N493 Module 8 assignment: health promotion program evaluation paper, a full sample

Did the Sealants Reach the Children Who Needed Them? A First-Year RE-AIM Evaluation of a School-Based Dental Sealant Program

Student Name

RN to BSN Program, Aspen University

N493: Community Health II

Instructor Name

Month Day, Year

Did the Sealants Reach the Children Who Needed Them? A First-Year RE-AIM Evaluation of a School-Based Dental Sealant Program

A health promotion program is only as good as the evidence that it reached the people it was designed for and produced the change it promised. This paper evaluates the first year of a composite school-based dental sealant program serving seven- and eight-year-olds in a low-income district, the program planned in an earlier module. It follows the national public health framework for program evaluation, organizes findings with the RE-AIM framework, reports illustrative first-year results, and recommends changes for the second year. All data are composite figures created for teaching.

Evaluation Approach

The federal framework walks evaluators through six linked steps, beginning with bringing stakeholders in and describing the program, moving through choosing a design and collecting credible evidence, and ending with conclusions that can be defended and findings that are actually used (Centers for Disease Control and Prevention [CDC], 1999). Stakeholders for this evaluation included the district's school nurses and principals, the county health department, the contracted dental team, the state oral health program that funded the work, and a small group of parents. They agreed on the main evaluation question in the title and on two secondary questions: whether children with decay found at screening received care, and whether the program could continue in schools without disrupting instruction.

Findings are organized using RE-AIM, whose five lenses, audience reached, results achieved, uptake by settings, delivery as intended and staying power, suit health promotion programs (Glasgow et al., 1999). RE-AIM was chosen because a sealant is known to work; the real question for a school program is whether it reaches enough children, in the right schools, reliably enough to matter.

Reach

Reach is the proportion and representativeness of the target population who participated. Of 1,120 second and third graders enrolled across the five schools, 718 families returned consent forms (64 percent), exceeding the objective of 60 percent, and 602 forms (54 percent of all children) gave positive consent. Return rates varied widely by school, from 81 percent at the school where the nurse called every family that had not responded to 47 percent at the school with the largest share of families who speak languages other than English and Spanish. The children reached were therefore not fully representative: families with the greatest language barriers were least likely to take part.

Effectiveness

Sealants were placed on at least one first permanent molar for 548 of the 602 children with positive consent (91 percent); the remainder were absent on all clinic days or had molars not yet fully erupted. At screening, 31 percent of children had untreated decay, and all received referral letters. By the end of the year, school nurses had confirmed a dental visit for 44 percent of referred children, short of the objective of 50 percent.

The retention check at one year, the program's short-term measure of effectiveness, is scheduled for next fall, so decay prevention cannot yet be assessed directly. The program relies on strong external evidence for that outcome: resin sealants markedly reduce decay in first permanent molars, and children without sealants have substantially more decay than children with them (Griffin et al., 2016). The first year shows the program delivered an effective intervention; whether that intervention stays on the teeth, and whether referred children get treatment, remain the open questions.

Adoption, Implementation, and Maintenance

Adoption refers to the settings and staff willing to take part. All five elementary schools participated, and all five school nurses took on consent follow-up, although principals at two schools asked for fewer clinic days because of testing schedules. Implementation refers to fidelity and cost. The dental team followed the infection control and sealant protocols on every clinic day observed, children spent an average of 12 minutes out of class, and the cost per child sealed was within the budget the funder approved. The main implementation problem was consent: forms were sent home only in English and Spanish, and schools that relied on backpack mail alone had the lowest returns.

Maintenance refers to whether the program can be sustained. The state grant covers two more years. The district has agreed to include the program in its school health plan, and the health department is exploring Medicaid billing for sealants placed on enrolled children, which would reduce dependence on grant funding.

Recommendations for Year Two

Four changes follow from the findings. First, translate consent forms into the two additional languages most common in the lowest-return school and add personal follow-up by phone or at pickup through bilingual staff, since the school with phone follow-up achieved the highest return rate. Second, strengthen referral follow-through by having the school nurse schedule dental appointments with families during a phone call rather than sending letters alone, and by partnering with the federally qualified health center's dental clinic to reserve appointments for referred children. Third, schedule a make-up clinic day at each school for absent children. Fourth, complete the retention check next fall and begin tracking decay rates at screening each year so that effectiveness can be measured directly over time.

Sharing Results

Results will be shared in formats suited to each audience: a two-page summary with charts for principals and the school board, a full report for the state funder, a presentation at the county board of health, and a short letter home to families, translated into the district's main languages, thanking them and describing what the program found. Sharing results with families is not a courtesy; it builds the trust that raises consent rates in the next year.

Conclusion

In its first year, the school-based sealant program met its consent objective, sealed teeth for most children whose families agreed, and gained the support of every school in the district. It fell short on referral follow-through and did not reach families facing the greatest language barriers as well as it reached others. The RE-AIM framework made those strengths and gaps visible, and the CDC evaluation steps ensured that stakeholders shaped the questions and will use the answers. With the recommended changes, the second year can move closer to the program's real goal: sealants for the children who need them most.

References

Centers for Disease Control and Prevention. (1999). Framework for program evaluation in public health. MMWR Recommendations and Reports, 48(RR-11), 1-40.

Glasgow, R. E., Vogt, T. M., & Boles, S. M. (1999). Evaluating the public health impact of health promotion interventions: The RE-AIM framework. American Journal of Public Health, 89(9), 1322-1327. https://doi.org/10.2105/AJPH.89.9.1322

Griffin, S. O., Wei, L., Gooch, B. F., Weno, K., & Espinoza, L. (2016). Vital signs: Dental sealant use and untreated tooth decay among U.S. school-aged children. MMWR. Morbidity and Mortality Weekly Report, 65(41), 1141-1145. https://doi.org/10.15585/mmwr.mm6541e1