Brighter Smiles: Service Learning, Inter-Professional Collaboration and Health Promotion in a First Nations Community

By Harrison, Rosamund L.; MacNab, Andrew J. et al. | Canadian Journal of Public Health, May/June 2006 | Go to article overview

Brighter Smiles: Service Learning, Inter-Professional Collaboration and Health Promotion in a First Nations Community


Harrison, Rosamund L., MacNab, Andrew J., Duffy, Damian J., Benton, David H. J., Canadian Journal of Public Health


ABSTRACT

Objective: The goal of Brighter Smiles was to improve children's dental health in a remote First Nations community in British Columbia in the context of a service-learning experience for pediatrics residents.

Setting and Participants: The provincial Ministry of Health had competitive funds available for collaborations between remote communities and medical educators. Hartley Bay (Gitga'at), a tribe of the Tsimshian Nation, responded by declaring children's dental health to be a primary health concern. This northern community has an on-reserve population fluctuating around 200 people and is accessible only by air or water.

Intervention: A convenience sample of children had a baseline dental exam; parents also completed a questionnaire about dental health behaviours. Only 31% (4/13) of pre-kindergarten and 8% (2/26) of kindergarten to Grade 12 children had no dental caries. Planning of the Brighter Smiles intervention involved community leaders, teachers, parents, Elders, health care staff, pediatrics residents, and dental and medical faculty from the University of British Columbia (UBC). Brighter Smiles includes school-based brush-ins, fluoride programs, classroom presentations, and regular visits by UBC pediatrics residents to Hartley Bay to provide well-child care that includes age-appropriate dental counselling to parents at the clinic visits.

Outcomes: An early success indicator was a significantly increased proportion of dental service provider's time scheduled for preventive maintenance services rather than dental rehabilitation (restorations and extractions).

Conclusions: The goal of providing a service-learning experience for trainee pediatricians in a remote community has been achieved. In addition, early indicators demonstrate improvements in child oral health.

MeSH terms: Rural health services; education, medical, graduate; health promotion; oral health; ethnic groups

First Nations groups in Canada have made significant progress on many important issues, including self-government and land claims, but the health of their people continues to lag behind that of other Canadians. Nowhere is this imbalance more evident than in the area of dental health. Although steady reduction in the prevalence of dental decay in older children has been reported,1 the extent and severity of dental caries in young Aboriginal children remains alarming.2-6 In addition, malocclusion is a widespread and consistent oral finding in First Nations youth.7 Costly treatment programs alone will never be able to take care of the existing oral health problems. However, culturally-appropriate, community-based oral health promotion initiatives may lead to measurable improvements in oral health.8,9 Indeed, First Nations themselves have requested improved access to preventive dental services.10

Rural settings, including First Nations communities, continue to be underserved by physicians and medical specialists. Developing greater empathy for the needs of an underserved population is more likely to occur if medical trainees have experience working with "special populations" during their training programs.11 In 2001, the B.C. Ministry of Health, in collaboration with the University of British Columbia (UBC) Faculty of Medicine, launched the Special Populations Initiative, a program to support teaching and research initiatives that address the care of populations whose health status and/or access to services is at greater risk or measurably lower than that of the general population. As a direct result of this funding opportunity and in response to a need expressed by the community of Hartley Bay, a First Nations village in British Columbia, the Brighter Smiles program was developed.

The global service learning goal of Brighter Smiles was to provide a learning and service experience for UBC pediatric medical residents in a remote First Nations community. The other goal was to design and implement a program to improve the oral health of the community's children. …

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