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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 13.1: Preventive Dental Visit: Pregnancy

MCH Best Logo young woman receiving oral health exam

Strategy. Provider Education

Approach. Collaborate with obstetrical and/or nurse midwifery associations to train their members to conduct oral health risk assessments, provide preventive oral health care, and make referrals.

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Overview. Provider education is an evidence-based strategy that has shown utility in increasing use of professional services other than oral health by MCH population groups. While limited research has been conducted to verify results with populations in need of oral health services, this research can serve as a proxy to gauge effect. However, more research is needed for conclusive results.1 Prenatal care associations include obstetric, nurse midwifery, and family practice groups; partneships provide an opportunity to train their members to conduct oral health risk assessments, provide preventive oral health care, and refer pregnant women to oral health professionals for dental visits. Examples of preventive oral health care include education and anticipatory guidance and fluoride varnish applications.2

Evidence. Expert opinion. Strategies with this rating are recommended by credible, impartial experts and are consistent with accepted theoretical frameworks. However, the strategies have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects. This strategy was drawn from Holt K, Louie R. 2019. Strengthening State and Jurisdiction Efforts Related to Title V Maternal and Child Health National Performance Measure 13 (Oral Health). Washington, DC: National Maternal and Child Oral Health Resource Center. This expert opinion is based on multiple resources.3 (Read more about understanding evidence ratings).

Target Audience. Providers.

Outcome. Proportion of pregnant women with a dental claim.

Examples from the Field. There are currently 6 ESMs across all states/jurisdictions that use this strategy directly or intervention components that align with this strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Collaborate with obstetrical and/or nurse midwifery associations to train their members to provide preventive oral health care to pregnant women and referrals to oral health professionals for dental visits,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of obstetricians and/or nurse midwives trained in preventive oral health care in the past 12 months.
  • Number of obstetricians and/or nurse midwives providing preventive oral health care to pregnant women and referrals to oral health professionals for dental visits in the past 12 months.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percentage of obstetricians and/or nurse midwives trained in preventive oral health care in the past 12 months.
  • Percentage of obstetricians and/or nurse midwives providing preventive oral health care to pregnant women and referrals to oral health professionals for dental visits in the past 12 months

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of obstetricians and/or nurse midwives trained in preventive oral health care in the past 12 months who report an increase in knowledge about the importance of receiving preventive dental care during pregnancy.
  • Number of pregnant women, seen by providers who received preventive oral health education, who had a dental visit in the past 12 months.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percentage of obstetricians and/or nurse midwives trained in preventive oral health care in the past 12 months who report an increase in knowledge about the importance of receiving preventive dental care during pregnancy.
  • Percentage of pregnant women, seen by providers who received preventive oral health education, who had a dental visit in the past 12 months.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Possible Data Sources for ESMs:

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


References:

1 Perkins, R. B., Zisblatt, L., Legler, A., Trucks, E., Hanchate, A., & Gorin, S. S. (2015). Effectiveness of a provider-focused intervention to improve HPV vaccination rates in boys and girls. Vaccine, 33(9), 1223-1229.

2 Holt K, Kolo S, Louie R. 2020. Title V National Performance Measure 13 (Oral Health): Strategies for Success (2nd ed.). Washington, DC: National Maternal and Child Oral Health Resource Center.

3 Resources used to establish expert opinion:

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.