Rural Mexican immigrant parents' interpretation of children's dental symptoms and decisions to seek treatment
Dept. Preventive & Restorative Dental Sciences, Center to Address Disparities in Children's Oral Health (CAN DO Center), University of California San Francisco, USA. Community dental health
(Impact Factor: 0.6).
12/2009; 26(4):216-21. DOI: 10.1922/CDH_2320Horton06
Mexican-origin children have higher rates of decay and lower dental utilization rates than children from all other racial/ethnic groups. Different cultural groups' interpretations of dental symptoms illuminate their different decision-making process about seeking care. Through ethnography in a small rural U.S. city, we examined low-income Mexican immigrant caregivers' interpretations of their children's dental symptoms and evaluations of the need for treatment.
We conducted 49 in-depth interviews with 26 Mexican immigrant caregivers about their perceptions of their children's dental symptoms, and observations of five such caregivers' help-seeking episodes and 30 other caregivers' presentation of their children's symptoms at dental clinics. All interviews and fieldnotes were analyzed qualitatively through a series of readings and codings.
A conceptual model of caregivers' decision-making processes was developed. Most caregivers deduced the health of teeth from visible appearance, and thus children's complaints of pain alone were often ineffective in triggering a dental visit. Caregivers often delayed treatment because they viewed their children's oral disease as mere "stains" requiring cleaning rather than as bacterial infections requiring restorative treatment. Parents appeared to confuse carious "stains" with fluorosis stains common in rural Mexico.
Even when Mexican immigrant caregivers recognize a dental problem, they often misinterpret it as a "stain." Caregivers' interpretations of decay were shaped by their lack of experience with children's decay in rural Mexico. Oral health education programs should help rural immigrant caregivers distinguish between "stains" and "cavities," and understand the heightened oral hygiene requirements of the cariogenic diet in industrialized countries.
Available from: Maryam Amin
- "However, even for those who had dental coverage through a governmental health benefit program, the underutilization of dental services for younger children has been very common especially the preventive services . Low dental attendance may stem from the trending belief of immigrant families that professional care is needed only when a dental problem arises, rather than seeking out preventive measures    . "
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. To evaluate the impact of an educational workshop on parental knowledge, attitude, and perceived behavioral control regarding their child’s oral health.
Materials and Methods
. A one-time oral health education workshop including audio/visual and hands-on components was conducted by a trained dentist and bilingual community workers in community locations. Participants were African parents of children who had lived in Canada for less than ten years. The impact of the workshop was evaluated by a questionnaire developed based on the theory of planned behavior.
. A total of 105 parents participated in this study. Participants were mainly mothers (mean age
years) who came to Canada as refugee (77.1%) and had below high school education (70%). Paired
-test showed a significant difference in participants’ knowledge of caries, preventive measures, and benefits of regular dental visits after the workshop (
). A significant improvement was also found in parental attitudes toward preventive measures and their perceived behavioral control (
). Parents’ intention to take their child to a dentist within six months significantly altered after the workshop (
. A one-time hands-on training was effective in improving parental knowledge, attitude, perceived behavioral control, and intention with respect to their child’s oral health and preventive dental visits in African immigrants.
Available from: Maryam Amin
- "However, even for those who had dental coverage through a governmental health benefit program, the underutilization of dental services for younger children has been very common especially the preventive services. Low dental attendance may stem from the trending belief of immigrant families that professional care is needed only when a dental problem arises, rather than seeking out preventive measures1234. Preventive health behaviors have been frequently identified as having the potential to reduce mortality and morbidity during childhood. Therefore, measures need to be taken to enhance the understanding of dental diseases and the importance of prevention among recent immigrants. "
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To evaluate the effectiveness of a one-session educational workshop on parental knowledge about and attitudes toward oral health of their young children and preventive measures as well as their perceived behavioral control.
A three-hour oral health education workshop including audio/visual and hands-on components was developed. Participants were parents of young children who had lived in Canada for less than ten years. Ten workshops were conducted in different community locations by a calibrated dentist and facilitated by bilingual trained community workers. The impact of the workshop was evaluated using a pre- and a post-intervention questionnaire developed based on the theory of planned behavior.
A total of 105 parents from Somalia, Eritrea, Ethiopia, and Oromo communities participated in 10 workshops. Participants were mainly mothers (86.1%) with mean age of 35.03 + 5.4 years who came to Canada as a refugee (77.1 %) and had below high school education (70%). Paired t test showed a statistically significant difference in participants’ knowledge of caries and preventive measures, benefits of a regular dental visit and identification, causes and progression of the disease after the workshop (P value < 0.05). A significant improvement was also found in parental attitudes toward preventive measures and dentists’ roles and parental perceived behavioral control (P < 0.05). Parents’ intention to take their child to a dentist within six months significantly altered after the workshop (p value <0.05).
A one-time hands-on training of African immigrants in respect to children’s oral health was effective in changing their knowledge about and attitudes toward preventive dental care and improved their intention to take action in a foreseeable future.
Available from: Sarah Horton
- "This reflects a level of poverty that makes paying out-of-pocket for dental services extremely difficult if not prohibitive. As a group, caregivers had had significant experience with children's oral disease: for example, of the 38 immigrant Mexican or Salvadoran caregivers, 23 (60%) reported that their focal child under age six had had cavities; eight reported their child had no dental visit yet and seven reported their child had had a visit but no cavities yet [47,48]. "
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ABSTRACT: Latino children experience a higher prevalence of caries than do children in any other racial/ethnic group in the US. This paper examines the intersections among four societal sectors or contexts of care which contribute to oral health disparities for low-income, preschool Latino1 children in rural California.
Findings are reported from an ethnographic investigation, conducted in 2005-2006, of family, community, professional/dental and policy/regulatory sectors or contexts of care that play central roles in creating or sustaining low income, rural children's poor oral health status. The study community of around 9,000 people, predominantly of Mexican-American origin, was located in California's agricultural Central Valley. Observations in homes, community facilities, and dental offices within the region were supplemented by in-depth interviews with 30 key informants (such as dental professionals, health educators, child welfare agents, clinic administrators and regulatory agents) and 47 primary caregivers (mothers) of children at least one of whom was under 6 years of age.
Caregivers did not always recognize visible signs of caries among their children, nor respond quickly unless children also complained of pain. Fluctuating seasonal eligibility for public health insurance intersected with limited community infrastructure and civic amenities, including lack of public transportation, to create difficulties in access to care. The non-fluoridated municipal water supply is not widely consumed because of fears about pesticide pollution. If the dentist brought children into the clinic for multiple visits, this caused the accompanying parent hardship and occasionally resulted in the loss of his or her job. Few general dentists had received specific training in how to handle young patients. Children's dental fear and poor provider-parent communication were exacerbated by a scarcity of dentists willing to serve rural low-income populations. Stringent state fiscal reimbursement policies further complicated the situation.
Several societal sectors or contexts of care significantly intersected to produce or sustain poor oral health care for children. Parental beliefs and practices, leading for example to delay in seeking care, were compounded by lack of key community or economic resources, and the organization and delivery of professional dental services. In the context of state-mandated policies and procedures, these all worked to militate against children receiving timely care that would considerably reduce oral health disparities among this highly disadvantaged population.
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