Program Planning in Community Dental Health

process of care steps

-Assessment

-Diagnosis

-Planning

-Implementation

-Evaluation

purpose of assessment

systematic approach to identify population or community needs and resources; get a community profile

assessment- why?

what are the problems?

who needs interventions?

what are the suspected causes of problems?

information to gather during assessment phase

obtain baseline data for planning, program evaluation, and determination of changes in disease trends

-identifies extent and severity of need

which phase is the basis for writing objectives and evaluation

assessment

assessment- what to measure?

-population profile

-epidemiology

-existing programs

-leadership

-human element

-resources

-fluoride

population profile

-number/age of population

-ethnic backgrounds

-diet and nutrition

-general health profile

-employment

-education

-income

-transportation

epidemiology

-pattern and distribution of oral diseases

-health and disease status and frequency

existing programs

-type of programs which currently exist

-who is responsible for administering program

-success/failure of existing programs

-community's acceptance of programs

leadership

-who are community leaders

-attitudes towards oral health issues

human element

-perceived needs

-acceptance

-demand vs. need

-access to care

-dental utilization rates

-any other factors thought to be associated with disease

resources

-funds:

-public/private/insurance

-grants: block grants and line-item grants (more detailed and specific)

-facilities

-location

-accessibility

-labor

types of data to collect

-quantitative

-qualitative

quantitative data

-objective data that can be measured

-numerically represents the size of a problem

examples of quantitative data

-incidence/prevalence

-plaque scores

-DMF scores

qualitative data

-data which reflect quality of things that cannot be measured or analyzed

-help to explain why a problem exists

example of qualitative data

reasons why people don't utilize dental services

sources of information

-existing information

-community agencies

-conduct surveys

-clinical screenings

existing information

-literature search (evidence based)

-national/state health surveys

-census bureau

-dental records/charts

community agencies

-state/local health departments

-dental/hygiene societies

-chamber of commerce

-voluntary health agencies

-universities

conduct surveys

-useful when assessing oral health knowledge, behavior, values, and attitudes

-self-administered written survey best choice for large groups

-telephone or person to person interview

-focus groups

clinical screenings

-to collect information about oral health status

-exams vs. screenings

exams vs. screenings

-exams are more thorough

-screenings are quick assessment of gross need

-neither include any service other than awareness

clinical screening types

-type 1

-type 2

-type 3

-type 4

type 1 screening

-complete exam using mirror, explorer, radiographs, pulp vitality tests, study models

-rarely used in public health

type 2 screening

-limited exam using mirror, explorer, posterior bitewings

-useful if program includes service to individuals

type 3 screening

-inspection using mirror, explorer, and adequate illumination

-more common in public health

type 4 screening

-screening with tongue depressor and available illumination ONLY

-becoming more favored

aspects of diagnosis

-prioritization of needs

-what to decide

-need to consult community leaders

prioritization of needs

method of imposing people's values and judgements of what is important onto raw data

need to decide:

-what community you will serve

-what problem you will address

need to consult community leaders and/or advisory/task groups

-helps gain community support

-helps understanding of economic, social, and political issues that may affect plan

common ways to set priorities

-problems affecting large number of people take priority over those small number

-more serious problem takes over less serious

define goal

broad statement of what program will accomplish

example of goal

to improve oral health

define objective

-specific, measurable statement describing desired result of program

-correctly written objective = evaluation of program

objectives have 5 components for oral health promotion:

-what

-extent

-who

-where

-when

what

condition or situation to be attained

extent

scope and magnitude of condition or situation to be attained

who

target group in which attainment will occur

where

geographic areas of program

when

time at or by which desired condition or situation is to exist

two kinds of objectives

-outcome

-process

outcome objective

states reduction of problem

example of outcome objective

By 2030, no more than 10% of population aged 6-17yo in Toothtown will have lost any teeth as result of caries.

process objective

states solution to a problem

example of process objective

By 2030, 90% of the population in Toothtown will have access to fluoridated water supply.

preparing a "blueprint" for the dental program should...

state methods to conduct program, ways to evaluate program, and possible alternatives and constraints

methods to conduct program

actual procedures carried out to achieve program objectives

selection of methods is based on:

-effectiveness

-practicality

-cost

-community acceptance

discuss commonly encountered constrains in public health dentistry

-lack of funding

-attitudes of professional organizations

-inadequate transportation

-personnel shortages

-community attitudes

-lack of facilities

-time to complete project

-dental practice act

implementation

-putting the plan into operation

-must identify each step needed to accomplish objectives

-make changed and adjustments in program, as needed

-pilot program

pilot program

-program operation on a limited scale as a trial run

-common "first step" in a community health programs

purposes of evaluation

-measure progress towards meeting objectives (evaluating effectiveness of program)

-identify problems in carrying out activities

-justify cost of program to get additional funds

method of evaluation is dependent upon your objectives

-evaluate decrease in caries by clinical screening

-evaluate increase in knowledge by questionnaire

-continuous

quantitative evaluation

-pre/post tests

-dental indices

qualitative evaluation

-surveys

-interviews

-personal statements

2 types of evaluation

-formative

-summative

formative evaluation

-internal

-examines program activities as they take place

-is program operating smoothly or are changes needed

summative evaluation

-evaluates success of program after it has occurred

-were the objectives accomplished?

evaluation mechanisms need to be:

-valid

-reliable

valid

measure what they are supposed to measure

reliable

produce same results on a consistent basis