CANCELLED - Assessing the Feasibility and Acceptability of Traditional Storytelling As a Tool for Oral Health Education Among American Indian/ Alaska Native Communities

BACKGROUND: Study objectives. American Indian (AI) populations suffer disproportionate rates of early childhood caries. This NIH- funded project aims to develop and test a culturally competent oral health educational intervention among AI population of California. Study objectives include development of the story, determination of feasibility and acceptability of study implementation, with a secondary objective of testing intervention effectiveness. Description of program/project. The project was guided by principles of Community Based Participatory Research (CBPR). Technical expertise was provided by academic oral health experts. Study participants were AI mothers of children aged 6 or below, and pregnant females.

METHODS:   A story embedded with oral health messages was developed by a group of AI storytellers, mothers, and oral health experts. Implementation was by oral narration to three groups of 6-8 AI mothers, recruited through community outreach at each of three CA tribal communities. The storyteller was trained to ensure consistency across the nine storytelling sessions. Surveys were administered before, immediately after, and six months after the implementation of storytelling and a focus group was conducted. Qualitative analysis of focus group and interview data was conducted by tallying up consistent themes in response to specific questions.

RESULTS:   53 women were enrolled. 81.1% reported annual household income below $40,000 and 32.1% reported being employed. 90.6% had dental insurance for themselves, and 84.9%, for their child. 53% of respondents reported their oral health as ‘fair’ or ‘poor’, and 67% had good health literacy level. 71% visited a dental clinic within the past year. The average percent of correct answers on oral health knowledge surveys before, immediately after and 6 months after the intervention were 83%, 94.9% and 91.7% respectively, indicating increase in knowledge following the intervention as well as maintenance of the knowledge 6 months later. Participants indicated overall acceptability of the intervention, with “new information”, “native concepts”, “ease of understanding” particularly appreciated. The storytelling format was found to be culturally relevant, with respondents indicating eagerness to share story with others. Suggestions for improvement included story length and alternate modes of dissemination. Staff narratives indicated study implementation to be feasible.

CONCLUSIONS:   This novel intervention was found to be acceptable to the participants from the three AI communities. Participant recruitment was successful and feasible.  Characteristics of target population, when combined with qualitative feedback about the story, will allow for the development of an improved product that could be disseminated among AI communities on a wider geographic scale.