title: Framing Young Childrens Oral Health: A Participatory Action Research Project.
abstract: OBJECTIVE
  Despite the widespread acknowledgement of the importance of childhood oral health, little progress has been made in preventing early childhood caries. Limited information exists regarding specific daily-life and community-related factors that impede optimal oral hygiene, diet, care, and ultimately oral health for children. We sought to understand what parents of young children consider important and potentially modifiable factors and resources influencing their children's oral health, within the contexts of the family and the community.
  
  
  METHODS
  This qualitative study employed Photovoice among 10 English-speaking parents of infants and toddlers who were clients of an urban WIC clinic in North Carolina. The primary research question was: "What do you consider as important behaviors, as well as family and community resources to prevent cavities among young children?" Five group sessions were conducted and they were recorded, transcribed verbatim and analyzed using qualitative research methodology. Inductive analyses were based on analytical summaries, double-coding, and summary matrices and were done using Atlas.ti.7.5.9 software.
  
  
  RESULTS
  Good oral health was associated with avoidance of problems or restorations for the participants. Financial constraints affected healthy food and beverage choices, as well as access to oral health care. Time constraints and occasional frustration related to children's oral hygiene emerged as additional barriers. Establishment of rules/routines and commitment to them was a successful strategy to promote their children's oral health, as well as modeling of older siblings, cooperation among caregivers and peer support. Community programs and organizations, social hubs including playgrounds, grocery stores and social media emerged as promising avenues for gaining support and sharing resources.
  
  
  CONCLUSIONS
  Low-income parents of young children are faced with daily life struggles that interfere with oral health and care. Financial constraints are pervasive, but parents identified several strategies involving home care and community agents that can be helpful. Future interventions aimed to improve children's oral health must take into consideration the role of families and the communities in which they live.
authors.affiliation: Department of Dental Ecology, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America.
authors.forename: Chimere C
authors.initials: CC
authors.lastname: Collins
authors.affiliation: Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America.
authors.forename: Laura
authors.initials: L
authors.lastname: Villa-Torres
authors.affiliation: Department of Dental Ecology, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America.
authors.forename: Lattice D
authors.initials: LD
authors.lastname: Sams
authors.affiliation: Oral and Craniofacial Health Sciences, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America.
authors.forename: Leslie P
authors.initials: LP
authors.lastname: Zeldin
authors.affiliation: Department of Pediatric Dentistry, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America.|Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States of America.
authors.forename: Kimon
authors.identifier: http://orcid.org/0000-0003-1290-7251
authors.initials: K
authors.lastname: Divaris
mesh_terms: D000328:Adult; D017028:Caregivers / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D003731:Dental Caries / Q000191:economics / Q000517:prevention & control* / Q000523:psychology; D005190:Family / Q000523:psychology; D005247:Feeding Behavior / Q000523:psychology; D005260:Female; D017144:Focus Groups; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D007223:Infant; D008297:Male; D009657:North Carolina; D009909:Oral Health; D009910:Oral Hygiene / Q000191:economics / Q000523:psychology*; D010353:Patient Education as Topic; D011203:Poverty / Q000191:economics*; D036301:Qualitative Research