Bryant Lucinda L, Quissell David O, Braun Patricia A, Henderson William G, Johs Nikolas, George Carmen, Smith Vong, Toledo Nikola, Thomas Jacob, Albino Judith E
Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, 13001 East 17th Place B119, Aurora, CO, 80045, USA.
Department of Craniofacial Biology, School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA.
J Community Health. 2016 Apr;41(2):340-53. doi: 10.1007/s10900-015-0102-5.
Successful interventions require consistent participation by intended recipients. We utilized mixed methods to describe participation of 518 parent-child dyads enrolled in a randomized cluster trial of a 2-year oral health intervention for Head Start (HS) families across Navajo Nation delivered by native Community Oral Health Specialists (COHS). We quantitatively assessed factors that contributed to participation and qualitatively examined barriers and strategies. The intervention offered fluoride varnish (FV) and oral health promotion (OHP) activities for two cohorts (enrolled in 2011, N = 286, or 2012, N = 232) of children in the HS classrooms and OHP for parents outside the classroom. Child participation was good: FV: 79.7 (Cohort 1) and 85.3 % (Cohort 2) received at least 3 of 4 applications; OHP: 74.5 (Cohort 1) and 78.4 % (Cohort 2) attended at least 3 of 5 events. Parent participation was low: 10.5 (Cohort 1) and 29.8 % (Cohort 2) attended at least three of four events. Analysis of survey data found significant effects on parent participation from fewer people in the household, Cohort 2 membership, greater external-locus of control, and a greater perception that barriers existed to following recommended oral health behaviors. Qualitative analysis of reports from native field staff, COHS, community members, and the research team identified barriers (e.g., geographic expanse, constraints of a research trial) and suggested strategies to improve parent participation (e.g., improve communication between COHS and parents/community). Many challenges to participation exist when conducting interventions in rural areas with underserved populations. Working with community partners to inform the development and delivery of interventions is critical.
成功的干预措施需要目标受众的持续参与。我们采用混合方法描述了518对亲子参与一项随机整群试验的情况，该试验是由本土社区口腔健康专家（COHS）为纳瓦霍族全国范围内的开端计划（HS）家庭提供的为期两年的口腔健康干预。我们定量评估了影响参与的因素，并定性研究了障碍和策略。该干预为HS教室中的两组儿童（2011年入学，N = 286；或2012年入学，N = 232）提供了氟化物涂漆（FV）和口腔健康促进（OHP）活动，并为教室外的家长提供了OHP。儿童参与情况良好：FV方面，第一组79.7%，第二组85.3%接受了4次涂漆中的至少3次；OHP方面，第一组74.5%，第二组78.4%参加了5次活动中的至少3次。家长参与率较低：第一组10.5%，第二组29.8%参加了4次活动中的至少3次。对调查数据的分析发现，家庭人口较少、属于第二组、外部控制点较强以及更认为遵循推荐的口腔健康行为存在障碍等因素对家长参与有显著影响。对本土现场工作人员、COHS、社区成员和研究团队的报告进行定性分析，确定了障碍（如地域广阔、研究试验的限制），并提出了提高家长参与的策略（如改善COHS与家长/社区之间的沟通）。在农村地区为服务不足的人群开展干预时，存在许多参与方面的挑战。与社区伙伴合作以指导干预措施的制定和实施至关重要。
