The project Healthy food and Healthy teeth in children from low socio-economic positions led by Professor Monique van der Veen at ACTA Preventive Dentistry, received €40,000 from Eklund Foundation in 2020.
Congratulations on receiving the grants! How did you learn about Eklund Foundation?
Through my work at the oral hygiene school of Inholland Amsterdam and the Academic Centre for Dentistry Amsterdam, we have connections with TePe, a brand I am already familiar with for a long time through the special grips for people with a motoric handicap. Via meetings with TePe, we also learned about the Eklund Foundation, and via our research director, we are informed about the allocations of the Eklund Foundation each year.
Can you briefly tell us about the aim of your project?
We see large differences in caries experience between children from families with a low or a high socio-economic position, especially when their mothers have a migration background (i.e., are not born in the Netherlands). In Amsterdam alone, approximately 30,000 children do not attend the dentist. We want to investigate the reasons behind the health gap and why children do not attend the dentist, even though dental care is insured for all children up to 18.
The aim of this project is to reduce the general burden of caries in the low-SEP part of the population by community-based participatory action research (PAR), a collaborative approach towards research where science meets the community. We intend to imbed oral health and the interventions co-created in the project as part of the Amsterdam Healthy Weight Project’s community-wide approach, where a chain of care professionals and the municipality strive to ensure all children can develop into healthy adults (and with a healthy smile).
How do you select the participants, and what age are the children?
We will attempt to interview all oral health providers in the low SEP areas of Amsterdam, as well as nurses/physicians at the consultation bureaus. We have discussion panels with people involved in youth care from the municipality and the Amsterdam healthy weight project. Via the neighbourhood/community workers, we will identify where and how to meet with mothers/families with young children – the mothers seem to be most involved in taking children to pre-school/daycare or the play-ins. Children under five years of age are in focus. We hope to speak to around 20 families per low SEP area of Amsterdam, and where possible, observe them at their own home.
How do you motivate the families to take part in this project?
By talking to them and giving back. We are active at the health fair in spring and autumn; we participate in the baby-cafés and play-ins held in the neighbourhood or community centres; we provide cooking workshops to promote healthy diets and toothbrushing workshops to teach parents how they can brush their children’s teeth. Quite simply, we do our utmost best not to patronize them, but listen. We want to hear what difficulties they face. We want them to help each other in giving tips. We seem to do something good; we are asked to come back.
What kind of results are you hoping for?
We need to grip the barriers and facilitators for healthy diets; proper oral hygiene combined with preventive visits to the dentist and/or oral hygienist (as part of an overall healthy lifestyle). In focus group discussions, we then provide the information via a problem tree analysis, which will form the basis for the co-creation of interventions. Such interventions can be finding solutions to how to fit toothbrushing moments into a cramped schedule; dentists and oral hygienists reaching out more or providing dental check-ups for the youngest children at the consultation bureaus; school brushing, etcetera. The ultimate outcome would be to raise a caries-free generation.
How will you involve citizens and other stakeholders in the project?
Stakeholders are parents and their children (<5yrs); general health providers (general physicians and paediatricians, nurses, dieticians, physiotherapists; psychologists; professionals at the consultation bureaus/mother and child bureaus; gynaecologists, midwives, etcetera); oral health providers; social care providers (community workers); organisations such as schools and sports clubs (e.g. what kind of food and drinks are promoted/provided) and the policymakers within the municipality. The essence of PAR is that stakeholders are also involved as researchers; although the researchers will do the first analysis, the outcomes will be shared with the respective stakeholders for feedback and used in co-creation session to develop interventions.
Are there other studies like this going on in the Netherlands?
Similar studies, as in PAR studies, focus on other aspects of health. There is a plan for a smaller-scale study to be run in Den Hague by the Healthy Teeth Foundation, and a larger project initiated by ACTA together with a multidisciplinary research consortium, where besides ethnographic parameters, microbiome and clinical measures are collected, and data will be used for modelling to select feasible interventions. There are two studies ongoing looking into the possibility to provide 1) dental check-ups at the consultation bureau (“Gezonde Peutermonden” initiated by University for applied sciences Utrecht and ACTA) by an oral hygienist (RCT control is regular care) and 2) early referral to the dentist at the age of 6 months by the consultation bureau nurse, followed by risk based care planning.