Impact of a community health advisor-based intervention on self-reported frequency of dental visits in a rural, low-income African American Alabama community

Background: Oral health disparities are wide and increasing for rural Southern African-Americans. For the Uniontown Smiles! project, we trained 13 experienced Community Health Advisors (CHAs) from Uniontown in the basics of oral health, including tooth-and-jaw anatomy, dental problems and remedies, proper diet, brushing and flossing, and regular dental visits and assigned them to spread this information among their fellow community members. Methods: We tested whether a 1-year CHA-based oral health education intervention in Uniontown, Alabama was associated with increased routine/preventive use of available dental services as measured by self-report in a pre-post telephone survey, relative to a comparison community. We also hypothesized that any detected association between the intervention and use of dental services was mediated by survey items measuring attitudes toward dental visits. Results: No direct association was found between the intervention and use of dental services, cancelling the possibility for mediation; however, a post hoc analysis revealed an indirect association between intervention and use, via attitudes toward the cost of a dental visit. Conclusions: A CHA-based intervention successfully influenced community attitudes toward dental visits, and these attitudes were in turn positively associated with use of dental services. Results suggest that indirect pathways of association may be useful in detection of intervention effect, in the absence of direct pathways. While the data did not indicate a direct effect of the intervention on the use-of-services outcome, it appears the intervention may have indirectly affected this outcome via attitudes. More rigorous outcome-based evaluations of CHA-based interventions generally are needed.