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Implementing the Pediatric Oral Quality of Life (POQL) instrument in clinical practice: Early results.

ABSTRACT

Purpose: The purpose of this study was twofold: first, to elevate the importance of oral health-related quality of life (OHRQoL) in the minds of oral health care providers involved in this project; and second, to evaluate the experience of those providers in administering the Pediatric Oral Quality of Life (POQL) instrument and propose strategies for implementation based on lessons learned. Methods: A workshop was conducted in summer 2016 during which participants were informed of their role in the project including the collection of OHRQoL data. At the end of the workshop attendees completed an evaluation stating that they agreed or strongly agreed that they had a good understanding of OHRQoL and felt competent to administer the POQL chairside. The oral health care workers administered the POQL to children and parents or guardians in fall 2016. A 17-item questionnaire designed to investigate how they felt about utilizing the POQL in practice was administered. Results: Twelve of nineteen practitioners (63%) provided full responses. Half were dental hygienists, 3 were dental assistants, 2 were office administrators, and 1 was a dentist. The majority reported full-time employment and had worked in their organization for 2 to 3 years. All child POQLs were completed chairside at various times during the appointment. Administration of the POQL took on average 6 minutes with most children receptive although not always sure why they were being asked how they felt about their teeth and mouth. Parents and guardians raised no objections to filling out the POQL or having their child do so. Oral health care workers reported the POQL provided greater insight into the child and his or her oral health. Challenges included the need to explain or rephrase questions, fitting the POQL instrument into the workflow, and time. Conclusion: Training and Implementation of the POQL instrument introduced the concept of OHRQoL measures as a part of data collection in dentistry. The oral health care worker responses and comments on the 17-item questionnaire show an elevated awareness of OHRQoL as a result of participating in this project. These early results indicate that implementing an OHRQoL measure in practice requires little time while providing a more complete picture of the impact of a child's oral condition on their quality of life.

RESUME

Objet : La presente etude visait 2 objectifs : le premier consistait a rehausser l'importance de la qualite de vie liee a la sante buccodentaire (QVLSB) dans l'esprit des prestataires de soins de sante buccodentaire qui ont participe a ce projet; le deuxieme, a evaluer l'experience de ces prestataires lorsqu'ils effectuaient l'evaluation de la Qualite de vie en matiere de la pediatrie buccodentaire (QVPB) et de proposer des strategies pour une mise en oeuvre fondee sur les lecons apprises. Methodologie : Lors d'un atelier tenu pendant l'ete 2016, des participants ont ete avises de leur role au sein du projet, ainsi que de la collecte des donnees sur la QVLSB. A la fin de l'atelier, les personnes presentes ont rempli un formulaire d'evaluation qui affirmait qu'elles etaient d'accord ou fortement d'accord que leur comprehension de la QVLSB etait tres bonne et qu'elles se sentaient competentes pour effectuer l'evaluation de la QVPB aupres des clients. Les travailleurs de soins de sante buccodentaire ont effectue l'evaluation de la QVPB aupres d'enfants et de parents ou de tuteurs a l'automne 2016. Un questionnaire a ete utilise, lequel etait compose de 17 elements concus dans le but d'examiner comment ces travailleurs se sentaient face a l'evaluation de la QVPB en cabinet. Resultats : Douze des dix-neuf praticiens (63 %) ont fourni des reponses completes. Parmi ceux-ci, la moitie etait des hygienistes dentaires, 3 etaient des assistantes dentaires, 2 etaient des administrateurs de cabinet et une personne etait dentiste. La majorite des participants ont signale etre employes a temps plein et avoir travaille dans leur cabinet pendant 2 a 3 ans. Toutes les evaluations de la QVPB ont ete effectuees aupres des enfants a divers moments pendant le rendez-vous. L'evaluation de la QVPB prenait environ 6 minutes et la majorite des enfants y etaient tres receptifs, bien qu'ils ne comprenaient pas toujours pourquoi on leur demandait comment ils se sentaient face a leurs dents et a leur bouche. Les parents et les tuteurs n'ont souleve aucune objection a obtenir une evaluation de la QVPB, ni a ce que leurs enfants soient evalues. Les travailleurs de soins de sante buccodentaire ont affirme que l'evaluation de la QVPB a fourni une meilleure comprehension de l'enfant et de sa sante buccodentaire. Les defis comprenaient le besoin d'expliquer ou de reformuler les questions, l'ajout de l'evaluation de la QVPB dans le flux du travail, ainsi que le temps. Conclusion : La formation et la mise en oeuvre de l'evaluation de la QVPB ont introduit le concept des mesures de la QVLSB comme partie integrante dans le cadre de la collecte de donnees en dentisterie. Les reponses et les commentaires que les travailleurs en soins de sante ont fournis sur le questionnaire montrent une conscientisation accrue de la QVLSB grace a leur participation a ce projet. Ces resultats precoces demontrent que la mise en oeuvre de mesures de la QVLSB dans les cabinets demande peu de temps et dressent un tableau plus complet de l'effet que l'etat buccodentaire d'un enfant peut avoir sur sa qualite de vie.

Key words: oral health care providers, oral health-related quality of life, pediatric dentistry, Pediatric Oral Quality of Life (POQL), quality of life

CDHA Research Agenda category: capacity building of the profession

INTRODUCTION

The World Health Organization (WHO) has emphasized for the past 70 years the importance of health providers considering a patient's quality of life. (1) WHO describes health as a "state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity." (2) Recently, the US Department of Health and Human Services' Healthy People 2020 has incorporated health-related quality of life (HRQOL) into its topics and objectives. (3) Healthy People 2020 comprises a set of 10year national goals and objectives for improving the health of all Americans. Beyond traditional collection of biological data, practitioners are challenged to consider the psychosocial aspects of HRQOL. Therefore, it is important for health care providers to be educated about HRQOL and be given tools and strategies for gathering these data.

A recent movement in health care, commonly referred to as person-centred care, emphasizes the importance of providers considering health-related quality of life (HRQOL). (4) A shift in thinking exclusively about illness to a focus on wellness with emphasis on patient goals and preferences is critical to achieving the kind of HRQOL promoted by WHO and Healthy People 2020. Walji et al. describe person-centred care as "care given with the patient and his or her family, rather than care given to the patient." (4) Research has shown that person-centred care contributes to greater concordance between provider and patient when it comes to treatment plans, better health outcomes, and increased patient satisfaction. (5) It is within this context that oral health-related quality of life (OHRQoL) emerged.

Like the HRQOL, OHRQoL assesses the more subjective impact of oral health status on an individual's quality of life. OHRQoL has been defined as a "multidimensional construct that reflects (among other things) people's comfort when eating, sleeping, and engaging in social interaction; their self-esteem; and their satisfaction with respect to their oral health." (6) Brondani and MacEntee conducted a critical analysis of the past 30 years of literature on OHRQoL and concluded that, even though the concept had evolved over time, dentistry continues to operate predominately within a traditional biomedical, paternalistic, disease-oriented environment. (7) Within this mindset, there is an assumption that what is "normal" for the client is determined by the oral health care provider with little regard for client input. Dental hygienists have a real opportunity to distinguish themselves when it comes to the delivery of person-centred care, by placing people and families at the centre of decisions and working alongside them to achieve the best outcome.

Theoretical models for dental hygiene-the Human Needs Model (HN) and the Oral Health-Related Quality of Life Model (OHRQL)-developed in the 1990s are designed to provide a framework for developing dental hygiene diagnoses based on the biopsychosocial measures recognized as critical to outcomes in today's person-centred care environment. (8,9) The HN and OHRQL models guide dental hygienists beyond the collection and analysis of traditional biological data to also include the collection and analysis of psychosocial variables that ultimately affect client outcomes. A textbook was published in 1995 by the 2 dental hygiene researchers who developed the HN theory. (10) The text is currently being updated to a fifth edition. It has been reported that approximately 80 to 100 dental hygiene education programs in the United States and Canada have adopted this textbook. (11) The OHRQL model was one of several models of OHRQoL studied by Brondani and MacEntee. In their findings they acknowledge the OHRQL model as one of a few OHRQoL models to illustrate a new understanding of oral health as being about more than just illness. (7) Yet, a recent study exploring how the OHRQL is being applied in education, research, and practice found that the collection and use of this data has been minimal in all 3 settings. (12) While dental hygiene has the foundation upon which to build this person-centred health care movement, it is going to take greater effort to bring the education and practice communities onboard.

The literature on OHRQoL as it applies to adult populations spans several decades. However, the literature on ORHQoL in children has only recently begun to emerge. A variety of instruments for capturing these measures in children have been developed in recent years. (13-17) The Pediatric Oral Quality of Life (POQL) instrument was developed by a team of researchers from Boston University, with an emphasis on capturing experiences and views of both children and their parents or guardians. (18) Validity and reliability have been reported. (18) While parents and guardians can serve as proxies, research shows discrepancies between a proxy and child's scores, making the parent or guardian reports complementary to, not substitutes for, child reports. (19)

The current project is part of a larger study funded by the US Department of Health and Human Services National Institutes of Health-National Institute of Dental and Craniofacial Research (NIDCR) where the collection of OHRQoL from the participating children, parents, and guardians took place using the POQL instrument. Funding by NIDCR was contingent upon the collection of OHRQoL measures, as one of many measures to be included in the larger study. It is clear from this stipulation in the grant that the NIDCR recognizes the need for dentistry to become more person-centred, and one strategy for achieving this is the addition of quality of life measures that can quantify the psychosocial aspects of the individual. We are unaware of any studies to date that have examined the experience of the practitioner in the collection of pediatric oral health-related quality of life data. If dental hygienists are to take a leading role in the person-centred health care environment, it will be important to explore the experience of the practitioner and provide recommendations for how to collect OHRQoL data.

The purpose of this project was twofold: first, to elevate the importance of OHRQoL in the minds of oral health care providers involved in this project; and second, to evaluate the experience of oral health care practitioners in administering the Pediatric Oral Quality of Life (POQL) instrument and propose strategies for implementation based on lessons learned.

METHODS AND MATERIALS

This study was approved by the University of Missouri-Kansas City Institutional Review Board (#17-040).

Questionnaire

A 17-item questionnaire was developed by the authors to capture descriptive data and solicit feedback from participating oral health care workers about the process and procedures used for implementing the POQL instrument in practice. The questionnaire was delivered in an online format using SurveyMonkey [R]. It employed a combination of forced choice and open-ended responses.

Process and procedure

A mobile school-based dental program, a fixed school-located dental program, and a fixed safety-net dental clinic participated in this study. The 3 participating programs are all unique in the manner in which they deliver oral health care services to children. One program employs dental hygienists to participate in school-based oral health programs where mobile equipment is used for the delivery of care. Another program employs a more traditional mix of dental workforce personnel who deliver oral health care services in fixed school-located dental clinics. The third program conducts screenings in schools but the actual delivery of care is provided in 2 safety-net dental clinics in the community.

All 3 clinics agreed to integrate the POQL instrument (parent report and child self-report) into their standard process of care. An orientation to the study was provided at a full-day onsite workshop at the University of Missouri-Kansas City School of Dentistry. Directors and dental hygienists selected by each program attended the workshop. These attendees were responsible for taking the information learned at the workshop back to their respective programs. At the orientation, HRQL, OHRQoL, and the POQL instrument were introduced. Participants practised using the POQL instrument through role-play exercises followed by a group discussion to answer any questions that emerged about the administration of the POQL. The POQL instrument consists of a parent report (for children ages 5 to 14) and a child self-report (for those ages 8 to 14). Parents and guardians completed the POQL Parent Report instrument (Appendix 1) for children participating in the study. Oral health care providers administered the POQL Child Self-Report instrument to participating children ages 8 to 14 (Appendix 2). At the conclusion of the workshop, all participants completed an evaluation. Two of the questions were designed to measure their understanding of HRQL and OHRQoL and if they felt competent to administer the POQL chairside.

In spring 2017, directors of the 3 dental programs were contacted via e-mail to request assistance in distributing the 17-item questionnaire to individuals who had administered the POQL instrument as part of the project. The directors forwarded the e-mail and link to the questionnaire to 19 oral health care workers. The questionnaire was open for 2 weeks.

RESULTS

Nine participants attended the 2016 workshop and completed the post-workshop evaluation. All 9 participants either agreed or strongly agreed that they had a good understanding of the HRQL and OHRQoL and that they felt competent to administer the POQL chairside.

Of the 19 study participants identified by their respective programs as responsible for the administration of the POQL instrument, 12 completed the 17-item questionnaire resulting in a 63% response rate. The majority of the participants were dental hygienists (50%) followed by dental assistants (25%). Eighty-three percent (83%) reported working full-time, and the majority (64%) reported being employed in their current setting for 2 to 3 years (Table 1).

Table 2 provides verbatim responses from the oral health care workers who filled out the 17-item questionnaire. Across the 3 participating programs, study participants administered 326 child POQL instruments. Analysis of responses to the questionnaire showed that process and procedure were different in some aspects depending on the practice setting. For this reason, the responses in Table 2 have been categorized into 3 types of dental programs: mobile school-based dental program, a fixed school-located dental program, and a fixed safety-net dental clinic. An example of these differences is seen by how the POQL instrument was introduced to parents and guardians. In the mobile school-based program, one strategy was to send a letter home in the children's backpacks to introduce the concept to parents. Another strategy employed by the mobile school-based program was to have parents and guardians fill out the consent form for the child POQL and completion of the parent POQL during parent-teacher conferences, thereby minimizing the chance of information being lost in a backpack and not returned to the school. Those practising in fixed dental clinics (fixed school-located and fixed safety-net) introduced the POQL as part of the standard paperwork when the parent or guardian presented to the office with their child. In all instances a rationale was provided for administering the POQL, ranging from "we are participating in a study with UMKC" to "this survey is being used to help us see if our services at the clinic are helping clients with better oral health." Gaining acceptance from parents and guardians did not pose a problem regardless of practice setting. Overall, the practitioners found parents and guardians receptive and willing to participate and have their children participate.

When asked to comment on the reactions encountered from parents, guardians, and children when responding to the POQL questions, practice setting was not a factor. Parents and guardians willingly filled out their POQL with few to no questions. The practitioners experienced varying reactions from children. Some stated that the children were positive and, in many instances, seemed to "like being able to answer questions" and enjoyed the interaction. Some practitioners reported that the child was unsure about the POQL as illustrated by the following: "They did not always understand why we were asking about their feelings about how they felt" or "Some of the children seemed confused by why we asked such silly questions at times." When asked about challenges encountered when incorporating the POQL into their process of care, 2 of the 12 (17%) practitioners noted the need to restate or reword some of the questions in order to help the children understand what they were being asked. It was not surprising to find that time was a factor, along with trying to find a good fit in the workflow or routine to administer the instrument. Most of the practitioners reported administering the instrument either at the beginning of the appointment before any treatment was rendered, or when waiting for the dental exam. When asked specifically about the time involved to administer the POQL, the average time was 6 minutes, and ranged from 2 minutes to 15 minutes.

Participating practitioners were asked if they learned anything from the data collected. The majority (75%) provided responses that ranged from "have not seen the results yet" or "I didn't look at the data that much ..." to "yes that ... some kids are greatly impacted by their teeth" to "the answers were sometimes interesting, like a middle school student who was missing #9 ... reported she didn't mind ... but she felt embarrassed and sad because the boys at school made fun of her."

DISCUSSION

The first purpose of this project was to elevate the importance of OHRQoL in the minds of the oral health care providers involved in this project. Participants were initially introduced to HRQL and OHRQoL during the orientation workshop held for the study. The literature on HRQL and OHRQoL was examined along with the impact of social determinants. Researchers estimate that over half of an individual's or community's health is attributable to social determinants. (20) Examples include income, gender, where a person lives, access to health care, and insurance. Responses on the post-workshop evaluation conducted in summer 2016 and prior to the launch of the project showed that 100% of the attendees agreed or strongly agreed that they had a good understanding of OHRQoL and felt competent to administer the POQL chairside. Qualitative comments in Table 2 regarding whether they learned anything from data collected from the administration of the POQL instrument provide further evidence that some of the project participants saw how OHRQoL data contributed to a fuller picture of the client and family, thereby supporting person-centred care. Practitioners reported learning things about the client that they would never have known had they not collected POQL data, such as instances of students being embarrassed about their oral conditions, and a sense that children enjoyed being asked how they felt about their health and oral health. As to whether the POQL data resulted in any changes in the way care was provided, the results in Table 2 show that, in general, the addition of POQL data had little impact on the provision of care. This finding illustrates the need for further education on how this data can be used in the provision of person-centred care. Collectively, the outcomes of this study provide evidence that the importance of OHRQoL was elevated in the minds of oral health care providers involved in the project.

The second purpose of this project was to evaluate the experience of oral health care practitioners administering the POQL instrument and to propose strategies for implementation based on lessons learned. Process and procedure for the implementation of the POQL instrument were dependent upon the context in which each practice operated. For example, one of the programs incorporated the POQL instrument into its electronic health record, while other programs used a paper-based approach to gather this information. Practitioners in this study found the addition of the POQL instrument to their daily routine to take a minimal amount of time-approximately 6 minutes. While time was identified as a barrier, it actually took little time to make the POQL part of the workflow. In addition to time, a concern over resistance by children, parents, and guardians was raised at the summer 2016 workshop. Table 2 shows that children, parents, and guardians were receptive to the administration of the POQL.

Limitations to this project include both the number and settings of participating programs. The 3 programs represented non-traditional settings: mobile school-based, fixed school-based, and fixed safety-net. While findings from the present study are not generalizable to all dental programs, they nevertheless enable us to understand how the POQL instrument can be utilized in a clinic setting and suggest areas for further empirical exploration.

CONCLUSION

Based on the findings from this project, several recommendations regarding process and procedure for implementing the POQL instrument in practice are offered. They are as follows:

* Practitioners need to be educated about person-centred care and the impact of social determinants on health, in order to understand why they are collecting the data as oral health care providers.

* Practitioners need education on HRQL and OHRQoL. If this has not been introduced during their professional education, then it is even more imperative that time be devoted to educating them. This could easily be accomplished through continuing education programs.

* Practitioners can learn how to administer the POQL instrument through role playing or other strategies, allowing them to become comfortable with asking these questions of children and addressing any questions that parents or guardians may have.

* The POQL instrument should become a standard part of data collection (both child and parent or guardian) and therefore not require parental or guardian consent beyond normal consent for receiving oral health services.

* The POQL instrument (both child and parent or guardian) should be collected early in the appointment so that this information can be used in the assessment process and subsequent treatment planning.

Finally, further research is needed regarding the implementation of OHRQoL measures in the practice of dentistry and dental hygiene. Practitioner insights into how this information informs the process of care and assists in the delivery of person-centred care are needed. Additionally, research exploring the outcomes of care in environments where OHRQoL measures are factored into treatment planning and decisions is essential.

WHY THIS ARTICLE IS IMPORTANT TO DENTAL HYGIENISTS

* The dental hygiene profession has been slow to incorporate oral health-related quality of life measures into clinical practice, despite a growing movement towards person-centred care.

* This article explores oral health practitioners' experience in administering a quality of life instrument to pediatric clients in 3 different clinical settings.

* Collecting quality of life data requires little time yet provides key information to guide treatment planning and care for pediatric clients.

ACKNOWLEDGEMENTS

Drs Gadbury-Amyot, Simmer-Beck, and Scott held grants from the National Institutes of Health-National Institute of Dental and Craniofacial Research, NIH/NIDCR UH2DE025510, during the conduct of the study.

CONFLICT OF INTEREST

The authors have declared no conflicts of interest.

Caption: APPENDIX 1. MODIFIED PEDIATRIC ORAL QUALITY OF LIFE (POQL) PARENT REPORT (AGES 5 TO 14)

Caption: APPENDIX 2. MODIFIED PEDIATRIC ORAL QUALITY OF LIFE (POQL) CHILD SELF-REPORT (AGES 8 TO 14)

REFERENCES

(1.) World Health Organization. Constitution of the World Health Organization. Amendments adopted by the fifty-first World Health Assembly, 15 September 2005. New York: WHO; 2006.

(2.) The WHOQOL Group. The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med. 1995;41(10):1403-409.

(3.) Office of Disease Prevention and Health Promotion. Health-Related Quality of Life ft Well-Being [Internet], Healthy People 2020 [cited 2017 Aug 17], Available from: https://www.healthypeople.gov/2020/topics-objectives/topic/health-relatedquality-of-life-well-being

(4.) Walji MR, Karimbux NY, Spielman Al. Person-centered care: Opportunities and challenges for academic dental institutions and programs. J DentEduc. 2017;81(11):1265-272.

(5.) Flocke SA, Miller WL, Crabtree BF. Relationships between physician practice style, patient satisfaction, and attributes of primary car c. J Fam Pract. 2002;51(10):83 5-40.

(6.) US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.

(7.) Brondani MA, MacEntee Ml. Thirty years of portraying oral health through models: What have we accomplished in oral health-related quality of life research? Qual Life Res. 2014; 23:1087-1096.

(8.) Williams KB, Gadbury-Amyot CC, Bray KK, Manne D, Collins P. Oral health-related quality of life: A model for dental hygiene. J Dent Hyg. 1998;72(2):19-26.

(9.) Darby ML, Walsh MM. A proposed human needs conceptual model for dental hygiene: Part I. J Dent Hyg. 1993;67(6):326-34.

(10.) Darby M, Walsh M. Dental Hygiene Theory and Practice, 1st ed. Philadelphia: WB Saunders; 1995.

(11.) MacDonald L, Bowen DM. Theory analysis of the Dental Hygiene Human Needs Conceptual Model. Int J Dent Hyg. 2017;15(4):e163--3172. DOI:10.1111/idh.12256.

(12.) Gadbury-Amyot CC, Austin KS, Simmer-Beck M. A review of the oral health-related quality of life (OHRQL) model for dental hygiene: eighteen years later. IntJ Dent Hyg. 2018;16(2): 267-78. DOI:10.1111/idh.12277.

(13.) Cunnion DT, Spiro A, Jones JA, Rich SE, Papageorgiou CP, Tate A, et al. Pediatric oral health-related quality of life improvement after treatment of early childhood caries: A prospective multisite study. J Dent Child. 2010;77(1):4-11.

(14.) Li L, Wang H, Han X. Oral health-related quality of life in pediatric patients under general anesthesia: A prospective study. Medicine (Baltimore). 2017;96(2):e5596.

(15.) Jokovic A, Locker D, Stephens M, Kenny D, Tompson B, Guyatt G. Validity and reliability of a questionnaire for measuring child oral-health-related quality of life. J Dent Res.2002;81(7):459-63.

(16.) Broder HL, Wilson-Genderson M. Reliability and convergent and discriminant validity of the Child Oral Health Impact Profile (COHIP Child's version). Community Dent Oral Epidemiol. 2007;35 Suppl 1:20-31.

(17.) Pahel BT, Rozier RG, Slade GD. Parental perceptions of children's oral health: The Early Childhood Oral Health Impact Scale (ECOHIS). Health Qual Life Out. 2007;5:6.

(18.) Huntington NL, Spetter D, Jones JA, Rich SE, Garcia Rl, Spiro A 3rd. Development and validation of a measure of pediatric oral health-related quality of life: the POQL. J Public Health Dent. 2011;71(3):185-93.

(19.) Levi RB, Drotar D. Health-related quality of life in childhood cancer: Discrepancy in parent-child reports. Int J Cancer Suppl. 1999;12:58-64.

(20.) Commission on Social Determinants of Health. Closing the gap in a generation: Health equity through action on the social determinants of health. Final Report of the CSDH. Geneva: World Health Organization; 2008.

Cynthia C Gadbury-Amyot *, MS, EdD; Melanie L Simmer-Beck *, MS, PhD; JoAnna M Scott *, PhD

* University of Missouri-Kansas City School of Dentistry, Kansas City, Missouri, USA

Correspondence: Cynthia C Gadbury-Amyot; amyotc@umkc.edu

Manuscript received 21 November 2017; revised 23 February 2018; accepted 10 April 2018
Table 1. Questionnaire responses from oral health care workers

                                                 Response
Question                                         n (%) (a)

Which of the following describes your primary
role in your practice setting?

Dental hygienist                                 6 (50%)
Dental assistant                                 3 (25%)
Office administrator                             2 (17%)
Dentist                                          1 (8%)
Other (if other please explain)                  0

Which of the following best describes your employment?

Full time                                        10 (83%)
Part time                                        2 (17%)
Other (if other please explain)                  0

Please indicate at which dental program you
provide oral health care services

Mobile school-based                              4 (33%)
Fixed school-located                             7 (58%)
Fixed safety-net                                 1 (8%)

How long have you worked in the dental
program that you indicated above?

0-1 years                                        3 (27%)
2-3 years                                        7 (64%)
[greater than or equal to] 4 years               1 (9%)

Which describes how you implemented the POQL?

Paper form                                       11 (92%)
Software (entered in computer)                   1 (8%)
Other (please explain)                           0
                                                 Mean (sd)

How many minutes did it take on average to       6.30 (4.0)
administer the POQL survey to the children?      minutes

(a) Percentages may not add up to 100% due to rounding

Table 2. Analysis of oral health care worker
responses to open-ended questions

                             Summary of
                        comments (verbatim)
                         from participating
                          dental programs

POQL question          Mobile school-based

How did you            * A letter was sent
introduce to your        home in all the
schools and/or           children's backpacks
patients that you        explaining the grant
would be using a         and expectations of
questionnaire (POQL)     school and parents,
to capture               [one school used
information on           teacher conference
children's oral          times to inform
health-related           parents]
quality of life?
                       * To my patients
                         I simply stated that
                         I had some questions
                         to ask them about
                         their oral health.

How long did           * Rural schools took
it take to gain          two days. Urban
acceptance from          schools took 3 to
your schools and/or      4 weeks.
patients to the
addition of POQL in    * NA
your data collection
process and actual     * Patients were fine
implementation?          with the process.

At what point in       * The children were
the appointment          interviewed prior
does the POQL get        to their preventive
implemented?             appts.

                       * Immediately

                       * At the beginning of
                         the appointment,
                         before any
                         treatment.

                       * In the beginning
                         of the appointment.

Please explain the     * The parents who
reactions you            were talked to in
encountered from         [site] were stopped
parents when asked       at teacher
to fill out the          conferences. I did
POQL survey.             not see them
                         personally. The
                         rest of the parents
                         received the
                         interview in the
                         back pack and asked
                         to return it the
                         same way. Before we
                         could any of this
                         the school and
                         school board needed
                         to approve this line
                         of communications.

                       * N/A

                       * I did not deal with
                         parents at all.

Please explain the     * Children needed
reactions you            encouraged to think
encountered from         of the question and
the children when        answer.
administering the        They are already
POQL.                    anxious about our
                         noise and smells
                         let alone being
                         asked these
                         questions.
                         Sometimes we had to
                         reask the question
                         in a different way.

                       * Positive

                       * Some thought it was
                         weird but they all
                         answered the
                         questions for me.

                       * Children were
                         positive. I did not
                         have any negative
                         reactions from any
                         children. I think
                         they kind of liked
                         being able to answer
                         questions. I thought
                         they enjoyed the
                         interaction.

What are the           * Time and one more
challenges you           piece of paper.
encountered with
implementing the       * NA
POQL survey into
your process of        * Some of the kids
care?                    didn't really
                         understand the
                         questions.

                       * Just remembering
                         to ask the
                         questions, make
                         it part of the
                         routine.

Did you learn          * It was interesting
anything from the        to get the child's
data collected on        point of view of
the POQL survey?         their own health.
Please explain
                       * NA

                       * Kids are more
                         accepting of their
                         physical appearance
                         when they are
                         younger. The older
                         the kids were, the
                         more likely that
                         the appearance of
                         their teeth/smiles
                         bothered them a
                         little.

                       * The answers
                         were sometimes
                         interesting, like
                         a middle school
                         student who was
                         missing #9. She
                         reported that she
                         didn't mind how she
                         looked, but she felt
                         embarrassed and sad
                         because the boys at
                         school made fun of
                         her.

Did collecting POQL    * No
data from your
patients change        * NA
anything in the way
you provide care?      * No

                       * Reminded me to
                         be sympathetic to
                         children's feelings
                         about their personal
                         image and their
                         space.

Is there anything      * No
else you would like
us to know about       * I found it to be
collection of oral       quite enjoyable,
health-related           it let me take some
quality of life          extra time with the
data using the           children, and to
POQL?                    get to know them
                         personally.

                           Summary of comments (verbatim)
                         from participating dental programs

POQL question          Fixed school-located    Fixed safety-net

How did you            * Asked pt to           * Did not respond
introduce to your        please fill out a
schools and/or           questionnaire for
patients that you        (dental clinic) to
would be using a         better understand
questionnaire (POQL)     our pts
to capture
information on         * We stated that we
children's oral          were conducting an
health-related           anonymous survey
quality of life?         to see how dental
                         care can impact
                         lives

                       * Would you mind
                         answering a few
                         questions for a
                         school based
                         survey we are
                         doing?

                       * We let them know
                         that we were
                         participating in a
                         study from UMKC and
                         asked if they would
                         be willing to

                       * Survey been used
                         to help see if our
                         serves at this
                         clinic is helping
                         clients with better
                         oral health.

How long did           * Not sure              * It was easily
it take to gain                                  added to the
acceptance from        * We were able to         clinic policies
your schools and/or      implement it right
patients to the          away.
addition of POQL in
your data collection   * Not very long from
process and actual       my perspective.
implementation?          But, I know it was
                         more challenging
                         for the front desk
                         to get the parents
                         survey sent home
                         and returned.

                       * Acceptance was very
                         fast with the
                         parents that came
                         into our office.
                         It took a few days
                         and sometimes a
                         follow up call for
                         the questionnaires
                         we sent home with
                         the school kids.

                       * Everyone was very
                         willing to do
                         survey.

                       * The school and
                         students are very
                         accepting of our
                         program

At what point in       * Either at the         * Initially for
the appointment          beginning or end        parents. After
does the POQL get        when waiting for        xrays with
implemented?             an exam                 hygienist.

                       * At the end of the
                         appointment while
                         waiting for an
                         exam by the
                         dentist

                       * Usually at the end
                         of the appointment
                         while waiting for
                         an exam.

                       * The first
                         appointment that
                         the patient came
                         to when they got
                         the surveys. For
                         most it was their
                         comps. But if the
                         pt. was here for
                         tx we would give
                         it to them as well.

                       * Beginning if have
                         time or at end of
                         appointment

                       * At the very
                         beginning of the
                         appointment or
                         at the end

Please explain the     * They didn't mind      * They were pretty
reactions you            at all                  neutral about
encountered from                                 completing the
parents when asked     * No reactions, very      document.
to fill out the          receptive. Have a
POQL survey.             lot of paperwork
                         that the parents
                         are used to having
                         to complete

                       * From my stand point
                         the patients that
                         I encountered
                         seemed to be
                         receptive.

                       * They were very
                         willing to fill
                         them out.

                       * Everyone was happy
                         to do anything, to
                         keep program to
                         continue

                       * Many of the parents
                         did not have a
                         problem filling out
                         the survey; never
                         came across any
                         problems

Please explain the     * They didn't           * I don't think
reactions you            mind at all             some kids really
encountered from                                 understood
the children when      * Some of the             the questions
administering the        children seem           or were afraid
POQL.                    confused by why         of what an
                         we asked such           "honest" answer
                         silly questions         may result in.
                         at times

                       * No reactions, very
                         receptive. Have a
                         lot of paperwork
                         that the parents
                         are used to having
                         to complete

                       * That they were
                         willing to help us
                         so that we may
                         continue to serve
                         the school based
                         kids here and
                         their families.

                       * I only did the
                         parent portion.

                       * They did not always
                         understand why we
                         asking about their
                         feelings about
                         they felt

                       * Many of the
                         students did not
                         have a problem
                         filing out the
                         survey; never came
                         across any problems

What are the           * None                  * Time was the
challenges you                                   only challenge I
encountered with       * Trying to implement     believe
implementing the         it into my
POQL survey into         workflow. If I had
your process of          time while waiting
care?                    for an exam, this
                         worked well

                       * Some of the wording
                         of the children
                         survey. I had to
                         reword things like
                         'Have you ever
                         cried because of
                         your teeth. Some
                         of the kids looked
                         at you like you
                         were crazy.

                       * Taking the time to
                         explain, when we
                         had people waiting
                         to check in/out.

                       * No problems using
                         was time during
                         visit get it
                         fill out

Did you learn          * Yes that parents      * Have not seen
anything from the        don't always know       the results yet
data collected on        when child is in
the POQL survey?         pain or how long
Please explain           they have been

                       * Yes, that children
                         are more open when
                         you ask open ended
                         questions

                       * Yes that they
                         are some kids are
                         greatly impacted
                         by their teeth.
                         That it takes a
                         family as a whole
                         to help educate
                         and encourage and
                         teach Oral Hygiene.

                       * I didn't look at
                         the data that much,
                         but it seems that
                         the parents were
                         not as concerned
                         as I thought they
                         would be when their
                         child was in pain.

Did collecting POQL    * No                    * Not yet
data from your
patients change        * No, comprehensive
anything in the way      care for every
you provide care?        patient, every
                         time

                       * I like to think we
                         do a great job as
                         is in providing
                         the best care
                         possible.

                       * No, not really.
                         We are kind to all
                         of our patients.

                       * Some patient need
                         more oral health
                         education.

Is there anything      * No                    * Did not respond
else you would like
us to know about       * No
collection of oral
health-related         * No
quality of life
data using the
POQL?
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Article Details
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Title Annotation:ORIGINAL RESEARCH
Author:Gadbury-Amyot, Cynthia C.; Simmer-Beck, Melanie L.; Scott, JoAnna M.
Publication:Canadian Journal of Dental Hygiene
Article Type:Report
Date:Jun 1, 2018
Words:6275
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