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LITERATURE REVIEW PAPER ORAL HEALTH ON WHEELS: A SERVICE-LEARNING PROJECT FOR DENTAL HYGIENE STUDENTS

LITERATURE REVIEW PAPER

ORAL HEALTH ON WHEELS: A SERVICE-LEARNING PROJECT FOR DENTAL HYGIENE STUDENTS

By

Student Name

An assignment

submitted in partial fulfillment

of the requirements for

DH 1400 Dental Hygiene Theory II

Salt Lake Community College

April 9, 2020

 

Title

Oral Health on Wheels: A Service-Learning Project for Dental Hygiene Students

Authors

Heather Flick, RDH, MS, MPH; Sheri Barrett, EdD; Carrie Carter-Hanson, RDH, MA, EdD

Overview

The Commission on Dental Accreditation (CODA) has been the accrediting body for dental hygiene programs nationally for many years. They have established regulations and standards that student hygienists must meet in order to become registered dental hygienists. In more recent years, there has been a transitional focus toward creating more culturally competent student hygienists. The need has been derived from the 2020 Surgeon General’s Healthy People report which showed the extreme “disparities in oral health, and access to care within the low income and underserved” populations (Flick, Barrett, Carter-Hanson, 2016, p. 226).

The CODA standards require that students obtain cultural competence through having experience “managing a diverse patient population and have the interpersonal and communication skills to function successfully in multicultural work environment (Standard 2.17), and that they are competent in assessing the treatment needs of patients with special needs, (Standard 2.12)” (Flick, et al., 2016, p. 226). Studies have suggested that “the best way for students to . . . gain a sense of cultural competence is through and implementation of service-learning opportunities” (Flick, et al., 2016, p. 227).

Purpose

The purpose of this study was to assess, through both quantitative and qualitative data, how service-learning “increased student awareness of underserved populations, cultural diversity, clinical skills, confidence building, dental team working relationships and the delivery of ethical patient care” (Flick, et al., 2016, p. 228).

Methods

The participants of this study were dental hygiene students who attended Johnson County Community College during the time period from 2009 to 2013. Prior to participation at the mobile clinic, second year students were required to complete a preliminary series of modules on “Practical Oral Care for People with Developmental Disabilities” which also included a take-home exam pertaining to the module materials (Flick, et al., 2016, p. 228). The preparation allowed students to build a framework of understanding of differing populations before providing patient care.

After preparatory measures were completed, the second-year dental hygiene students were rotated through a clinical outreach entitled, “Oral Health on Wheels” (OHOW). This clinical site was established in a forty-three-foot custom designed truck that accommodated two dental hygiene student clinicians. The mobile facility enabled each student volunteer to provide the full scope of oral health care to a culturally diverse population, twice a week for a period of three weeks (Flick, et al., 2016). During that time, students experienced one to one faculty attention, developed patient rapport and interaction with volunteer dentists, worked closely with Spanish translators as well as provided care to a variety of patients.

Patients were acquired through partnerships OHOW had with Johnson County Developmental Supports (JCDS), Johnson County Department of Health and Environment (JCDHE), and the Center of Grace (Flick, et al., 2016). Johnson County Developmental Supports provided patients with intellectual and developmental disabilities. Johnson County Department of Health and Environment provided pregnant patients and Center of Grace referred primarily Hispanic patients to the dental hygiene student volunteers.

At the culmination of the end of the second year of the dental hygiene program, just prior to graduation, a survey was administered to the senior student service-learning participants. The subjects of this research were self-selected because completion of the survey instrument was completely optional. Although the survey was not a requirement for graduation, over the five-year study was conducted, a total of 90 students consented to and participated in the survey.  The survey assessed, “the degree to which OHOW increased student awareness of underserved populations, cultural diversity, clinical skills, confidence building, dental team working relationships, and the delivery of ethical patient care. Students also provided open ended feedback about which rotation may have influenced their clinical dental hygiene education as well as future professional endeavors” (Flick, et al., 2016, p. 228).

The survey was modeled from the Health Professions Schools in Service to the Nation program handbook entitled “Methods and strategies for Assessing Service-Learning in the Health Professions” (Flick, et al., 2016, p 228).  The survey included twenty-five questions which were separated into three sections.  The first section consisted of ten questions associated with skill development on a five-point Likert scale. The second section consisted of eleven questions related to students’ experience on the service-learning rotation. Again, the five-point Likert scale was used. The last section included four questions that prompted students to reflect upon the things they learned; things they would change; advice they would give to OHOW and any other comments they wanted to include (Flick, et al., 2016).

The response data gathered from the survey was subjected to ANOVA and Pearson correlation coefficient statistical analysis which enabled investigation of the “relationships between student responses to key questions in the survey” (Flick, et al., 2016, p 226).

Reliability

It was evident throughout the entire study that the desired intent was to assess student’s cultural competency gained through service-learning experiences at OHOW. The survey was modeled after the accredited Health Professions Schools in Service to the Nation program’s handbook entitled, “Methods and Strategies for Assessing Service-Learning in the Health Professions” The data was subjected to ANOVA and Pearson correlation coefficient statistical analysis. (Flick, et al., 2016, p 226). There was no evidence given regarding a survey pilot testing. However, because the survey was derived from a handbook used nationally, the survey model was considered reliable.  The survey date was gathered over a period of five years wherein the students all participated in the same preliminary preparation, the same three-week rotation at OHOW, and the same twenty-five question survey.

Validity & Bias

Although these factors alluded to the reliability of the research, it would be superficial to neglect issues presented in the validity and bias of the study. The study stated that students were blinded throughout the survey process; however, the study showed no evidence of a blinded method. The students consented to participation and completed the survey.

The population was also not representative of all student dental hygienists. The participants were all students from one specific school program.  A survey of a randomized sample of dental hygiene students from a variety of dental hygiene programs would have contributed to the validity of this research. The outcome only reflects the experience of those in the singular program thus not accurately representing the student dental hygiene population.

It was also important to note the potential bias that could have been present in the student responses due to professors’ expectation. This was not to say the participants’ responses were incorrect; however, it was possible that survey participants failed to share the complete details of their experience which would result in tainted data.

Results

The results of the study confirmed a strong correlation between service-learning and student satisfaction. The survey data indicated “out of the 90 students who responded to the survey, 85 (94.44%) indicated satisfaction and personal growth after their clinical experiences . . . Students reported significant satisfaction, personal growth and confidence while working with clients with intellectual and developmental disabilities (p ≤0.05)” ((Flick, et al., 2016, p. 229). This strong correlation coincides with CODA standards and expectations.

Discussion

The study confirmed the authors’ initial predictions. Service-learning truly “increased student awareness of underserved populations, cultural diversity, clinical skills, confidence building, dental team working relationships and the delivery of ethical patient care” (Flick, et al., 2016, p. 228). It was through their experience working with OHOW that the student hygienists developed cultural competency. To support the results of this research, a meta-analysis could be conducted to analyze service-learning performed by dental hygiene students nationally.

Insights Gained & Significance

The results of this study illustrated the importance service-learning plays in student hygienists educational learning and progression. This research was particularly significant to all dental hygienists and hygiene programs nationwide. The Surgeon General’s Healthy People 2020 report highlighted major issues that exists in the oral health field. Many lack access to care due to poor socioeconomic factors. Student hygienists are the future of dental hygiene. As cultural competency is developed through service-learning, hygienists will be more equipped and capable to treat the underserved and culturally diverse populations.

Service Learning

The data in this research strongly supported the inclusion of service-learning into an educational curriculum. Service-learning is a critical component of the Dental Hygiene Program at Salt Lake Community College. Opportunities for service learning are included in college curriculums for several reasons. The literature suggests, successful service-learning is known to improve student learning, to promote civic engagement and to address social needs which are crucial in aiding student hygienists to become culturally competent (Flick, et al., 2016).

Service-learning improved student learning. One student hygienist participant from Johnson County Community College, comments included, “I wish I could have been on the truck all the time, I learned so much” (Flick, et al., 2016, p 231). The authentic hands-on experience of volunteering at OHOW clinic brought a sense of reality to didactic lessons in the classroom. The reality of the applicability of taught lessons, deepened student learning and understanding. The Pearson statistical analysis demonstrated “a major increase in the student’s perceived ability to learn more skills during their rotation on the Oral Health on Wheels service-learning project” (Flick, et al., 2016, p 231).

Service-learning promotes civic engagement as student interaction is promoted in culturally diverse populations. Diversity promotes empathy, understanding and compassion for the world around them. Student hygienists volunteering at OHOW had the opportunity to treat patients with intellectual and developmental disabilities to treat pregnant women, and to treat Hispanic adults. Each opportunity was highly enjoyed by the students. Results indicated that many students expressed “how the OHOW rotation exceeded their clinical expectations and personal satisfaction in treating clients with special needs” (Flick, et al., 2016, p. 229).

Service-learning addresses social needs while strengthening the community as a whole.  As mentioned previously, the Surgeon General’s Healthy People 2020 report indicated the imminent need for the oral health to expand the outreach to the underserved and underprivileged populations. OHOW provided oral treatment to over 249 patients throughout the study who would not have received care otherwise (Flick, et al., 2016, p 229). The imagined benefit of educational institutions nationally providing service-learning experiences is incredible.

Conclusion:

In conclusion, the Commission on Dental Accreditation (CODA) standards of implementation of service-learning into educational curriculum has increased student hygienist cultural competency through evidence collected in this research.  The student hygienists who participated at OHOW experienced increased student satisfaction and learning through interaction in treating underserved populations. Further studies of the impact of service learning on students’ post-graduation practices should be conducted to determine the long-term implications of community service requirements in dental hygiene program curriculums.

 Reference

Flick, H., Barrett, S., & Carter-Hanson, C. (2016). Oral Health on Wheels: A Service Learning Project for Dental Hygiene Students. The Journal of Dental Hygiene90(4), 226-233. Retrieved from http://jdh.adha.org

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