摘要：Objectives. We obtained in-depth information from low-income parents and caregivers of young children about their knowledge and understanding of and practices related to the prevention and control of dental caries (tooth decay). Methods. In 2010, we conducted 4 focus groups in Maryland communities with low-income, English-speaking parents and caregivers who had at least 1 child aged 6 years or younger or who were pregnant. We developed a focus group guide based on findings of a previous statewide random telephone survey of adults with young children. Results. Most participants had limited understanding of and extensive misinformation about how to prevent dental caries. They were confused about the use of juice and its impact on their child’s teeth and had limited understanding of the use of fluorides to prevent caries. Most did not drink tap water and did not give it to their children; rather, they used bottled water. Conclusions. These results and those of the statewide telephone survey strongly suggest the need for educational interventions designed for those with limited levels of education. Dental caries (tooth decay) is the most common disease of children, even more common than asthma. This disease has serious health consequences, causes needless suffering, and affects children’s ability to eat, speak, and learn. 1 Moreover, when left untreated dental caries can result in death, as was the case with Deamonte Driver, a 12-year-old boy in Prince George’s County, Maryland, who died in 2007. 2 Data from the National Health and Nutrition Examination Survey for 1999 to 2004 showed that approximately 23% of children aged 2 to 11 years have untreated dental caries. Black and Hispanic children and those living in families with income less than 100% of the federal poverty level had more untreated decay (27.6%, 33.0% and 32.5%, respectively) than their counterparts. 3 Maryland data from the 2011–2012 survey of school children showed that 13.7% of children in kindergarten and third grade had a history of decay in their primary teeth. 4 Despite these data, dental caries is preventable. However, many parents and caregivers do not know how to prevent this disease or understand their role in doing so. Because parents are the primary caregivers of young children, their knowledge, understanding, and practices influence their child’s oral health and practices. Several studies have found that parental knowledge and behaviors do have an impact on dental caries among young children. 5–7 Plutzer and Spencer 7 reported that providing oral health anticipatory guidance to pregnant women who were expecting their first child significantly reduced rates of severe early childhood caries in children aged 20 to 22.5 months. Educational interventions using motivational interviewing techniques have also demonstrated decreases in early childhood caries in children whose average age was 3.5 years. 8 Thus, to determine what Maryland adults understand about caries prevention, we conducted a statewide random-sample phone survey. The results indicated that they have critical gaps in their basic understanding about how to attain and maintain children’s oral health, especially those with lower levels of education or whose children are Medicaid recipients. Respondents were not very knowledgeable about how dental caries can be prevented, they did not know that fluoride prevents cavities, and few had heard of dental sealants, another caries-preventive agent. Moreover, many reported that they neither drank fluoridated tap water nor gave it to their child to drink. 9 Thus, we cannot assume that adults have access to and know and act on existing knowledge of evidence-based methods for dental caries prevention and early detection for the benefit of their children. 1,9–12 Individuals with low health literacy skills and chronic diseases have less knowledge of their disease and its treatment, fewer self-management skills, and poorer health outcomes than health-literate individuals. 1,13–15 Low health literacy skills affect individuals’ ability to communicate with their health care providers and comprehend educational materials. 14,16–19 Low levels of oral health literacy are associated with lower levels of oral health knowledge, higher levels of dental caries, higher rates of appointment failure, and fewer dental visits. 15,20–23 Given the importance of oral health to overall health and because low oral health literacy can have a negative impact on the oral health of adults and their children, we conducted focus groups with pregnant women, parents, and caregivers who were insured by Medicaid or uninsured. Our objective was to obtain an in-depth understanding of the participants’ knowledge and practices related to preventing tooth decay in children that phone surveys could not reasonably obtain. The focus groups were part of a systematic statewide needs assessment of the oral health literacy of the public and health care providers. We used the Precede–Proceed Model of Health Program Planning and Evaluation to guide the social, epidemiological, behavioral, environmental, and educational assessments. 24 These assessments included surveys and focus groups regarding the knowledge, attitudes, and practices of medical and dental providers related to caries prevention and their use of recommended communication skills.
