Final Program Plan:

Little Smiles Children’s Oral Health Awareness Initiative

Submitted by: Aine Gibson

Student number: L30898018
Date: December 16, 2020
Submitted to: Dr. Burch
Course: HLTH 634
 Program Plan
Program Plan to Increase Awareness of Children’s Oral Health
LittleSmiles Non-Profit Organization
The City of Lancaster Public Health Department

Audiences: Primary African American and Hispanic parents aged 20-40 years of age with
low socio-economic status residing in the City of Lancaster

Secondary Grandparents and additional caregivers to school aged children

Community advocates
Local media
Local medical professionals
Local policy decisionmakers

Products:

LittleSmiles in collaboration with the Lancaster Public Health Department has developed promotional
materials to be disseminated for the duration of this initiative. These include the following:

 Comprehensive awareness and engagement campaign

This campaign will use traditional and novel approaches to work collaboratively with the
community to increase awareness of the importance of children’s oral health

 Mass media and social media advertisements

Bus and bus shelter advertisements, billboards in target neighborhoods, radio ads,
Facebook/Instagram ads and local blog posts to be included

 Engagement activities
Radio and television question and answer segments with a Public Health Registered Dental
Hygienist and a Public Health Dental information phone line will be included

 Targeted school print materials

Printed promotional brochures/postcards in various languages targeted to families of school aged
children

Materials Distribution Plan:

Minority communities and inner city neighborhoods with an increased number of low socio-
economic status residents will be targeted for bus and bus shelter advertisements. Radio
promotional efforts will be focused on local popular urban radio stations. Facebook and
Instagram advertisements will be targeting using zip code and demographic metrics. Two local
‘mom blogs’ will be included in the initiative. Print materials such as brochures and postcards
will be sent home with all primary school aged children in the Lancaster Public School Board.

Evaluation:
LittleSmiles and the Lancaster Public Health Department will evaluate the program as follows:
  To be performed by Lancaster Public Health Department in partnership with the Lancaster
Community Health Center and Lancaster College MPH students
 Pre and Post intervention telephone surveys will be completed by the target audience. Post
intervention surveys will be administered at 1 month and 9 months after the intervention.
 Geographic trends in data will be investigated
 Quasi-experimental framework will be used to explore Medicaid dental billing data (stratified
random samples by zip code).
 Discussion of effectiveness of the communication plan and opportunities for improvement of
outcomes in addition to value for money of the intervention will be included.
 Presentation of program evaluation to stakeholders will take place upon completion of the
program evaluation analysis and final reporting.

Executive Overview
The intervention being proposed is an awareness campaign to increase caregiver knowledge and
understanding about the importance of children’s oral health. This campaign will include information and
assistance on achieving and maintaining a child’s good oral health and will increase access to local free
dental services for children. The campaign will be relevant to caregivers of school aged children in
general, however the specifically targeted audience will be African American and Hispanic parents aged
20-40 with low socio-economic status who reside in the City of Lancaster. The target population was
chosen as minority children from low socio-economic households experience disproportionately
worsened oral health outcomes.1

This campaign will be provided jointly by LittleSmiles, a local non-profit organization whose mandate is
to increase awareness of children’s dental issues, and the City of Lancaster Public Health Department in
partnership with the Lancaster Public School Board, Lancaster College, the Lancaster Community Health
Center and local community advocates.

LittleSmiles and Lancaster Public Health are qualified for this task as they employ public health dentist
and dental hygienists who work with the community and private industry to improve the oral health of
Lancaster children. This staff has public health experience in child and youth development, oral health,
health promotion and adult education techniques. LittleSmiles and Lancaster Public Health staff involved
in this initiative are knowledgeable regarding local no or low cost dental services in the area. These
organizations have strong, well established partnerships in place with local school boards, community
health centers and Lancaster College in addition to key stakeholders which enables the appropriate
design, implementation and evaluation of this campaign in a culturally competent manner.

Need for Intervention

The population at most risk of adverse dental outcomes in children is the minority community. African
American and Hispanic children of school age with low socioeconomic status, residing in the City of
Lancaster will therefore be prioritized for this campaign. Because the at risk group is children, their
caregivers will be the target audience for this campaign.

Currently in the US, 51.6% of children ages 6-9 have had dental caries and 15.5% have untreated dental
decay.1 Oral health is essential for overall health2 and many children in the City of Lancaster have unmet
dental needs. Misinformation about primary teeth and children’s oral health are commonplace in
Lancaster, resulting in adverse health outcomes for its most vulnerable residents, the children. A
widespread challenge to achieving adequate oral care for children is that many recipients of Medicaid are
unaware that dental benefits are included in this program. 2 Perceived and actual lack of access to quality,
affordable pediatric dental care is a significant barrier to improved oral health outcomes for minority and
low socio-economic families.2 Dental pain in children can cause behavioral issues and create challenges
to learning for these kids.3 Additionally, children may not be able to verbalize to a caregiver that they are
in dental pain. Many children in Lancaster do not attend regular dental visits which are so important to
achieving and maintaining good oral health. Minority and low socio-economic families are
disproportionately represented in this group as well. 1

Explanation of Intended Intervention

The following are goals and objectives for the program:

By March 14, 2021, a minimum of 65% of surveyed caregivers of school aged

children in the City of Lancaster will report an increase in awareness of the
importance of their children’s oral health as measured by a telephone survey.

By March 14, 2021, a minimum of 60% of surveyed minority caregivers of

school aged children in Lancaster will report an increase in feelings of self-
efficacy around the ability to help their child achieve good oral health.

By December, 2021, the number of regular children’s dental exams billed in the
City of Lancaster to Medicaid will increase 25%.

By July 1, 2021, the number of school children in Lancaster who are identified as
having an unmet dental need as measured by in-school dental surveillance
programs will decrease by 20%.

The project that contains the intervention is a collaborative engagement and awareness campaign to
improve the oral health of children in the City of Lancaster. Local radio and television media, social
media, bus and billboard advertising in addition to promotional print materials will be employed to
disseminate program messaging.

Short term outcomes of the intervention expected within a year of program initiation are as follows:
 Improve awareness of the importance of regular oral care for Lancaster school-age children
among their caregivers.
 Increased feelings of self-efficacy among caregivers of Lancaster children related to ability to
improve their child’s oral health.
 Improved oral health and overall health of these children.
 Increased utilization of preventive and restorative dental care among Lancaster children.

Long term potential outcomes of the intervention which may be seen after one year include:
 Reduction in number of school aged children who do not regularly attend dental appointments.
 Reduction in number of children in Lancaster with active dental decay
  By caregivers introducing good oral health habits to their children, they will be giving their
children a chance at improved oral health and overall health throughout their lifetime. This effect
may be intergenerational.
 Reduction in the expense of restorative dental treatment and emergency room visits for dental
pain as a result of improved prevention of dental disease.
 Increased self-esteem and confidence in community children as a result of having a healthy
mouth.
 Possible improvement in parental oral care habits as awareness and intent to model good habits
increases.

Market Review-The Customers

Using NCI’s Making Health Communications Programs Work, Stage 1 framework:

1. Behavioral

Misconceptions about children’s oral health are common among the target audience. 2,4 These include
beliefs that primary dentition is unimportant as baby teeth fall out eventually. Many are unaware that
dental insurance is included in Medicaid benefits. 2 Among this population, food and housing security can
be an issue, therefore their child’s dental care may not be a priority. Highly cariogenic diets can be less
expensive and are therefore more common among this group. 4 Children may lack access to dental care
products such as toothbrushes and toothpaste.

2. Cultural

This audience includes many new Americans and English as a second language speakers. 5 Public Health
marketing must therefore be provided in various languages. Resources may be discarded if the audience
cannot read English. Cultural norms regarding oral health and oral hygiene practices may differ. Cultural
food choices and beliefs about children’s sugar intake may create barriers to their children achieving oral
health.

3. Demographic

This audience includes people with less education, low income, single parent families and visible
minorities. Each of these factors is associated with poorer oral health outcomes and less comprehension
about the importance of children’s oral health. 6 Low income and single parent families may not be able to
take time off work which presents an additional barrier to their child attending dental appointments. Shift
work may also be a challenge if childcare is used at bed or waking times when brushing would normally
occur. Low income neighborhoods also have decreased access to dental professionals. 5

4. Physical

The characteristics of the audience are that they are African American and Hispanic females, ages 20-40.
They may have a family history of poor oral health which may normalize poor oral health among this
group. Also included in the audience are low income ethnic minority fathers aged 25-30.

5. Psychographic
Attitudes of the audience include wanting the best for their children. Individual choice in health decisions
is highly valued. Because they have low socioeconomic status, they may be struggling and overwhelmed
due to poverty and lack of resources/support. Low self-efficacy about oral health is more prevalent
among this group.5 Common beliefs include ‘soft teeth run in my family’, ‘I give my child sweets to show
I love them’, ‘I can’t afford dental care’, ‘dental appointments are painful’. 2

Product Review
The service being offered is an awareness campaign to increase caregiver knowledge of the importance of
good oral health for their child and how they can achieve this. Print, media and social media ads will be
included in the campaign. Engagement is a key component of the initiative and will include radio and
television question and answer call-in segments. A Public Health Dental information phone line will also
be accessible for community members wanting more information. Bus and bus shelter ads, billboards in
target neighborhoods, radio ads, radio and television Q&A segments, Facebook/Instagram ads and local
blog posts will all be included. Additionally, print promotional material in various languages will be sent
home with all school children in Lancaster public schools.

This campaign will address caregiver feelings of lack of control of their children’s oral health. It will
increase awareness and education to dispel common misconceptions about ‘soft teeth’ and the assumption
that caries and gingivitis are inevitable. It will offer relevant, culturally competent information and
discussion about how caregivers can properly care for their child’s teeth and gums and where to access
free or low cost services locally.

Because this campaign will be designed and delivered in collaboration with several local community
groups, it will be more culturally competent and relevant to the target audience then other mass public
health initiatives. This program is unique in the strength and breadth of its partnerships, which will
increase the chances of success in achieving campaign goals.

A unique characteristic of this campaign is that it is targeted specifically to our priority population,
caregivers of school-aged children in the Lancaster Minority community. Resources and information
provided will be culturally competent, useful and relevant to this specific demographic. This campaign
also brings a collaborative approach that engages the community and relies on two-way communication, a
community conversation to achieve the campaign goals.

Strategies
Image
The image portrayed will be one of trustworthiness and knowledge, cultural competence, relevance,
helpfulness and acceptance. The unique selling points of this initiative are that the public health and
dental experts will be collaborating extensively with local community members from the target audience.
These advocates will share relevant stories that the audience can connect with culturally and emotionally.
These partnerships will also lend improved insight into benefits and barriers (perceived and actual) of the
target population. This will result in a deeper understanding of the community which will improve the
likelihood of program success.

Features
The campaign will emphasize features and customer services such as specialized dental knowledge for
the target audience that is current, geographically and culturally relevant. That this campaign is being
delivered locally, from within the community will be emphasized. Organization members from within the
priority population will be included in this work. Information and assistance will be provided about how
to achieve and maintain a healthy mouth for school aged children in Lancaster. The team delivering the
campaign will be highly knowledgeable about local programs and services for those who cannot afford or
access dental care.

Local Need
This initiative meets the need of the thousands of Lancaster children who go to school everyday with
dental pain and the thousands more who do not regularly access dental care. Lack of knowledge and
understanding about the importance of children’s oral health and how to go about achieving good oral
health is causing adverse health outcomes for Lancaster children. By increasing awareness of the
importance of oral care for kids and working with caregivers to identify and address barriers to care, this
campaign will improve these outcomes for children.

Price
This will be no cost to recipients and is funded jointly through the City of Lancaster and the Lancaster
Community Foundation.

Value
This campaign will be worth the price to recipients because they will be receiving information and
support at no cost to benefit the health of their child. Additionally, caregivers will have to less missed
work to bring their child to dental treatment appointments, and potentially saving them money if eligible
for publicly funded free dental services.

It is worth the price to the City of Lancaster (funder) because the saying that ‘prevention is less costly
than the cure’ is certainly true in the case of dental health. By improving the dental health of our city’s
children, Medicaid dollars will be saved on emergency room visits for dental pain and on costly
restorative dental procedures. There is also long term value in that this initiative will assist caregivers in
creating good habits for their children that can throughout their lifetime, having the potential to impact
their health for decades and that of future generations.

Selling Points
The selling point of this campaign is that it can help improve children’s oral health. The staff involved
with the campaign understand the unique barriers and challenges that caregivers experience in the
community and can assist in facilitating access to services available to address these issues. The
campaign workers are able to troubleshoot a caregiver’s unique situation to improve the oral health of
their child. All the services provided throughout this campaign are of no cost and it is within a caregiver’s
power to improve their child’s oral health, through the campaign, they will learn how.

Channels
The campaign will be promoted through bus and bus shelter ads and billboards in targeted neighborhoods.
Radio ads will be aired on 2 local radio stations (92.5 CISS FM and 93.5 FLOW FM). These radio
stations have also offered to give provide interview time monthly for call-in question and answers with
the initiative’s public health dental hygienist for the duration of the campaign. The public health dental
hygienist will also make an appearance on the local Lancaster TV station LCTV to kick off the campaign.
Social media marketing will also be included, focusing on Facebook and Instagram ads in addition to blog
posts on LittleSmiles634.weebly.com and by local Lancaster mom-blogger ‘ErikaBlogs’. Print
promotional materials in various languages will be sent home with all children who attend Lancaster
public grade schools.

Budget

Budget Justification
Public Health Staff salaries Lancaster Public Health salaried staff being
used for the initiative, therefore a
percentage of their FTE and cost for their
salary will be allocated for this work.
Health promoter 0.3 FTE $15,000
Dental Hygienist 0.2 FTE $12,000
Supervisor 0.2 FTE $17,000
MPH student No cost Partnership to provide practicum
opportunity through local college
Graphic Designer-contracted for $2,000 Investment in a skilled designer will
this job only improve uptake of the message
Translation services $300 Essential to have ads in various languages
common in the community
Research costs
Focus groups $1,000 Incentive grocery gift cards provided to
increase number of participants in focus
groups
Surveys (includes evaluation $200 Incentive grocery gift card draw to increase
surveys) number of participants
Promo materials testing No cost MPH student to visit local grocery stores
and ask shoppers for feedback on
promotional materials to ensure our
intended message is being communicated
appropriately
Paid advertising
Radio ads $7,000 Large number of target audience listens to
local radio at home, in car or at work
Bus shelter ads $5,000 Target audience low income, many don’t
have access to a car
Bus ads $7,000 Target audience frequent bus users
Billboards $10,000 In select neighborhoods to get the message
to pedestrians, motorists and those using
public transit
Local TV segment No cost LCTV added RDH as interview guest on
‘hot topic of the month’ segment to widen
the reach of messaging
Facebook/Instagram ads $5,000 To run 1 week/month for a year. Most in
target audience have cell phones and check
FB/Instagram daily
ErikaBlogs $100 Budget to purchase dental gift basket for
blogger to draw a winner for on her blog.
Incentive for user engagement.
 Print ads for schools (brochures
to send home with kids, posters,
postcards etc) in various
languages
TOTAL ANNUAL COST
$20,000 All public school children will be sent
home with a brochure or postcard to give
to their parent to give the best chance of
reaching all households. Also allows for
materials in other languages to be
disseminated appropriately.
$101, 600

Evaluation

The Health Belief Model informed not only the communication plan but also the program’s evaluation.
The evaluation will include pre and post intervention surveys, collection of Medicaid dental billing codes,
data and trend analysis and a final evaluation report for decision-makers and stakeholders. Achievement
of all above outlined objectives will be evaluated. The evaluation will be performed by the City of
Lancaster Public Health Department in collaboration with Lancaster College and the Lancaster
Community Health Center. The Community Health Center will identify families who wish to participate,
MPH students from Lancaster College will be providing assistance in the administration of surveys and
data collection and analysis. Pre-intervention telephone surveys will be completed by the target audience
to obtain baseline data which will be compared to post-intervention responses. Post-intervention surveys
will be completed at 1 month and 9 months after the intervention. A control respondent group will be
included. Geographic trends will also be explored to assist with future program planning. A thorough
analysis will be completed by the evaluation team and will include a discussion of trends and potential
bias/confounding factors. Future opportunities for improvement of program outcomes in addition to value
for money will be included in the final report.

Evaluation findings will be presented to stakeholders, including the local Board of Health, the Lancaster
Public Health Healthy Communities Division, students at the college, the Board of Trustees for the
Community Health Center and other interested community members.
 References

1. Healthy People 2020. Oral Health. https://www.healthypeople.gov/2020/topics-objectives/topic/oral-

health/national-snapshot. Updated October 8, 2020. Accessed November 13, 2020.

2. Murthy V. Oral Health in America, 2000 to Present: Progress Made, but Challenges Remain. Public
Health Reports. Mar-Apr 2016;131:224-225.

3. Watt RG, Mathur MR, Aida J, Bonecker M, Venturelli R, Gansky S. Oral Health Disparities in
Children: A Canary in the Coalmine? Pediatr Clin North Am. 2018 Oct;65(5):965-979.

4. Kranz AM, Duffy E, Dick AW, Sorbero M, Rozier RG, Stein BD. Impact of Medicaid Policy on the
Oral Health of Publicly Insured Children. Matern Child Health J. 2019 Jan;23(1):100-108.

5. Jakopic R. U.S. Department of Health and Human Services Administration for Children and Families.
National Study of Child Care for Low-Income Families. Patterns of Child Care Use Among Low-Income
Families. https://www.acf.hhs.gov/sites/default/files/opre/patterns_childcare.pdf. Published September
2007. Accessed November 1, 2020.

6. Como D, Duker L, Polido J, Cermak S. The Persistence of Oral Health Disparities for African
American Children: A Scoping Review. Int J Environ Res Public Health. 2019 Mar; 16 (5):710.