Using the Behaviour Change Wheel to develop an oral hygiene self-care intervention for Punjabi immigrant adults: an illustrative example.

Background: This article describes the development of an oral hygiene self-care behaviour change intervention (Safeguard Your Smile [SYS]) for Punjabi immigrant adults, using the Behaviour Change Wheel (BCW) theoretical framework. Methods: The 3 stages and 8 steps of the BCW were followed to develop the face-to-face SYS intervention. Identification of the problem in behavioural terms was enabled by referring to the results of a qualitative focus group (FG) previously conducted by the research team. Following the BCW method, the sources of behaviour were defined in terms of capability, opportunity, and motivation. Appropriate intervention functions, policy categories, behaviour change techniques (BCTs), and modes of delivery were then identified, selected, and mapped. Concrete strategies were chosen to bring about the desired oral hygiene self-care behavioural change. Results: Two main barriers to oral hygiene self-care faced by Punjabi immigrant adults were identified from the original FG: 1) inadequate knowledge and 2) inconsistent daily routine. Oral hygiene self-care behaviour was designated as a target behaviour, detailing frequency, duration, and technique. Five intervention functions (education, training, modelling, environmental restructuring, and enablement) and 2 policy categories (communication and service provision) were identified to influence the capability, opportunity, and motivation related to oral hygiene self-care behaviour. Nine BCTs were selected to influence desired oral hygiene self-care behaviour among adults. Conclusion: The development process for this SYS intervention may be employed by researchers to design a behaviour change intervention for other populations. However, additional strategies tailored to each specific context and population must be incorporated.

Contexte: Cet article décrit le développement d'une intervention de changement de comportement en matière de soins personnels d'hygiène buccodentaire à l'intention des immigrants pendjabis appelée Safeguard Your Smile (SYS), en utilisant le cadre théorique de la « roue de changement de comportement ¼ (RCC). Méthodologie: Les 3 stades et les 8 étapes de la RCC ont été suivis pour élaborer l'intervention de SYS en personne. Cibler le problème en matière de comportement a été rendu possible en se référant aux résultats d'un groupe de discussion qualitatif (GD) précédemment mené par l'équipe de recherche. Les sources du comportement ont été définies en matière de capacité, d'opportunité et de motivation, selon la méthode de la RCC. Les rôles d'intervention, les catégories de politiques, les techniques de changement de comportement (TCC) et les modes de prestation appropriés ont ensuite été ciblés, sélectionnés et répertoriés. Des stratégies concrètes ont été choisies pour obtenir le changement de comportement souhaité en matière de soins personnels d'hygiène buccodentaire. Résultats: Deux principaux obstacles aux soins buccodentaires personnels auxquels sont confrontés les immigrants pendjabis ont été ciblés dans le GD initial : 1) des connaissances inadéquates et 2) des habitudes quotidiennes incohérentes. Le comportement de soins personnels d'hygiène buccodentaire a été défini comme un comportement cible, détaillant la fréquence, la durée et la technique. Cinq rôles d'intervention (éducation, formation, modelage, restructuration de l'environnement et habilitation) et 2 catégories de politiques (communication et prestation de services) ont été ciblés pour influencer la capacité, l'opportunité et la motivation liées au comportement de soins personnels d'hygiène buccodentaire. Neuf TCC ont été sélectionnés pour influencer le comportement souhaité en matière d'hygiène buccodentaire chez les adultes. Conclusion: Le processus de développement de cette intervention SYS peut être utilisé par les chercheurs pour concevoir une intervention de changement de comportement pour d'autres populations. Cependant, des stratégies supplémentaires adaptées à chaque contexte et population spécifiques doivent être incorporées.

Development and pilot testing of an oral hygiene self-care photonovel for Punjabi immigrants: a qualitative study.

Introduction: The purpose of this research study was to develop and pilot test a culturally and linguistically appropriate oral hygiene self-care photonovel for Punjabi immigrants. Methods: Purposeful sampling technique was used to recruit 5 members of a Punjabi community organization (the Sikh Women's Association of Montreal) for participation in 3 focus group sessions in August 2015. A thematic content analysis approach was used to sort the data, enabling identification of the storyline and photonovel contents from the themes that emerged. Comic Life 3 version 3.1.1 software was used to create a "Safeguard Your Smile" (SYS) photonovel, which was printed for pilot testing. Ten additional participants were recruited for this pilot testing, enabling further revision of the photonovel based on their suggestions. Results: Four major themes emerged from the focus group discussions: 1) lack of understanding of oral hygiene self-care and risk factors; 2) lack of oral hygiene self-care-related awareness and routine; 3) lack of emphasis on prevention by oral health care providers; and 4) perceived barriers to accessing dental health care. Thematic content analysis revealed a lack of knowledge of oral hygiene self-care skills and routine. Guided by these overarching themes, a final version of the photonovel script was created including photographs of key characters. The photonovel was subsequently printed for pilot testing. Pilot test results revealed close to 80% of participants agreed that the SYS photonovel was culturally and linguistically appropriate and easy to understand. Conclusions: A culturally and linguistically appropriate photonovel may be a useful tool for enhancing oral hygiene self-care knowledge among ethnic communities. Further studies are required to test the effectiveness of such a tool.

Introduction: L'objectif de cette étude de recherche était de concevoir et d'effectuer un essai pilote d'un roman-photo pertinent sur le plan linguistique et culturel sur les soins d'hygiène buccodentaire personnels pour les immigrants pendjabis. Méthodologie: Une technique d'échantillonnage choisie à dessein a été utilisée pour recruter 5 membres d'un organisme communautaire pendjabi (l'Association des femmes sikhes de Montréal) pour qu'elles participent à 3 groupes de discussion en août 2015. Une approche d'analyse de contenu thématique a été utilisée pour trier les données, permettant d'utiliser les thèmes émergents pour identifier le contenu du scénario et du roman-photo. Le logiciel Comic Life 3, version 3,1,1 a été utilisé pour créer un roman-photo « Safeguard Your Smile ¼ (SYS), qui a été imprimé pour l'essai pilote. Dix participantes additionnelles ont été recrutées pour l'essai pilote, et leurs suggestions ont permis une mise à jour supplémentaire du roman-photo. Résultats: Quatre thèmes majeurs sont ressortis de ce groupe de discussion : 1) le manque de compréhension des soins personnels d'hygiène buccodentaire et les facteurs de risque; 2) le manque de conscientisation et de routine lié aux soins personnels d'hygiène buccodentaire; 3) le manque d'accent sur la prévention par les prestataires de soins de santé buccodentaire; et 4) la perception d'obstacles à l'accès aux soins de santé buccodentaire. L'analyse de contenu thématique a révélé des lacunes dans les connaissances sur les habiletés et la routine relatives aux soins personnels en hygiène buccodentaire. Guidé par ces thèmes principaux, une version finale du scénario du roman-photo a été créée, y compris des photographies des personnages principaux. Le roman-photo a ensuite été imprimé pour l'essai pilote. Les résultats de l'essai pilote ont révélé que presque 80 % des participants étaient d'accord que le roman-photo SYS était pertinent et facile à comprendre sur le plan culturel et linguistique. Conclusions: Un roman-photo pertinent sur le plan culturel et linguistique peut être un outil utile pour améliorer les connaissances des communautés ethniques sur les soins personnels d'hygiène buccodentaire. D'autres études sont requises pour évaluer l'efficacité d'un tel outil.

Effectiveness of "Safeguard Your Smile," an oral health literacy intervention, on oral hygiene self-care behaviour among Punjabi immigrants:A randomized controlled trial.

BACKGROUND: Research shows that immigrants have higher rates of oral diseases, poorer access to dental care services, and lower levels of health literacy than their Canadian-born peers. Oral health literacy has emerged as a potential pathway to reduce oral health disparities. The scarcity of studies on oral health literacy interventions, particularly among immigrants, lent urgency to this study, the purpose of which was to evaluate the effectiveness of an oral health literacy intervention promoting oral hygiene self-care behaviour among Punjabi immigrants. METHODS: The study used a parallel group, non-blinded, randomized controlled trial design. One hundred and forty (140) Punjabi immigrants between 18 and 60 years of age were enrolled. Participants were randomly allocated to receive either the Safeguard Your Smile (SYS) intervention or a conventional pamphlet. The following outcome measures were assessed at baseline and 3 months post-intervention: self-reported oral hygiene self-care behaviour and knowledge, plaque and gingival indices, and oral health literacy. A linear mixed model for repeated measures was used to compare the intervention and control groups (between) at pre- and post-intervention (within). RESULTS: Participants who received the SYS intervention showed improvements ( p <0.0001) for the following dependent variables: oral hygiene self-care knowledge and behaviour, oral health literacy, and plaque and gingival indices. CONCLUSIONS: SYS intervention enhanced positive oral hygiene self-care behaviour among Punjabi immigrants with low oral health literacy. SYS intervention can be employed among other vulnerable groups with low levels of oral health literacy to improve oral hygiene self-care behaviour.

CONTEXTE: La recherche montre que les immigrants ont des taux plus élevés de maladies buccodentaires, plus de difficulté à accéder à des services de soins dentaires et des taux plus bas de littératie en santé que leurs pairs nés au Canada. La littératie en santé buccodentaire s'est avérée être un moyen potentiel pour réduire les disparités de santé buccodentaire. La pénurie d'études sur les interventions de littératie en santé buccodentaire, notamment parmi les immigrants, confirme l'urgence de cette étude, laquelle vise à évaluer l'efficacité d'une intervention de littératie en santé buccodentaire qui fait la promotion du comportement de soins d'hygiène dentaire personnels parmi les immigrants pendjabis. MÉTHODOLOGIE: L'étude a utilisé un modèle d'essai comparatif randomisé à groupe parallèle, non à l'insu. Cent quarante (140) immigrants pendjabis de 18 à 60 ans ont été inscrits. Les participants ont été répartis aléatoirement pour recevoir soit l'intervention Safeguard Your Smile (SYS) ou un dépliant conventionnel. Les critères d'évaluation suivants ont été évalués au début de l'intervention et trois mois après l'intervention : le savoir et le comportement de soins d'hygiène dentaire personnels déclarés par le participant, les indices de plaque et de gencive et la littératie en santé buccodentaire. Le modèle linéaire mixte pour les mesures répétées a été utilisé pour comparer les groupes d'intervention et de contrôle pré (inter) et post (intra) interventionnels. RÉSULTATS: Les participants qui ont reçu l'intervention SYS ont montré une amélioration ( p <0.0001) dans les variables dépendantes suivantes : le savoir et le comportement en matière de soins d'hygiène dentaire personnels, la littératie en santé buccodentaire et les indices de plaque et de gencive. CONCLUSIONS: L'intervention SYS a amélioré le comportement positif en matière de soins d'hygiène dentaire personnels parmi les immigrants pendjabis ayant une littératie en santé buccodentaire faible. L'intervention SYS peut être utilisée parmi d'autres groupes vulnérables ayant un faible taux de littératie en santé buccodentaire afin d'améliorer le comportement de soins d'hygiène buccodentaire personnels.

Effectiveness of an alcohol-free essential oil-containing mouthwash in institutionalised elders receiving long-term care: a feasibility study.

OBJECTIVES: To conduct a feasibility study on investigating the effectiveness of an alcohol-free essential oil mouthwash (AF-EOMW) to reduce plaque accumulation and oral pathogen levels in institutionalised elders receiving long-term care and to obtain preliminary results. BACKGROUND: Although simple, cost-effective strategies to improve oral hygiene in seniors such as the use of mouthwashes have been shown to reduce the risks of respiratory diseases, little information is available on the feasibility of implementing these measures. METHODS: Twenty-five elderly participants with significant loss of autonomy were initially recruited and divided into two groups. A test group rinsed with an AF-EOMW twice a day, and a control group rinsed with tap water. Data on demographic characteristics, dental history and tobacco use were collected from a questionnaire. Problems encountered during recruitment and data collection were documented. Plaque index, denture cleanliness and salivary levels of several pathogens were measured at three time points: baseline (T0 ), day 22 (T1 ) and day 45 (T2 ). RESULTS: Eighteen participants completed the study. Several problems were encountered during recruitment and execution of the study protocol. No significant differences in clinical or microbiological measures were found between the test group and controls at three time points (p > 0.05). CONCLUSION: This pilot study shows that, if sufficient logistical and financial resources are available, it is feasible to conduct randomised clinical trials in a seniors' facility. The use of an AF-EOMW to improve oral hygiene in seniors was not found to be superior to tap water. However, larger controlled clinical studies are needed to confirm these results.

Oral health care systems in developing and developed countries.

Health care systems are essential for promoting, improving and maintaining health of the population. Through an efficient health service, patients can be advised of disease that may be present and so facilitate treatment; risks factors whose modification could reduce the incidence of disease and illness in the future can be identified, and further, how controlling such factors can contribute to maintain a good quality of life. In developed countries, clinics or hospitals may be supported by health professionals from various specialties that allow their cooperation to benefit the patient; these institutions or clinics may be equipped with the latest technical facilities. In developing countries, health services are mostly directed to provide emergency care only or interventions towards certain age group population. The most common diseases are dental caries and periodontal disease and frequently intervention procedures aim, at treating existing problems and restore teeth and related structure to normal function. It is unfortunate that the low priority given to oral health hinders acquisition of data and establishment of effective periodontal care programmes in developing countries but also in some developed countries where the periodontal profile is also less than satisfactory. Despite the fact that in several developed countries there are advanced programmes oriented to periodontal disease treatments, the concern is related to the lack of preventive oriented treatments. According to data available on periodontal status of populations from developed countries, despite the number of dentists and trained specialists, dental health professionals do not presently meet adequately the need for prevention, focusing mainly on curative care. The need for strengthening disease prevention and health promotion programmes in order to improve oral health conditions and particularly periodontal status in the majority of countries around the world is evident. Unfortunately, in many countries, the human, financial and material resources are still insufficient to meet the need for oral health care services and to provide universal access, especially in disadvantaged communities, in both developing and developed countries. Moreover, even though the most widespread illnesses are avoidable, not all population groups are well informed about or able to take advantage of the proper measures for oral health promotion. In addition, in many countries, oral health care needs to be fully integrated into national or community health programmes. Improving oral health is a very challenging objective in developing countries, but also in developed countries, especially with the accelerated aging of the population now underway and intensifying over the coming years.

Oral health, general health, and quality of life in older people.

The purpose of this report is to review the interrelationship between poor oral health conditions of older people and general health. The impact of poor oral health on quality of life (QOL) is analyzed, and the implications for public health intervention and oral health care are discussed. Findings from the current research may lead to the following conclusions: The available scientific evidence is particularly strong for a direct relationship between diabetes and periodontal disease; the direct relationship between periodontal disease and cardiovascular disease is less convincing. General and associated oral health conditions have a direct influence on elder people's QOL and lifestyle. The growing number of elderly people challenges health authorities in most countries. The evidence on oral health-general health relationships is particularly important to WHO in its effort to strengthen integrated oral health promotion and disease prevention around the globe.