Chapter 7. Public Education and Media Advocacy
Oral health promotion strategies need to be comprehensive, and consistent,
as well as culturally and linguistically appropriate. Key concepts of health
communication, public education, health promotion, media advocacy, health literacy,
and cultural competence are discussed. Tips and resources are given for framing
oral health messages. Key oral health messages to convey to improve the oral
health of young children and pregnant women are included. These generally coincide
with those of the new
statewide First 5 Oral Health initiative. Multiple media formats are needed to disseminate
Traditionally, most oral health education efforts have been conducted by dental
professionals during dental office visits, in schools by teachers or dental
hygienists, or by dental products manufacturers who were trying to sell products
such as toothpaste or toothbrushes. February is considered Dental Health Month
in the US by many national dental groups, so that oral
health messages and volunteer efforts are targeted to various community groups
throughout the month. Health communication researchers, however, have shown
that one-time efforts do not generally change behaviors or affect oral health
status. Reinforcement of key messages and provision of incentives are needed
at regular intervals. People also learn in different ways and selection of the
most effective media modality is important. Recently, researchers also have
discovered that the US public does not generally understand
1) the importance of oral health and its interaction with general health, 2)
the range of methods available to prevent and treat oral diseases, or 3) roles
and responsibilities for self-care and professionally delivered oral care and
follow-up. This situation sometimes creates friction and misunderstanding between
dental professionals, health professionals, policymakers and the public, as
well as missed opportunities for prevention, early detection and early care
for oral diseases. Improving health communication among these groups is the
focus of this chapter.
Many communities have struggled to develop effective oral health promotion
strategies that will be meaningful and motivating to various community members,
especially those who are not benefiting from available preventive measures and
dental care. Occasionally efforts have been targeted to policymakers to raise
their awareness of oral health issues and to suggest specific courses of action.
All these efforts are well-intentioned but often fragmented and not generally
evaluated. The new California First 5 Oral Health Initiative and other First
5 statewide public education campaigns present much needed opportunities to
coordinate, strengthen and better tailor oral health messages to various sectors
of the population. Rural communities can participate in these efforts in a number
of ways that are meaningful to local programs. Use the self-assessment
for this chapter to analyze what oral health activities and efforts your community
has attempted in the past and how successful they have been. Then proceed to
look at what resources are available to your community to pursue new strategies
using a framework to measure outcomes.
Definitions and Concepts
“Health communication is the study and use of communication strategies to inform
and influence individual and community decisions that enhance health.”(USDHHS,
Healthy People 2010, 2000.)
|"Health communication can contribute to all
aspects of disease prevention and health promotion…including 1) health professional-patient
relations; 2) individuals’ exposure to, search for, and use of health information,
3) individual’s adherence to clinical recommendations and regimens; 4) the
construction of public health messages and campaigns; 5) the dissemination
of individual and population health risk information (risk communication);
6) images of health in the mass media and the culture at large; 7 the education
of consumers about how to gain access to the public health and health care
systems; and 8) the development of telehealth applications."
USDHHS. Chapter 11. Health Communication.
Healthy People 2010, Vol 1, 2nd ed. Washington, DC: US
Govt Printing Office, 2000.
This chapter defines public education as the various communication methods
that are used to convey oral health messages to members of the public who are
not health professionals or dental professionals, e.g., parents, childcare workers,
Head Start staff. Public education is then a subset of the broader field of
"Media advocacy is the strategic use of mass
media to support community organizing to advance a social or public
Berkeley Media Studies Group
The National Literacy Act of 1991 defined literacy as “…ability to read,
write and speak in English, and compute and solve problems at levels of proficiency
necessary to function on the job and in society, to achieve one’s goals, and
develop one’s knowledge and potential.”
| Literacy skills are the strongest predictor
of health status in the U.S.
Health literacy is an important element of oral health communication.
Nearly one-half of all American adults have difficulty understanding and acting
upon health information. Health literacy means enabling people to obtain,
process and understand basic health information and services and then act
in their own interests. Analyses of oral health education materials produced
over the past 20 years shows that most materials are written at a college
literacy level. Recent recommendations are for materials to be visually appealing
and written at about the 3rd to 5th grade level, using
“plain language” rather than technical terms. People with limited English
proficiency or limited education may have less knowledge of oral disease prevention
and management, and limited use of oral health service, thus resulting in
poor oral health status. Health literacy needs to be addressed in the context
of culture and language, and is crucial to quality health care.
The term “culture” includes shared ideas, meanings and values acquired by
members of a society. Culture influences health beliefs and health practices.
"Eliminating health disparities and increasing access to care for
all individuals including ethnically and culturally diverse populations
within the U.S. will require transformation
in the way services are currently provided. Cultural competence
is one tool that can be used to eliminate disparities through the
infusion of culturally competent principles into the policies and
practices of organizations providing dental services."
National Center for Cultural Competence
Cultural competence is a developmental continuum that ranges from cultural
destructiveness to cultural blindness to cultural proficiency, with various
stages along the way.
How to “Frame” Oral Health Messages
- emphasize prevalence of the problem
- explain severity of the problem
- identify consequences of the problem
- underscore the efficacy of prevention in solving the problem
- mainstream the issue.
of messages for each of these characteristics. The First 5 Oral Health
Initiative and efforts in other states build on this research, but also
emphasize oral health in relation to school readiness. View anticipatory
guidance messages as well as oral health messages for health professionals,
the early childhood education team and parents on the
First Smiles website.
The same concepts of framing messages also apply to the field of media
advocacy. Media advocacy activities are generally organized around two concepts:
- framing for access: shaping the story to get attention
and gain access to the media
- framing for content: telling the story from a policy or
The Berkeley Media Studies Group provides the following “framing” tips
for media advocacy.
Framing for Content
- Translate individual problem to social issue
- Assign primary responsibility
- Present policy or solution
- Make practical appeal
- Develop story elements
Framing for Newsworthiness
- Controversy, conflict, injustice
- Irony or uniqueness
- Population of interest
- Significance or seriousness
- A breakthrough or milestone
The Center for Health Improvement’s Health Policy Guide pro vides
a brief but useful overview of
techniques for working with the media to get your message out. It covers
media interviews, press releases, press conferences, letters to the editor,
op-ed pieces, and radio. A section in Chapter
5 of the Healthy People 2010 Oral Health Toolkit also
provides tips for working with the media.
- Oral health is part of overall health
- Poor oral health affects quality of life
- Oral disease is linked to other health problems
- Oral disease is an infectious, progressive disease that can be prevented
- Prevention is cost-effective
- Fluoride is the best way to prevent oral disease
- When oral disease is left untreated, we all end up paying more
- Ensuring good oral health is a blend of community responsibility and
- An Institute of Medicine study on health literacy (see references) recommends:
- “People have opportunity to use reliable, understandable information
- Include health and science as part of the K-12 curriculum
- People can assess credibility of health information
- Cultural contexts of diverse people should be integrated into health
- Health practitioners communicate clearly with patients during health
- There is ample time for discussions between health care providers and
- Patients feel free and comfortable asking questions
- Rights and responsibilities in relation to health and health care are
presented in clear, understandable language
- Informed consent process and forms are understandable to patients.”
All of these concepts are important
when designing programs and materials for public education and provision
of oral health services. For more information on health literacy, view the
following website: http://www.hsph.harvard.edu/healthliteracy
and see the Designing Program and Materials Resources at the end of this
One way to increase oral health literacy
in young children is to acquire developmentally appropriate books that touch
on oral health subjects. The Maine Oral Health Program has assembled a categorized
bibliography of children’s books on oral health that notes the targeted
age levels. Family Resource Centers, Head Start programs, local libraries,
and other programs should acquire a variety of such books to make available
to teachers and families. A variety of other interesting learning activities
for educational settings and for parents to use are included in the Cavity
Free Kids curriculum, developed by the Washington Dental Service and adapted
for use in California (see the Resources section.) A number of other educational
resources for children are also included in the Resources section.
Using Health Promotion Theories
A variety of health promotion theories have been researched to explain
how people make decisions to adopt or change certain health behaviors. A
useful reference that provides an overview of the theories is
Theory at a Glance:
A Guide for Health Promotion Practice by Glanz and Rimer (2003).
The following table from that document summarizes the focus of these theories.
Type of Activity
Level of Change and Promising
- Educational Materials
- Behavioral Programs
Stages of Change Modell
- Health Belief Model
- Consumer Information Processing Model
- Social Learning Theory
Change the Environment:
- Policy Changes
- Regulatory Changes
- Organizational Changes
Community Organization Theories
- Organizational Change Theory
- Diffusion of Innovations Theory
- ABCD A Manual for Dental Providers: available through
Includes a section on Family Oral Health Education and handouts for parents
(your baby’s teeth, fluoride varnish, and lift the lip).
- A Place of Our Own: Dental Care is a resource section of a broader
for early childhood educators in California.
- Bright Futures in Practice: Oral Health Pocket Guide, 2004:
available through http://www.mchoralhealth.org/PDFs/BFOHPocketGuide.pdf
to download or can also order multiple copies. This pocket guide is designed
to help dental professionals and others implement the oral health-related
guidelines published in Bright Futures: Guidelines for Health Supervision
of Infants, Children, and Adolescents. Chapters cover oral health
supervision guidelines, risk assessment, screening, examination, anticipatory
guidance, measurement of outcomes.
- California Dental Association maintains a website (http://www.smilecalifornia.org)
that has a section for the public. It includes fact sheets on various
preventive measures and one on “Information for moms and moms-to-be”.
Their main website (http://www.cda.org/public) includes a “patient’s
bill of rights”.
- Cavity Free Kids: Oral Health Education for Preschoolers and their
Families. 2003. Washington Dental Service Foundation. This curriculum
is being adopted by California First 5 to provide training for Head Start
staff and parents, WIC staff and childcare staff. Other states such as
Oregon, Washington, and Hawaii are also using this curriculum.
- CDA Foundation. Easy Steps to Oral Health. 2002. Three packages are
tailored toward a specific age group and are available in both English
and Spanish. Each package contains an educational video with corresponding
mail-back evaluation postcard, a take-away brochure and a narrowcast display.
Package One “Cavity Free Families” is for pregnant mothers and families
with infants. Package Two “Look at My Teeth” is for families with children
of ages one through three. Package Three “ My Trip to the Dentist” is
for families with children ages three through five. A DVD with all three
packages is available for providers to use in waiting rooms and was distributed
to all CDA members with the March 2003 CDA Journal. Ordering information
is at http://www.cdafoundation.org/news_dvd.htm.
- First Smiles Oral Health Education & Training Project is
the California statewide First 5 oral health initiative. Materials to
be shared with parents, caregivers, early childhood educators and health
professionals are featured on the website. Many useful resources will
be placed on the project website at
check the site often.
- Mestman SS and Herman AD. What To Do For Healthy Teeth.
La Habra, CA: Institute for Healthcare Advancement. 2004. Order
http://www.iha4health.org. Easy to read,
easy to use reference book for parents and others on oral health topics
for all age groups. Written by a dentist and a childcare educator. Includes
pages for notes and health related phone numbers.
- Healthy Smile, Happy Child: Early Childhood Caries Prevention. Maternal
and Child Health, Nevada Bureau of Family Health Services, 2002. This
training aid/kit contains materials on early childhood caries prevention
and fluoride varnish, including a brochure, anticipatory guidance curriculum,
and presenter manuals. The 74-page anticipatory guidance curriculum includes
schedules (prenatal to 24 months) and resources for oral health care.
The accompanying presenter manual includes class objectives, an outline,
and participation notes, as well as camera-ready copies for making 43
Power Point slides and a post-training evaluation form. Download most
materials from http://health2k.state.nv.us/oral/.
- National Maternal and Child Oral Health Resource Center Fact
Sheets. Download from http://www.mchoralhealth.org/pubs1.html.
Inequalities in Access: Oral Health Services for Children and
Adolescents with Special Health Care Needs, 2nd ed being
released in early 2005.
This illustrated fact sheet highlights the inequalities in oral
health care for children and adolescents with special health care
needs. The fact sheet presents data on conditions and disabilities
affecting the oral health of these children and adolescents, barriers
that make it difficult for them to access oral health care, and programs
to help them gain access to such care.
Oral Disease: A Crisis Among Children of Poverty, 1998.
This illustrated fact sheet documents the problem of dental decay
and other oral diseases in children from families with low incomes.
The fact sheet presents data on access to care for vulnerable children,
the percentage of children enrolled in Medicaid/EPSDT who receive
a preventive dental service, the incidence of dental decay in culturally
diverse populations, and the costs of care in terms of both national
economic priorities and personal pain and suffering.
Oral Health and Learning: When Children’s Oral Health Suffers,
So Does Their Ability to Learn, 2001.
This illustrated fact sheet highlights the connection between
oral health and learning. It addresses topics such as lost school
time, inability to concentrate, decreased school performance, impaired
speech development, inadequate nutrition, and reduced self-esteem.
Oral Health and Health in Women: A Two-Way Relationship. 2004.
This illustrated fact sheet discusses how women can maintain their
own oral health, which will in turn help to keep their baby’s mouth
Preventing Tooth Decay and Saving Teeth With Dental Sealants,
2nd ed. 2003.
This illustrated fact sheet highlights the benefits of using dental
sealants as a preventive oral health measure. It discusses what dental
sealants are, how they can be used to prevent tooth decay, and programs
to increase their use. The fact sheet also provides data on the cost-effectiveness
of dental sealants and the number of children and adolescents who
have used them.
Promoting Awareness, Preventing Pain: Facts on Early Childhood
Caries, 2nd ed, 2004.
This illustrated fact sheet describes the problems associated
with early childhood caries (ECC) and provides suggestions on how
to prevent or stop the progression of this infectious disease. It
also presents data on the number of children with ECC and the cost,
both financial and in terms of a child's overall well-being of ECC.
Trends in Children's Oral Health, 2001.
This illustrated fact sheet highlights available data on key issues
affecting the oral health of infants, children, and adolescents. It
presents information on early childhood caries, oral injuries, tobacco
use, the protective role of fluoride and dental sealants, children
with special health care needs, and access to care.
Head Start: An Opportunity to Improve the Oral Health of Children
and Families, 2003.
This illustrated fact sheet highlights an overview of children
in Head Start, data on access to oral health services and oral health
status, and promising strategies to improve oral health in these children.
Oral Health Tip Sheet For Head Start Staff: Working With
Health Professionals To Improve Access To Oral Health Care. 2003.
Oral Health Tip Sheet For Head Start Staff: Working With Parents To
Improve Access To Oral Health Care. 2003.
These two tip sheets were created to help Head Start staff deliver
consistent messages to promote good oral health and help them strive
for successful dental appointments.
- New Parent Kit Brochures. Brochures on a variety of topics are
available in English and Spanish on the California Children and Families
Commission website at http://www.ccfc.ca.gov/parentinfo.htm.
Oral health information is integrated with general health information.
- Oral Conditions in Children with Special Needs: A Guide for Health
Care Providers: available at http://www.nohic.nih.gov is a teaching tool
for health professionals that includes color photos of oral conditions
and anticipatory guidance messages.
- Oral Health Information for the Early Care and Education Community.
Kansas Head Start Association. 2001. This website includes core
information and resource materials focusing on early childhood.
- Oral Health…From Pregnancy Through the Toddler Years: An Oral Health
Education Program for Health Professionals: available through http://www.colgatebsbf.com/par_oral_preg.asp.
This kit for health professionals, produced by Colgate-Palmolive Company,
provides a teaching module on oral health education for four key stages
of life: pregnancy, birth to 6 months, 6 to 18 months, and 18 to 24 months.
The booklet discusses topics such as eating, brushing, and flossing during
pregnancy; care of the infant's gums; use of bottles and pacifiers; and
tips on snacking and brushing. Also provided are common questions and
answers from families, reproducible brochures (in English and Spanish),
and a poster.
- State of California, DHS, Maternal and Child Health Branch. Stop
the Spread of Tooth Decay. 2003. Pamphlets and posters promoting oral
health care for families with children from birth to five years. Written
in English and Spanish. County health departments or MCH programs can
order for free in packages of 100 pamphlets.
- Washington Dental Service Foundation: Oral Health Focus http://www.deltadentalwa.com/oralhealth/o_1.htm)
includes short paragraphs about many topics in a “did you know?” format.
- WIC and Head Start Lesson Plans and Bulletin Boards on Oral
Health. Maryland Dept. of Health and Mental Hygiene.
- ZATA Zoo Animal Teaching Aids (http://www.teachingaid.com): Fuzzy puppets
(about 15 inches high when seated), come in 5 animal characters that have
large mouths with flossable teeth, water squirter, and oversize toothbrush.
Web site also includes stories, plays and poems, coloring sheets, and
a user group board to post ideas. Good for use with young children. Cost
about $85 each on the website.
For Designing Programs and Materials
- Centers for Disease Control and Prevention. Scientific and Technical
Information. Simply Put. 2nd ed. Atlanta, GA: CDC,
1999. Available in pdf format at http://www.cdc.gov/od/oc/simpput.pdf.
- First 5 California Implementation Tools for School Readiness Series.
Health and Social Services. 2004. Oral health is included in this
document and PowerPoint presentation at http://www.healthchild.ucla.edu/First5CAReadiness/materials.
- Freimuth VS and Quinn AC. The contributions of health communication
to eliminating health disparities. AJPH. 94(12):2053-55,
- Health Communication Partnership has an online Field Guide
to Designing a Health Communication Strategy; this can be accessed
Although the guide doesn’t have an oral health focus, it is still a valuable
- Institute of Medicine. Health Literacy: A Prescription to End Confusion.
Washington, DC: The National Academy Press. 2004. Order from http://www.iom.edu/report.asp?id=19723.
- National Cancer Institute. Making Health Communication Programs
Work: A Planners Guide. Bethesda, MD: NCI, 2002. (order online for
free from https://cissecure.nci.nih.gov/ncipubs/details.asp?pid=209)
- The Partnership for Clear Health Communication is committed
to offering free and low-cost resources and programs that deliver information,
medical education and practice management tools to health care providers
and groups that provide information to patients. Visit the website at
http://www.AskMe3.org for more information
about the partnership or their Ask Me tool to help improve health communication
between providers and patients.
- UCSF Center for the Health Professions. Toward Culturally Competent
Care: A Toolbox For Teaching Communication Strategies is available
in CD-ROM format. The curriculum focuses on teaching clinicians to recognize
cultural differences in patient interactions and use specific communication
skills to improve patient care. For more information visit http://futurehealth.ucsf.edu/cnetwork/index.html.
- USDHHS. Writing and Designing Print Materials for Beneficiaries:
A Guide for State Medicaid Agencies. Baltimore, MD: HCFA, October
1999. (fax to 410-786-1905 to order for free—in process of being updated)
- Wallach L et al. Media Advocacy and Public Health: Power
for Prevention. Newbury Park, CA: Sage Publications. 1993.
What did you learn or accomplish as a result of reading this chapter? Did
it help you to organize your thoughts about what strategies for public education
and media advocacy would be most effective in your community? Were the resources
and examples helpful? Complete the feedback
form and tell us what was useful or not useful for you.