Understanding Motivators and Barriers to Children's Oral Health Care Among Low-SES and Hispanic Parents and Pregnant Women

Theoretical Background and research questions/hypothesis: Delta Dental of Colorado Foundation seeks to eradicate tooth decay among children ages 0-3, focusing on the 20 percent of the population with 80 percent of the cavities. Its existing public awareness campaign, focusing on stopping bacteria transmission between parent and child, showed a high recall rate but a low behavior change outcome, and the Foundation hypothesized that it was not resonating with the audience. It wanted to better understanding its target audience: low-income pregnant women and parents of young children, including the growing Hispanic population.

Methods: Working with Metropolitan Group (MG) and Customer Innovations (CI), the Foundation assessed current oral health promotions, reviewed third-party literature, and interviewed stakeholders (health/dental providers as well as audience experts) on challenges and opportunities in reaching the audience. The team then recruited 48 individuals to participate in in-home and in-clinic interviews in English and Spanish. This 1:1 format allowed an in-depth conversation and also provided insight into how home environment might affect oral health.

Results: Briefly, several core findings emerged in our analysis of the research:

• A closely-held value was the power of education to change their children’s lives. There was a strong perceived connection between oral health, education and future success.
• The bacteria transmission message was too complex, parents thought sharing germs built immunity, and parents didn’t want to give up intimate behaviors like sharing bites of food.
• Many parents avoided giving their children candy and soda, but did not know that other sugar-sweetened beverages were harmful. Likewise, parents were not rigorous about brushing their own teeth, or brushing with their children. They were open to this information.
• There was a strong “genealogy of care,” or the repeating pattern over generations of caring (or not caring) for children’s teeth. One exception was in the recent immigrant community, where a percentage of families had grown up in Mexico with no oral care (at home or at the dentist) and who were now embracing the new resources and practices available in Colorado.
• Four personae types emerged, defined by their level of oral health knowledge and their propensity to learn and adopt new behaviors, allowing for tight audience segmentation.

Conclusions: Using the research, the team built a creative concept, message frame and public will building strategy based on the shared value of education, the “ask” of brushing together and keeping sugary drinks out of sippy cups and bottles, and the ultimate goal to create a new social norm and a new generation of parents who care for their children’s teeth. The strategy relies on raising awareness, activating role models, giving clear direction and modeling behavior, and partnering with service providers to reach families through multiple channels. We are currently building a related campaign to build public will among policy makers and funders.

Implications for research and/or practice: The research is informing the Foundation’s planning for its next phase intervention. It also provides insight for others working to reach this population with oral health or other information.