Qualitative evaluation of the oral health characteristics of disadvantaged, hispanic parents/caregivers

Background: Early childhood caries, the most common childhood chronic disease, disproportionately affects disadvantaged, Hispanic children. Parent/caregiver oral health knowledge, attitudes and behaviors (OHB) influence caries risk. Objective: Identify attitudes and norms relevant to caries experience and parent/caregiver OHB (e.g., mouth-to-mouth sharing, bed-time bottle, tooth brushing). Design/Methods: Seven (6 in Spanish) qualitative, semi-structured focus groups (FG) conducted with parents/caregivers of children age 3-12 in 2012. Caregivers were recruited by phone from a randomly selected primary care cohort in a large urban safety-net health care system. Topics focused on determinants of OHB (caries knowledge and experiences, attitudes toward caries and preventive OHB, normative influences, strategies for countering pressures toward negative OHB, barriers to/perceived control). FGs were audiotaped, transcribed and thematically categorized. Results: Forty-two primarily Hispanic, poor mothers participated (39% attendance rate). Most possessed knowledge necessary for preventive OHB but reported barriers to implementation. Issues such as inconvenience and child discomfort were frequently associated with lack of preventive OHB. Normative influences included participants' mothers and other female relatives and friends, medical/dental professionals and media. Normative groups had a mixed influence on caregivers' OHB, with family members often discouraging preventive OHB. Having an older child with caries experience motivated caregivers to adopt preventive OHB. Strategies to improve OHB included developing routines, making OHB fun and including normative groups. Conclusions: Caregivers were knowledgeable regarding caries etiology, viewed caries as negative, and were interested in engaging in preventive OHB even if normative groups discouraged these behaviors. Interventions must target caregivers as well as influential groups.