Introduction: More Than Words: Reframing Our Approach to Oral Health Literacy

GUEST EDITORS

Lindsey A. Robinson, DDS, is a board-certified pediatric dentist and has maintained a dental practice in Grass Valley, Calif., since 1996. She has served on the National Academies of Sciences, Engineering and Medicine Roundtable on Health Literacy as an oral health representative since 2013. Conflict of Interest Disclosure: None reported.

Nicole Holland, DDS, MS, is an assistant professor and the director of health communication, education and promotion in the Tufts University School of Dental Medicine’s Department of Public Health and Community Service. Her research interests include the intersection of health literacy, language access and oral health as well as the impact of oral health messaging in the media. Conflict of Interest Disclosure: None reported.

The intersection of health literacy, health equity and oral health is bursting with opportunities to enact change for a better future for our patients, communities and nation. As stated in both the foundational principles and overarching goals of the most recent release of the national health promotion and disease prevention initiative Healthy People 2030: Achieving health and well-being requires eliminating health disparities, achieving health equity and attaining health literacy.[1] Of note, 15 oral healthrelated objectives have been identified to facilitate achieving those goals.[2] Building from the definitions of personal and organizational health literacy referenced from Healthy People 2030,[3] this issue of the Journal of the California Dental Association takes a unique look at how oral health organizations can play a critical role at the intersection of health literacy and health equity. The authors offer rich perspectives with key takeaways, including concrete action steps and useful resources. It is our hope that readers will finish this issue catalyzed and ready to affect change in their respective practices and organizations.

The issue kicks off with the article “Organizational Health Literacy in Oral Health: A Multilevel Perspective” by the team led by Dr. Lindsay Rosenfeld. The authors make a compelling argument for how organizational health literacy can be used to reach oral health and health equity goals. By presenting best practice examples across national, state and community levels, the authors elucidate the crucial role of oral health organizations in driving system-level changes and challenge readers to consider how an organizational health literacy approach can help improve the oral health of our patients and communities.

A system-level approach would be remiss without considering the significance of linguistic diversity in our communities and the ways in which language barriers impact the provision of equitable oral health care services, which is often overshadowed in larger discussions of oral health literacy. Dr. Holland’s article outlines a brief historical overview of language access policy and its impact on the dental profession, providing actionable recommendations for dental providers to facilitate equitable, quality care for their patients and communities. Adequately stating, “Oral health cannot be positioned as a matter of social justice, health equity and human rights if patients are unable to gain, process and understand oral health, available oral health services and healthy oral health behaviors,” the article “Oral Health Literacy Framework: The Pathway to Improved Oral Health” by Drs. Francisco Ramos-Gomez and Tamanna Tiwari details myriad ways in which health literacy influences oral health. The authors propose a conceptual framework addressing language, culture and other factors impacting oral health literacy and the effects on oral health outcomes.

The issue culminates in two distinct examples of applied organizational approaches to oral health literacy. The article “UCLA-Sesame Street Collaboration To Improve Children’s Oral Health” by Dr. James Crall and his team sheds light on a collaborative partnership between UCLA and Sesame Street resulting in an evidence-based, children’s oral health awareness campaign to inform families and caregivers about the importance of early childhood oral health and finding a dental home by age 1. With a goal of improving the oral health of children in Los Angeles County, this article acknowledges the limitations of narrowly focusing on biological risk factors of early childhood caries and highlights the need for a broadened scope focused on social, behavioral and family factors and oral health literacy. The article “Innovative Health Literacy Strategy Advances Health Equity: Perspective of Cambridge Health Alliance Past and Present Department Chiefs” by Drs. Ryan Lee and Brian Swann details the transformative experience of an expanding dental department in a nonprofit, community hospital by exploring how fundamental health literacy principles, particularly the role of provider literacy, impact the ways in which equitable oral health care and services are communicated and practiced throughout their safety-net organization.

We thank our many health literacy colleagues for generously sharing their knowledge and experience as authors for this Journal issue. Collectively, the articles articulate the understanding that health literacy is multidimensional and influenced by environmental conditions, system complexities, communication context and social and cultural factors. With the exacerbation of health disparities and inequities in a post-pandemic world, now is the time for practices and organizations to focus intentional efforts on health literacy improvements to optimize oral and overall health for all.

RESOURCES

1. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Healthy People 2030 Framework.

2. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion.

3. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Health Literacy in Healthy People 2030.