]Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America
                Forsyth Institute, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceived and designed the experiments: CC LVT LDS LZ KD.

                • Performed the experiments: CC LVT.

                • Analyzed the data: CC LVT KD.

                • Contributed reagents/materials/analysis tools: LVT LDS LZ.

                • Wrote the paper: CC LVT LDS LPZ KD.

                Author information
                http://orcid.org/0000-0003-1290-7251
                Article
                PONE-D-16-17942
                10.1371/journal.pone.0161728
                4993516
                27548714
                99b30331-8b4a-49ad-b802-27dac3fb26ff
                © 2016 Collins et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 May 2016
                : 10 August 2016
                Page count
                Figures: 4, Tables: 2, Pages: 19
                Funding
                Funded by: Dora Lee and John C. Brauer Dental Research Fund and the Dental Foundation of North Carolina, Inc
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000072, National Institute of Dental and Craniofacial Research;
                Award ID: U01DE025046
                Award Recipient :
                A M.S. Research Support grant from the Dora Lee & John C. Brauer Dental Research Fund and the Dental Foundation of North Carolina, Inc. to Ms. Chimere Collins and a grant from the National Institute of Dental and Craniofacial Research, National Institutes of Health (U01DE025046) to Dr. Kimon Divaris. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Oral Medicine
                Oral Health
                People and Places
                Population Groupings
                Age Groups
                Children
                People and Places
                Population Groupings
                Families
                Children
                Medicine and Health Sciences
                Pediatrics
                Child Health
                Medicine and Health Sciences
                Public and Occupational Health
                Child Health
                Medicine and Health Sciences
                Public and Occupational Health
                Behavioral and Social Aspects of Health
                Biology and Life Sciences
                Anatomy
                Digestive System
                Teeth
                Medicine and Health Sciences
                Anatomy
                Digestive System
                Teeth
                Biology and Life Sciences
                Anatomy
                Head
                Jaw
                Teeth
                Medicine and Health Sciences
                Anatomy
                Head
                Jaw
                Teeth
                Biology and Life Sciences
                Behavior
                Medicine and Health Sciences
                Oral Medicine
                Social Sciences
                Sociology
                Human Families
                Custom metadata
                The first- and second-order codes derived from the analysis of participant interviews are available upon request from the corresponding author ( Kimon_Divaris@ 123456unc.edu ). Permission to share group session digital recordings or full transcripts was not obtained.

                Uncategorized
                Uncategorized

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