SDM Research Assessing Oral Health Care Perceptions, Needs Among African American Elders

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Beth Adams, 215-573-8224

While much of the research at the University of Pennsylvania School of Dental Medicine (SDM) is going on in a laboratory or clinical setting, the work of Dr. Ann Slaughter, Assistant Professor of Dental Care Systems, is taking her out into the community, where she is investigating the oral health attitudes and perceptions of African American elders. Dr. Slaughter began her study in this area over a year ago, with the goal of developing effective health promotion strategies for this minority population.

"African American elders experience a disproportionate level of oral disease and utilize dental services less often than their counterparts in the general population," notes Dr. Slaughter. "Our main objective is to determine the reasons for this, and in turn, how we can create effective health promotion interventions that are more culturally sensitive."

The first phase of her research involved a pilot survey of African American seniors in the community, which led to a University Research Foundation grant that further examined oral health perceptions of African American elders through ethnographic focus groups at senior centers in West Philadelphia.

Within the focus groups, the seniors were asked about their oral health behaviors (brushing, flossing, and preventive dental visits) from a cultural perspective, looking at their oral health habits growing up and how those habits have changed since they became elders. Dr. Slaughter reports that in general they found that while brushing was something that the seniors had always done, they knew little about flossing, thought it was hard to do, and felt that flossing was not practiced among their social contacts. As for preventive dental care, while fear and cost were among the reasons given for not visiting the dentist regularly, the major barrier was related to their past experiences.

"A key finding in terms of these seniors' attitudes toward dental providers is that the race of the dentist was not considered important," says Dr. Slaughter. "What is most important to them is how they are treated. They want someone who is understanding and sensitive to them, who takes time to explain the procedures - these are the factors that impacted their utilization patterns. We thought this was a very significant finding in terms of our geriatric curriculum, for we can tell our students that by paying a little more attention to their behavior in managing these patients, they can increase the likelihood that they will return for ongoing care."

Another key finding from the focus group data is the impact of linking oral health to general health. "Maintaining good health was very important to the seniors we talked to," says Dr. Slaughter, "which told us that one of the strategies for motivating them to practice preventive behaviors is to educate them about how oral health conditions can have negative consequences on their general health."

While Dr. Slaughter and her collaborators - statistician Dr. Lynne Taylor and social worker and ethnographer Dr. Virginia Smith, both of the Center of Excellence on Minority Health at the University's School of Medicine - are continuing to analyze the focus group data, their next step was to gain a better understanding of the concept of perceived need among this elder population. To undertake this phase of their research, funded through a Brookdale Fellowship, they again returned to senior centers in West Philadelphia, this time conducting clinical screenings of the elders along with the a survey of their health perceptions.

"By doing the screenings, we were able to compare the seniors' actual oral health status to their perceived status," explains Dr. Slaughter. "In addition, we wanted to identify specific symptoms and oral conditions that may not be perceived as important enough to stimulate them to seek preventive services."

Among 157 elders screened and surveyed, 64% required clinical care, while only 47% reported a perceived oral care need. Those specific oral conditions that the elders most often failed to identify as problems included abnormal gingiva (34%), retained roots (32%), cavities (35%) and ill-fitting prosthesis (45%).

"These conditions were not causing them pain, and therefore, they were not identifying these conditions as perceived problems," adds Dr. Slaughter. "In addition, only 10% of the population rated their health status as being poor, so they weren't connecting these actual dental problems to their general health. This suggested that we need to develop a health education program with particular emphasis on identifying the asymptomatic signs of oral conditions and relating them to how they may compromise general health."

Testing such an intervention program is the current focus of Dr. Slaughter's research activities. In June, she began a study of a health promotion education program at senior centers in North Philadelphia.

"If this community intervention program seems to have some promising results, then the next step would be to test this methodology with other ethnic groups that suffer disparities in oral health, such as Asian or Hispanic populations," says Dr. Slaughter. "Another future goal would be to use this process in the homebound population."