Oral Health Education and Navigation Program for Older Immigrants with Limited English Proficiency

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PROJECT SUMMARY Building upon the evidence that limited English proficiency (LEP) poses a critical risk to older immigrants' oral health and dental care, the proposed study focuses on older Korean Americans as an initial target group for evaluating an oral health education and navigation program designed to promote older LEP immigrants' use of preventive dental services. The study is based on four premises: (1) oral health knowledge and healthcare navigation skills are critical imperatives in reducing oral health disparities in LEP populations and, thus, are important intervention targets, (2) bilingual and bicultural community health worker (CHW) participation is critical in reaching out to older LEP immigrants, (3) language diversities in LEP populations, as well as differences in personal needs, necessitate a sustainable method to personalize the intervention (i.e., computerized tailoring), and (4) the combination of “human touch” (CHWs) and “digital touch” (technology) requires a pilot test to evaluate feasibility and acceptability. The program we envision is an oral health education and navigation assistance program that is personalized by a computerized tailoring system and delivered by CHWs. The long-term goal of the program, inspired by the Transtheoretical Model (TTM) and the Fogg Behavioral Model (FBM), is to promote both proximal (oral health knowledge and self-efficacy) and distal (use of preventive dental services) outcomes. As a first step toward the goal, this R21 study pursues the following activities: (1) focus group with a Community Advisory Board, (2) assessment of the local dental service environment, (3) content development for education and navigation materials, (4) development of a computerized tailoring system, (5) development of protocols for CHW training and monitoring, and (6) pilot testing and evaluation of the program. Each step will be guided by the principles of Community-Based Participatory Research (CBPR). The products from these initial activities will include a content library of oral health education materials and local resources for dental care, a computerized tailoring system, and a protocol for CHW training and monitoring. Pilot testing will be conducted with 40 older Korean Americans who meet the eligibility criteria (having LEP and no use of preventive dental services in the past 12 months). Each participant will be assigned to one of four trained CHWs and will receive a personalized one-on-one education session (30 minutes, using an iPad). The research team will contact participants three months later to determine whether they had used any preventive dental services since the education session. Using an adaptive design, a CHW-led personalized navigation assistance program will be provided to non-users. The research team will collect and analyze data from both the participants and the CHWs, including quantitative data on participation rate and satisfaction with the program and qualitative feedback. The findings will form a solid foundation for a larger, definitive study with a clinical trial (e.g., R01) to identify behavioral health outcomes and provide a translational model for reducing barriers to preventive dental services for diverse LEP groups.