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GUEST EDITORIAL |
Dept. of Oral Biology, Box 357132, University of Washington, Seattle, WA 98195-7132, USA;
* corresponding author, bdale{at}u.washington.edu
KEY WORDS: disparities • caries • culture • genetics • antimicrobial peptide
Successfully bringing research out of the laboratory and into the local community relies extensively on the creation and use of effective communication models to translate highly specialized investigations into relevant inquiries that can have real effects on real lives. Developing and using more creative ways to communicate will facilitate fundamental research to be translated into new, clinically useful approaches to prevention, diagnosis, and treatment.
The Beta-Defensins Project is a case in point. How could we engage a diverse rural community in our study of the possible role of oral antimicrobial peptides in caries prevention? How could we explain that this peptide could be a genetic factor that contributes to caries susceptibility? How could we discuss our interest in learning more about a natural antibiotic present in oral mucosa and saliva without losing our audience?
What we needed was a means of stating the purpose of the research in a manner that engaged both stakeholders and target participants. The unforeseen lynchpin in this study was effective communication with subjects who are not science-literate, to gain their cooperation. This project turned out to be a valuable learning experience in building teams that can talk with one another.
We were fortunate to be able to build on oral health outreach and education programs that began several years ago through the work of the University of Washington Oral Health Collaborative. This dynamic and ongoing effort created a network within rural communities in Washington State that includes local communities, their clinics and colleges, and the University of Washington. Having identified a community within the existing network, we next met with people from this community. These included the school principal and district nurse as well as dental staff from community clinics and other agencies. We presented our ideas and listened to their questions and suggestions. We were impressed with the commitment of the principal to her school and that of the various professionals to the community as a whole. We then modified our approach to reflect the school, its culture, and the largely Native American/Hispanic culture. We found several ways of giving back to the community—through education, dental exams, referrals, and the employment of a talented local bilingual college student.
Still, our lab and the local community seemed light years apart. The language, experiences, and expectations of the two groups differed radically. Where was the common bond? It was picture talk. From the time of the Lascaux caves and possibly earlier, groups of people who differ in language have spoken with one another through pictures. The dashboard of your car, the desktop of your computer—both rely on pictures (icons) to communicate important information between the senders and receivers of messages who cannot be assumed to share a common spoken or written language.
This led us to use the most popular of all picture-based formats—the comic book—as our basic tool for talking with the local community about our beta-defensins research. We told our story in pictures. We translated our hypothesis into everyday images of good and evil. Beta-defensins became the Wildcat Warrior, a super-hero incarnation of the local school mascot with the ability to prevent tooth decay. His arch enemies, Strepto the Mutans and his army of bad-mouth bacteria, were the villains. The plot was simple: Good battles evil; good prevails. The message was relevant and understandable: The presence of something called a peptide, a natural antibiotic, might make a difference in the battle to keep teeth healthy. A second message suggested that foods high in sugar help the bad bacteria army grow larger and harder to defeat. Then came the third message: Readers were invited to join the team, participate in the research, and become part of the answer to preventing tooth decay. Their presence and participation were defined as important to our research outcome.
To have discovered a means for effective communication with the community was, perhaps, as important a step forward as having the right samples to complete the research in the laboratory. Working through the process—from seeing a need to communicate to creating a functional medium to facilitate this conversation—brought to life the textbook admonition to "involve local communities". A seminal change in perception occurred during this process. The paradigm shifted. The process of consent for human subjects that we had initially sought for the project changed. Gaining participants for our study evolved from being part of the problem to becoming part of the solution.
Encouraging, enabling, and empowering participants to "have a say" in the research that both relies on them and affects them—these open the door for future cooperation and collaboration. Individuals and their perceptions take on new importance in such a model. This is an opportunity for synergy among science, health, and the arts. Oral health research can become a working part of the "disease prevention/health promotion" outreach and education model. This model is generally conceded to be critical to achieving improved oral and overall health for populations traditionally penalized by a disparity of access to oral health care. As dental researchers, we know that genetics, environment, behavior, culture, and access to care all affect oral health. As scientists in the post-genomic era, we have the opportunity to share this knowledge with a wider circle of influence as we conduct research to improve oral health for diverse populations. As educators and responsible investigators, we must communicate with our research participants.
Teaming research and the community at large is the beginning of shared wisdom that makes a difference in oral health outcomes and remains in the experience of affected communities long after we have packed up our swabs and samples and returned to our labs. Anecdotal interviews, a mural, or improvisational drama might also be used to reach and teach local audiences. For our study, picture talk in the form of a comic book enabled us to link with the community in our efforts to understand and prevent oral disease. Further development of imaginative solutions to communication issues will benefit us as researchers as well as the communities we serve.
Dr. Dale is on the faculty of the Dept. of Oral Biology, University of Washington, and is a basic scientist whose recent work focuses on antimicrobial peptides in oral health. Ms. Brown is a program manager for the Washington State Dept. of Social and Health Services in Region 2, with headquarters in Yakima County. Ms. Wells, in the Dept. of Dental Public Health Sciences, University of Washington, is a dental hygienist and educator who focuses on oral health education in the Yakima Valley. They are participants in a study entitled "Beta-defensins in caries-prone children" as part of the Northwest/Alaska Center to Reduce Oral Health Disparities, funded by NIDCR Grant U54 DE14254.
Accepted July 16, 2003
This article has been cited by other articles:
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  P. MILGROM, R. I. GARCIA, A. ISMAIL, R. V. KATZ, and J. A. WEINTRAUB Improving America's access to care: The National Institute of Dental and Craniofacial Research addresses oral health disparities J Am Dent Assoc, October 1, 2004; 135(10): 1389 - 1396. [Abstract] [Full Text] [PDF]
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