Parental Oral Health Beliefs and Practices toward Young Children's Dental Caries among Chinese Immigrant Parent

Background. Dental caries is the most common chronic childhood disease. Chinese immigrant children have higher decayed and filled primary teeth than their US counterparts. There is limited information regarding Chinese American immigrant families' oral health beliefs and practices, which could influence their children's oral health outcomes. This study generated new knowledge about parental oral health beliefs and practices toward early childhood caries among Chinese immigrant parents toward the long-range goal of improving immigrant children's oral health. Aims. The overall goal of this cross-sectional descriptive study was to describe Chinese immigrant parents' Explanatory Model of dental caries (etiology, onset of symptoms, pathophysiology, course of caries, treatment) and the impact of Chinese culture, Chinese health beliefs and behaviors on parents' oral-health care of their children. Methods. Purposive and modified respondent-driven samplings were used to recruit Chinese immigrant parents of children aged 0-6 years through Chinese immigrant agencies and participant referrals in King County, Washington. Participants completed in-person, semi-structured interviews that included perceived influencing factors in order to capture cultural and personal perspectives about early childhood caries and children's oral health care. Interviews were audio-recorded, transcribed verbatim in Chinese and analyzed using content analysis. Results. Forty-six parents participated in the study. Parents believed the causes of dental caries included diet and oral hygiene habits, biological and somatic factors (inheritance, genetic, inborn and transmission issues), children's biting fingers habit, and lack of routine dental visits. They held different understandings on the age of onset for dental caries. Most parents recognized the onset of disease through dental examinations, children's toothaches, and color changes on their children's teeth. Parents were familiar with dental caries through personal experiences and experiences with their friends' children. Parents believed childhood caries had the potential to have a short-term or lifelong negative impact on their children. Most parents would immediately seek professional help for caries treatment, but indicated that information about dental caries and its prevention was needed from dental professional. Furthermore, results from the analysis using a framework derived from a critical analysis of Chinese culture revealed that 11 concepts were reflected in parents' oral-health beliefs and practices. Parents believed that they: (1) had an obligation for their children's oral care; (2) valued their children's training in oral care; (3) expected children to be independent in tooth brushing; (4) allowed children to receive sweets as gifts from relatives; (5) expressed fatalism regarding children's dental caries; (6) believed kinship contributed to children's dental caries; (7) obeyed dentists' authority; (8) avoided confrontation with dentists and family members; (9) demonstrated group orientation related to friends' dental knowledge and advice; (10) valued face related to children's physical facial appearance; and (11) were concerned dental caries would affect their children's school achievement. Results from the analysis using a framework derived from a critical analysis of Chinese health beliefs and behaviors revealed that eight domains were related to their oral-health beliefs and practices, including (1) belief regarding primary teeth; (2) belief regarding tooth worms; (3) belief regarding gum bleeding; (4) belief regarding sugary foods; (5) belief regarding a balanced diet; (6) belief regarding self-care; (7) belief regarding the need for dental care services; and (8) belief regarding tooth extraction. Implications. Explanatory Model of dental caries could be applied to assess parental beliefs and practices towards childhood dental caries. Understanding of Chinese culture, health beliefs and behaviors could be helpful in developing oral-health interventions in relation to family needs. Caries prevention intervention is needed to facilitate parents' daily assistance roles in children's oral hygiene behaviors, as well as healthy diet habits. The knowledge served as a foundation for developing a conceptual framework for designing culturally relevant family-focused interventions to improve immigrant children's oral health.