Peru Bright

Spots Project

Identifying Outliers in Dental Hygiene

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 Meet the Team:

University of San Martín de Porres Dr. Marcia Vieira da Motta

Francesca
Justin Hur Sonia Gloege Phoebe Dodge Iverson Sun
Pozzi

We are international development students with diverse backgrounds and experience. This project
interested us because it is a unique opportunity to propose an innovative approach to a complex issue.
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Table of contents:
Situational Overview

Bright Spots Approach

Study Proposal

Implementation

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 Why Caries?
Prevalence of Tooth Decay: Key Contributing Factors:

of 5-year-old children in Microflora

90% Peru have Early Childhood
Caries

Prevalent in low
SES socioeconomic status
areas of Lima, Peru

All current research

Why? focused on treatment, but
not prevention
Host & Teeth Dietary Habits

(2) WHO. (2019) Ending Childhood Dental

(1) Escobar, Mora, & Castañeda (2022) Caries

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 Socio-ecological model for caries:
Community - Level Influences Family Coping Skills

Physical Enviro Development

Health Behaviors

Physical & demographic

Social Enviro attributes
Family - Level Influences Family
Composition Biologic & Genetic
endowment
Physical Safety

Use of dental care

Social Support Health Behaviors &

Child - Level Influences Social Capital Practices

Culture Family Function Dental Insurance

Practices
Oral Health

(2)

(2)WHO. (2019) Ending Childhood Dental Caries

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Table of contents
Situational Overview

The Bright Spots Approach

Study Proposal

Implementation

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Bright Spots Overview:
What are Bright Spots?
Bright Spots methodology emphasizes
identifying and understanding what
works well in certain situations,
encouraging the adoption of effective
strategies and practices to drive
positive change.
Connection to Caries:
Applying the Bright Spots approach to
child caries allows for the evaluation
of our targeted survey that identifies
effective strategies, enabling
data-driven interventions to address
the issue.
How is this Valuable?
Bright Spots helps identify the
key elements that drive
Identifying successful outcomes in specific
situations, enabling clients to
Success Factors replicate and adapt these factors
to their own context
Bright Spots allows clients to
Efficient pinpoint the most effective
strategies and practices,
Resource
Allocation
ensuring that resources are
invested in areas with the
highest potential impact.
The Bright Spots approach relies
on evidence-based analysis,
Data-Driven ensuring that recommendations are
Decision Making grounded in data, ultimately
leading to more informed
decision-making.
(3) Marsh et al (2004)
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Bright Spots Application in Vietnam:
Positive Deviants in Vietnam: A Solutions-based approach:

● Sternin studied "positive deviants",

who overcame challenges faced by the
entire community(3)
Solutions
● Their families utilized existing
resources in innovative ways (3)

A Community-Driven Approach:

1. Engaged local caregivers in

discovery process
Enduring Practical Efficient
2. Interviewed community members to
discover their insights and
experiences
(3) Marsh et al (2004)

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 Objective: to study positive
deviants of Peruvian children
without caries and their caregivers
to better understand successful
practices

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Table of contents:
Situational Overview

The Bright Spots Approach

Study Proposal

Implementation

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 3 Phases:

Phase 1 Phase 2 Phase 3

Dental Checkups & Habits Survey Bright Spots

Dietary Evaluation
Questionnaire

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Table of contents:
Situational Overview

The Bright Spots Approach

Study Proposal

Implementation

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Phase 1*
Dental Examinations
Conduct dental exams for all 100 children** sampled. Identify caries and caries
free children.

Dietary Questionnaire Values Survey

Questions about what types of food ● The Schwartz's Value Survey
the children eat and other ● Available in Argentinian Spanish
behavioral aspects of diet in the ● Measures 10 human values
home ● Believe there could be a
relationship between values and
Feeding Practices Survey dental hygiene

Assess feeding styles of caregivers

*We recommend that all close-ended questionnaires be administered through JotForm

**The number 100 is proposed, assuming that approximately 10% of children will be free of caries. 10 children without
caries is a suggestion provided by qualitative researchers from the University of Notre Dame; not statistically verified

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Example Questions:
Feeding Questionnaire:
How often during the dinner meal do you…

Say to the child “Hurry up and eat

1 2 3 4
4 5
5
your food.” Never Rarely Most of the Always
Sometimes
Time
Spoon-feed the child to get them to
eat dinner.

Schwartz Values Survey:

Power (authority, wealth, status) 00 1 2 3 4 5 6 7 88
Opposed to Not Important Of Supreme
Achievement (success, capability, my Values Important Importance
ambition)

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 Phase 2*
Habits Survey Example Questions

Following dietary questionnaire,

another questionnaire (Habits What are your struggles to maintain
your child's oral health and a good
Survey) given to all 100 caregivers
diet?

● Questions about the home life

and behavioral habits within What are the barriers you face in
the family maintaining your oral health and a
● This survey is intended to good diet?
account for potentially
unforeseen circumstances

*The proposal for Phase 2 was provided to us by a professor at the University of Notre Dame, and is still in development

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Phase 3: Current Brightspot Evaluation Model*
Open-Ended Questionnaire Example Questions

● Open-ended questions cover

3 areas: care, health, and What struggles do you have to
feeding practices maintain your child’s oral health?
● Evaluating for efficacy
and effectiveness Walk us through a typical weekday
● Could be conducted over or weekend eating routine.
the phone
When you are away, who looks after your
child? What advice do you give this person
in relation to care practices?

*No existing model for child caries; adapting from nutrition & cancer research.

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Next Steps
Pilot Study After the Study

● Goal: Test for cultural ● Analyze the data and identify

competency and efficacy trends
● Use a small test group of ≈ 10 ● Develop recommendations based
caregivers* of five year old on findings
children in Lima (same target ○ Educational materials
demographic) ○ Programs that promote healthy
dental practices
● Questions from each phase of
● Disseminate findings to
the study will be asked
○ JotForm
community stakeholders
○ Over the phone ● Implement interventions
● Refine study based on trial ● Monitor progress and make
results and feedback from necessary changes
researchers and participants

*the number 10 is just a suggestion provided to us by qualitative researchers at the University of Notre Dame; not
statistically verified

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Proposed Timeline*
Conduct a pilot study and refine the
Pilot Study study based on trial results and
feedback

Administer Conduct phases 1, 2, and 3 of

Questionnaires the study

Code qualitative interviews from

Data Analysis phase 3 and analyze data gathered
in all phases

Condense findings into a

Create Write-Up write-up with recommendations

Disseminate write-ups to
Intervention stakeholders and work to implement
community-driven interventions

*This is only an estimated timeline. This is subject to change.

Questions?

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References:
1. Escobar, C.S.R., Mora, O.A.U., Casteñada, G.M.W. (2022) Dental Caries in
Children Under 12 Years of Age in Peru. Universidad Peruana Cayetano Heredia.
2. WHO. (2019) Ending Childhood Dental Caries: WHO implementation manual. World
Health Organization.
3. Marsh, D., Schroeder, D., Dearden, K., Sternin, J., & Sternin, M. (2004) The
Power of Positive Deviance. BMJ, 329(7475):1177-1179.
4. Moore, S., Tapper, K., & Murphy, S. (2007) Feeding Strategies Used By Mothers
of 3-5-year-old Children. Appetite, 49(3):704-707.
5. Zou, J., Du, Q., Ge, L., Wang, J., Wang, X., Li, Y., Song, G., Zhao, W., Chen,
X., Jiang, B., Mei, Y., Huang, Y., Deng, S., Zhang, H., Li, Y., & Zhou, X.
(2022). Expert consensus on Early Childhood Caries Management. International
Journal of Oral Science, 14(1).
6. WHO. (2022) Global Oral Health Status Report. World Health Organization.
7. Sternin, M., Sternin, J., & Marsh, D. (1998) Designing a Community-Based
Nutrition Program Using the Hearth Model and the Positive Deviance Approach- A
Field Guide. Save the Children.
8. Story, M., Kaphingst, K. M., Robinson-O'Brien, R., & Glanz, K. (2008). Creating
Healthy Food and eating environments: Policy and environmental approaches.
Annual Review of Public Health, 29(1), 253–272.
9. Peters, J., Parletta, N., Campbell, K., & Lynch, J. (2013). Parental influences
on the diets of 2- to 5-year-old children: Systematic Review of Qualitative
Research. Journal of Early Childhood Research, 12(1), 3–19.

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