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MacroPost #4

Addressing Competency “F14”: Advocate for political, social or economic policies and programs that will improve health in diverse populations.

 In Team Oral Health’s initial meeting with our precepting organization, the North Carolina Oral Health Collaborative (NCOHC), it was established that our goal for the semester would be to create a policy recommendation advocating for enabling dental providers to administer vaccinations. Under the described policy recommendation, dental providers would be permitted to administer seasonal influenza vaccinations, the series of Human Papillomavirus (HPV) vaccines and any other vaccines associated with managing future pandemics. If allowed to administer vaccinations, dentists could promote ease of access to vaccines for many vulnerable patient populations – including those frequently found within rural communities. Vaccination rates within rural communities are generally lower than those round in urban communities. Rural children are approximately thirty percent less likely have completed the full series of HPV vaccinations, resulting in an increased risk of HPV infection and related negative health outcomes (Lai et. Al, 2016).

Prior to initiating our work on drafting the policy recommendation and its accompanying campaign materials, our group worked to gain an understanding of just what advocacy is, how policies are categorized and how lobbying plays a critical role in the passage of legislation. During another group meeting, our preceptors gave a thorough presentation regarding these topics, and their explanations would serve as the basis of our group’s understanding as the semester’s work progressed. Per our preceptor’s presentation, “advocacy” refers to the act of supporting a cause or proposal. The aforementioned presentation defines the phrase “policy” as the laws and regulations created by the government in an effort to achieve established goals. Policies are then edited through the process of “systems change”. Each policy can be categorized into one the following three categories: restrictive policies, regulatory policies and facilitative policies. Restrictive policies prohibit an individual from partaking in an activity. Regulatory policies provide regulations over specified activities. Finally, facilitative policies are designed to implement and enforce the previously mentioned policy types.

Within the context of this practicum project, our group created campaign materials promoting advocacy supporting our proposed policy. Understanding the factors that have the potential to influence public policy also served an important role in the development of our policy recommendation. Our preceptors identified public opinion, economic conditions within communities, interest groups and lobbying as a few of the factors that may influence future policy. While drafting our policy, our group routinely discussed and incorporated several of these components to ensure the efficacy of our policy. Prior to drafting the policy, we used the process of power mapping to evaluate the potential for acceptance or negation of our policy by stakeholders in our state.

During the power-mapping process, the anti-vaccination community was identified as likely holding views contradictory to our proposed policy, and subsequently as an agent that may contribute to a negative attitude by the general public toward our proposal. In contrast, our team identified multiple stakeholders – such as professional organizations or other healthcare professionals - that may serve as a positive influence over the general public’s perception of this proposal. Of note, several of our identified probable supporters held some degree of sway within the community – such as political power or other forms of perceived authority.

While “advocacy” is an expansive and vague term, “lobbying” refers directly to attempts at influencing a piece of legislation (or policy) at any governmental level (as defined by the NCOHC). Although the primary focus of this semester’s work as a practicum group revolved around advocating for the awareness and support of vaccination by dental providers, lobbying will play a role in the future of our proposed policy. Presently, our practicum group has a meeting set in the upcoming weeks to present our policy recommendation to the NCOHC’s lobbyist. If all goes according to plan, our draft will be transcribed by the organization’s lobbyist into a bill and will eventually be brought forth into North Carolina legislation for consideration. Meeting with the professional lobbyist will transition our advocacy work into lobbying and will serve as a massive step forward in the journey to allow dental providers to administer vaccines, thus minimizing this disparity for rural communities.

As a nurse and future public health professional, advocating for dental providers to be permitted to administer vaccines initially presented as an obvious way to improve ease of access to vaccination for disadvantaged patient populations. However, creation of this campaign required being aware and mindful of potential sources of opposition. Creating thoughtful, factual counterarguments without emotional bias was challenging, but nearly as important as presenting our team’s position on the topic and served as a meaningful learning opportunity that will be invaluable to our future work as public health professionals.

 Lai, D., Ding, Q., Bodson, J., Warner, E., & Kepka, D. (2016). Factors Associated with Increased HPV Vaccine Use in Rural‐Frontier U.S. States. Public Health Nursing, 33(4), 283–294. https://doi.org/10.1111/phn.12223 

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Macro-Post #3

Addressing Course Competency “F19”: Communicate audience-appropriate public health content, both in writing and through oral presentation.

Working as a member of Team Oral Health has repeatedly required the ability to communicate succinctly and clearly though both verbal interactions and through written word. Because our project was deeply rooted in advocacy regarding promoting health within underserved populations through a legislative change, it was critical to be mindful of the targeted audience for each project or communication. While many of our projects were completed with the intention of presenting them to other graduate students or professionals with graduate level education, some aspects of the project were targeted at the general public. Our team worked to create content specific to the targeted audience of each project to ensure that the ideas were conveyed in a way that was meaningful and easily understood.

Within the initial stages of the practicum, our preceptors assigned topics for each team member to thoroughly research, with the expectation that our findings be summarized and presented to the team during a subsequent group meeting. As assigned, I independently researched the connections between poor oral health and an individual’s overall health status – particularly within the cardiovascular context. Later, I researched the correlation between the Human Papillomavirus (HPV), oral cancers and rural vaccination rates. In each instance, the information I discovered as part of my research was compiled and organized into a PowerPoint presentation that I shared with my teammates and preceptors. Conveying the necessary information within the presentations required the ability to adapt my communication style in a way that was appropriate for this context and my audience – individuals with graduate level (or in the process thereof) education with a previously established understanding of basic physiologic principles.

         Following the completion of our background research, my teammates and I collectively created a survey to be electronically distributed to North Carolina dental providers to assess their willingness to administer seasonal influenza vaccinations, the series of HPV vaccines and vaccines necessary in any future pandemics. Survey questions also assessed the dental providers’ perceived value in incorporating vaccine administration into their daily practices. Drafting the survey questions required communicating ideas using language that was clear, concise and unbiased. Because our intended audience were dental providers, and all of which presumably have doctoral degrees, survey questions were drafted under the assumption that the target audience would have a basic understanding of the anatomical and disease processes in question. The survey questions created by myself and my teammates were combined with those created by students within the University of North Carolina’s Gilling’s School of Public Health to create the final survey draft. Survey results are pending at this time, and unavailable for analysis.

       �� Following the survey creation and distribution, Team Oral Health began creating our campaign materials advocating for a legislative change that would subsequently enable dental providers to administer the aforementioned vaccines. As part of our campaign, I produced an infographic (a partial picture of which is present in a previous post) detailing the highlights of our project and reasoning supporting our advocacy. Creating an infographic that would be readily comprehensible by the general public was more challenging that I had anticipated. Given that I have an established medical background, as did our preceptors, I found myself struggling to limit the information included to the minimum needed to understand the project and refrain from using overtly medical language. However, under the guidance of our precepting organization, the final product appeared professional and could appeal to both the general public and dental professionals, alike. The facts and statistics included within the infographic were phrased as to be easily understood by the general public, or individuals that may have limited health literacy. Care was taken to ensure that the graphics included were relevant to the content and easy to interpret.

As the end of the semester, and this practicum project, approached, our team worked collaboratively to create a presentation conveying the entirety of the work we completed over the semester. A synopsis of our work was conveyed via an online – meeting platform using a visual presentation accompanied by voiceovers by each teammate. The conclusion of our presentation included an original video, produced by our team, conveying information regarding vaccine administration by dental providers to the general public – including the reasoning behind the project and potential impact for underserved communities. Because the presentation’s audience consisted of other Master of Science in Public Health students and public health professionals, the complexity of content presented was consistent with that experienced by our teammates (when working together) over the course of the semester. However, because our classmates had not previously been privy to the subject matter of our project, additional background information was included to promote their understanding. In addition to the survey, infographic and comprehensive presentation, our team also produced: a blog post communicating the potential role dentists could occupy in vaccine administration, social media posts designed to engage the NC Oral Health Collaborative’s online audience and a policy document highlighting our ideas for the future bill.

Because this practicum revolved so heavily around communicating information and promoting ideas to an expansive variety of audiences, it served as a beneficial exercise in being mindful of one’s target audience and adjusting one’s communications accordingly – and is perhaps one of the most important skills that I have developed this semester. Being mindful of one’s audience is crucial to my future as a future public health professional as it ensures that I can successfully interact with community members to promote health and positively impact health outcomes within communities.     

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Group meeting for Team Oral Health is morning! We’re currently finalizing our policy draft so that it is ready for our meeting with the organization’s lobbyist next week.

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Group meeting with Team Oral Health today! Drafts of my info graphic and our group blog post were presented to our preceptors, and their suggested revisions will be incorporated into our final products. If all goes according to plan, the blog post will be published on the NCOHC website. #TeamOralHealth

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As part of the advocacy campaign, I am drafting infographics that express the magnitude and breadth of the impacts this project may have on rural communities.

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While working under the guidance of the North Carolina Oral Health Collaborative (NCOHC), one of the primary focuses of Team Oral Health this semester has been the creation of campaign materials that will be utilized in advocating for a legislative change resulting in an expansion of the scope of practice of North Carolina Dentists. When the proposed changes pass, state dental providers will be permitted to administer the Human Papilloma Virus (HPV) and Influenza vaccinations within their practices, enabling patients to combine medical and dental visits - saving time and easing the financial burdens of seeking healthcare, particularly within vulnerable patient populations as are frequently found within rural communities. From the initial stages of research, this project has required a working knowledge concerning how to seek credible sources of quantitative and qualitative data to be used as the factual basis of the project. In addition to incorporating evidence-based research into the groundwork for this project, the creation of two sets of original survey questions - designed for two vastly different audiences - further exemplified the need for an ability to select quantitative and qualitative data collection methods appropriate to the project. 

The first compilation of survey questions drafted collaboratively by the members of Team Oral Health was designed to assess the interest and willingness amongst North Carolina dental providers and stakeholders to administer the influenza and Human Papillomavirus (HPV) vaccines. Given that vaccination administration is not presently a skill completed by dental providers, the data collected on provider willingness to participate will serve as a crucial building block for the remainder of the project. Each team member individually drafted survey questions, which were then compiled and edited for clarity prior to being presented to those at the precepting organization. The survey questions could each be placed into one of the following categories, as requested by the NCOHC: “Provider Understanding”, “Provider Perceived Value” and “Provider Willingness”. Questions primarily utilize the quantitative format, as they are close-ended in nature; questions require participants to select from provided multiple-choice options, rank their opinions quantitatively on a scale of one to five (one being strongly disagree and five being strongly agree). The questions drafted by our student group were then translated into the TypeForm program and will subsequently be distributed to stakeholders for completion. 

Of note, the survey questions created by the students within my practicum group will be combined with those written by individuals within the UNC Gillings School of Public Health. Presently, it is unclear as to if survey results will be available prior to the end of this practicum session. However, I will update this blog with information surrounding the survey results and data analysis process as it becomes available. 

In addition to the formal stakeholder survey, each student within our practicum group created questions to be utilized as part of a social media post within the NCOHC’s social media campaign. The questions designed for the social media campaign were crafted to assess the general public’s interest in receiving routine vaccinations as part of a dental visit, as well as gauge the audience’s current knowledge regarding vaccines.. Given the limited size and lack of randomization within the audience of the NCOHC’s social media platform, the social media campaign would not serve as a means to collect official data but rather as a way for the organization to engage its audience. 

In creating a social media campaign, the intention was to utilize the NCOHC’s twitter account to post one question per day, accompanied by an informational graphic. However, after discussion with our precepting organization, plans were laid forth to complete the social media campaign after the completion of the formal stakeholder survey to limit confusion and enable the organization to officially announce its ideas surrounding vaccination within the dental setting. Therefore, while the portion of the project was completed, the delay in its use presents challenges related to being unable to utilize the finished components in drafting the project’s final products. 

The semester - long process of researching rural dental health disparities and vaccinations as they relate to oral health, followed by subsequently drafting campaign materials has required an extensive working knowledge regarding how to appropriately utilize previously collected quantitative and qualitative data in research, and how to incorporate these methods into survey design. While I cannot claim to be an expert in data collection or survey design, engaging with these skill sets throughout the course of this practicum project has made these topics less daunting and has increased my comfort in interpreting data and designing data collection processes - skills that will undoubtedly remain valuable as I progress through the MSPH program and into my future career.  

Addressing Competency “F2” -  Select quantitative and qualitative data collection methods appropriate for a given public health context.

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The survey drafted by our practicum group is up and running! After final approval at this week’s group meeting, it should be on track for distribution to participants. One step further in this campaign process! #TeamOralHealth #vaccinate

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The North Carolina Oral Health Collaborative (NCOHC) aims to work cohesively with dental professionals and stake-holders across the state in providing education regarding the overall importance of oral health while simultaneously addressing the disparities that exist in assessing oral health resources amongst vulnerable patient populations, including those of minority groups or living within rural communities. The organization is an active voice in the advocacy for the North Carolina legislature to expand upon the scope of practice for dental professionals, enabling providers to provide more comprehensive care and better serve the patients within their communities. 

Prior to beginning this project, I was not aware of the significant incongruences that exist amongst racial groups and their access to oral health care in North Carolina. A significant factor in the limited access to dental care is the geographic isolation associated with rural communities combined with dentists’ tendency to practice within urban settings. A significant proportion of North Carolina’s Native American population resides within rural counties; sixteen of North Carolina’s rural counties have a Native American population one and a half times higher than the national average (Bell & Moss, 2018). Given the high proportion of this population within a historically - underserved geographic area, it is hardly surprising that amongst the state’s Native American population, as many as forty-three percent of individuals report that they have not visited a dental professional within the last year - compared to only thirty-two percent of non-hispanic white individuals. Additionally, approximately fifty-three percent of the adult Native American population reports having lost or had a permanent tooth removed while only forty-five percent of non-hispanic white individuals report experiencing the same (Bell & Moss, 2018). 

The disparities in accessing oral health care are not limited to the state’s rural Native American population. Elementary aged African American children experience  higher rates of dental caries (cavities) than non-hispanic white children, even when socioeconomic differences have been accounted for (Tencza, 2018). In addition to the disparities directly linked to oral health, such as caries and dental cleanings, recent studies have found children within these rural communities are significantly less likely to be vaccinated. Approximately only thirty percent of rural children have completed the series of Human Papillomavirus (HPV) vaccines, which have been found to be almost entirely effective in preventing strains of the virus that may result in various forms of cancer , including oral cancer. Approximately seventy - percent of oral cancers have been linked to the Human Papillomavirus and cancers may result years after the viral infection. Dentists play a critical role in the discovery and diagnosis of oral cancers, but are not presently permitted to administer vaccines (Lai et. Al, 2016). 

As a registered nurse, I frequently administer vaccines; vaccine administration (intramuscular injections) is a basic skill learned within the first year of baccalaureate nursing school. Given the doctoral preparation of dental providers and present disparities that exist amongst oral health and vaccination rates in rural communities across our state - enabling dental providers to administer vaccines would seemingly address both disparities. 

By connecting dental providers and stakeholders across the state, the North Carolina Oral Health Collaborative is addressing the aforementioned disparities through its advocating for change in legislative policy, to enable dental providers to administer vaccinations. As a profession, dentists presently utilize the skills needed to safely administer vaccines; dentists routinely inject medications into anatomically difficult places and are well versed in human anatomy. Additionally, the sequence of administration for multiple vaccines also corresponds with the timeline for recommended dental cleanings. Extending the scope of practice of dentists to include the administration of the influenza and Human Papillomavirus vaccines can serve as an intervention to increase vaccination compliance through expanding the accessibility of vaccines through enlarging  the pool of vaccination providers. A larger number of available  providers for vaccination administration can shorten travel times for patients, contributing to the accessibility of vaccines and ultimately decreasing oral cancer prevalence within North Carolina. As a member of Team Oral Health, I am working collaboratively with my classmates to design a policy recommendation document that will be presented to the North Carolina legislature in favor of this change to dentists’ scope of practice. In addition, we are also raising awareness and support through the creation of original campaign materials - including fliers, informative graphics and interactive social media posts such as polls and trivia.  

When implemented, the advancement of the scope for practice of dental providers will play an integral role in overall health promotion in rural communities. An increase in routine vaccine administration will lessen the financial impact that oral cancers and other preventable illnesses have on families and their communities, potentially freeing funds for other public health initiatives. Enabling dental providers to vaccinate patients can ease the logistics of healthcare; combining tasks into a single provider visit and eliminating the need for visits to multiple providers thus decreasing financial and travel burdens on patients. Given the potential benefits to both the health and financial burdens within rural communities, it is time to expand the scope of practice for dental professionals across North Carolina to include vaccine administration. 

Addressing Practicum Competency  R2 : Identify and distinguish the access to care barriers and the health care utilization challenges that affect the health of rural communities.

Bell, R., & Moss , M. (2018). Oral Health Disparities Amongst NC’s American Indian Population . The Road to Oral Health Equity in North Carolina , 4. https://publichealth.nc.gov/oralhealth/docs/OralHealth-Newsletter-092418-WEB.pdf

•Lai, D., Ding, Q., Bodson, J., Warner, E., & Kepka, D. (2016). Factors Associated with Increased HPV Vaccine Use in Rural‐Frontier U.S. States. Public Health Nursing, 33(4), 283–294. https://doi.org/10.1111/phn.12223

Tencza, M. (2018). Addressing Dental Caries Prevalence Disparities in Different Populations of Children with School Based Fluride Mouth Rinse Programs. The Road to Oral Health Equity in North Carolina , 9. https://publichealth.nc.gov/oralhealth/docs/OralHealth-Newsletter-092418-WEB.pdf

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Team Oral Health held a formal meeting with our practicum leaders to present an outline of our ideas for both campaign materials and a policy recommendation document. This upcoming week, we have been tasked with the creation of survey questions that will be used in collaboration with those produced by UNC to assess readiness and interest in dental providers administering vaccines.

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Teammate - meeting this morning for Team Oral Health! Together, our team began drafting the necessary components for the Oral Health Advocacy Campaign - which will include social media posts, informational graphics, and a formal policy proposal. #TeamOralHealth

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Team Oral Health had no formal meeting with our team leaders this week, however, students held a group zoom - meeting to discuss generating the materials for our project and creating central themes. #TeamOralHealth

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A critical step in formulating a plan for change is realizing where you stand. Today’s Team Oral Health meeting revolved around PowerMapping - a methodology that involves recognizing current relationships and their influences over topics of interest. It is critical to acknowledge relationships as resources when planning community-based interventions.

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Did you know that one in two American adults have some form of periodontal disease? Patients that have both Cardiovascular Disease and Peridontal disease are 1.5x more likely to have an acute cardiovascular event such as heart attack or stroke.

I presented my research on the correlations between poor oral health and cardiovascular this week during our practicing group meeting. It was fascinating to learn how oral health affects the various bodily systems!

#TeamOralHealth

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Group meeting with Team Oral Health today! Excited to begin researching how having poor oral health may impact the cardiovascular system!