title: Exploring oral health and hygiene practices in the Algonquin community of Rapid Lake, Quebec.
abstract: BACKGROUND
  Early childhood caries (ECC), a disease characterized by tooth decay in the primary teeth of children, has become particularly burdensome in Aboriginal communities in Canada. Prevalence estimates of ECC range between 50% and 100%. Most concerning are the severe cases of ECC that require treatment with restorative surgery under general anesthesia. These surgeries often displace children and families from their local communities to specialty hospitals for treatment; further, they are very costly to dental insurance payers such as the government. This study used community-based participatory research (CBPR) to explore oral health and hygiene practices in the Algonquin community of Rapid Lake, Quebec. A key goal of the study was to create a culturally adapted activity to promote children's oral health and hygiene practices.
  
  
  METHODS
  Focused ethnography was used to explore oral health beliefs and practices, and factors related to child oral health promotion with community members. Participants included children, parents, educators, healthcare workers, youth workers and elders. Semi-structured interviews were conducted with key informants. Following, two focus group interviews were conducted: one with parents and one with school children. All data were audio-recorded, transcribed and analyzed iteratively using thematic analysis. Preliminary findings were then used to develop oral health promoting activities for children in the community. These activities were designed in collaboration with community workers.
  
  
  RESULTS
  Three main themes emerged from the analysis: (1) a gap existed between oral health knowledge and oral health behaviors; (2) challenges for oral health promotion included attitudes and beliefs, access, and priorities; and (3) parents needed to be further integrated into health promotion strategies. Key outcomes included: (1) the development of Eagles & Otters, a game designed to increase children's oral health knowledge; (2) an activity sheet to promote child oral health behaviors in the home; and (3) increased capacity in oral health promotion in local youth, community research partners and the student researcher.
  
  
  CONCLUSIONS
  The findings of this study highlight the importance of both local and broader systemic interventions to promote children's oral health. At the local level, child oral health and hygiene was promoted through the development of activities designed to increase children's oral health knowledge and behaviors both at school and in the home where parents were directly implicated. Systemic level interventions are needed to address factors related to the social determinants of health, including cultural traditions, economic security, food security, and housing status. These factors contribute to overall health and enable the necessary conditions to promote and sustain oral health.
authors.affiliation: Ingram School of Nursing, McGill University, Montreal, Quebec, Canada. adonia.naidu@mail.mcgill.ca.
authors.forename: Adonia
authors.initials: A
authors.lastname: Naidu
authors.affiliation: Oral Health and Society, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada. mary.macdonald@mcgill.ca.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Macdonald
authors.affiliation: Ingram School of Nursing, McGill University, Montreal, Quebec, Canada. franco.carnevale@mcgill.ca.
authors.forename: Franco A
authors.initials: FA
authors.lastname: Carnevale
authors.affiliation: Kitiganik Health Clinic, Rapid Lake, Quebec, Canada. wj_nottaway@hotmail.com.
authors.forename: Waylon
authors.initials: W
authors.lastname: Nottaway
authors.affiliation: Kitiganik Health Clinic, Rapid Lake, Quebec, Canada. charlotceleste@hotmail.com.
authors.forename: Christine
authors.initials: C
authors.lastname: Thivierge
authors.affiliation: Kitiganik Health Clinic, Rapid Lake, Quebec, Canada. serge.vignola@hc-sc.gc.ca.
authors.forename: Serge
authors.initials: S
authors.lastname: Vignola
mesh_terms: D000328:Adult; D002648:Child; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion; D006801:Humans; D007198:Indians, North American; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009909:Oral Health; D009910:Oral Hygiene / Q000379:methods*; D011792:Quebec; D055815:Young Adult
keywords: Community Participation; Community-Controlled Health Services; Determinants of Health; Indigenous Health Worker; North America; Oral health; Public Health; Qualitative Research