A Guide for Developing and Enhancing Community Oral Health Programs  
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Step 3. Determine Priorities and Plan the Program

Addressing all the unmet needs and access issues identified in the needs assessment is rarely feasible. Therefore, it necessary to identify the needs that are of highest priority for the community. Determining health priorities helps direct resources to the programs that matter most to communities. Additionally, legitimate documented needs, including those that cannot be immediately addressed, can be useful for responding quickly to funding opportunities that may become available in the future.

Several priorities may be identified, some to be addressed immediately and others to be dealt with later. It is important to reach consensus on oral health priorities and to then create realistic objectives to address these priorities. A thorough priority-setting process that is inclusive and documented can help garner widespread support and endorsement for subsequent actions.

A. Prioritize Needs

The process of prioritizing needs is best accomplished by a group of stakeholders who have reviewed the analysis of assessment data, understand the issues, and are knowledgeable about the community. The more inclusive the process, the larger the group of stakeholders who will take ownership of the problem and of proposed solutions. The community oral health coalition can act as the core group for this process while involving other interested stakeholders.

Although it is essential to focus efforts to make tasks manageable and to show results, with so many competing priorities it is often difficult to determine where to channel resources. To differentiate among competing priorities, it is useful to establish criteria or guidelines for use in discussions about priorities. Before discussions begin, it is important to ensure that everyone involved understands and accepts the criteria for recommending and adopting priorities.

The following criteria may be helpful in making decisions about priorities:

Impact of Addressing the Problem. Assess the feasibility and impact of addressing the problem, and correlate the two. For example, the needs assessment may have identified a lack of oral health services available for young children. Stakeholders would then determine the feasibility and perceived impact of addressing this problem.

The Size or Extent of the Problem. Assess and compare the perceived size or extent of the problem (e.g., how many individuals are affected), the seriousness of the problem, and the feasibility of implementing evidenced-based interventions that will result in improved outcomes.

Indicators. Compare local oral health indicators to national oral health indicators. Use a ranking system (e.g., 1–5) to identify indicators as “better than,” “same as,” or “worse than,” and then arrive at a consensus about where the community should focus its efforts.

Availability of Acceptable Interventions. Assess the availability of interventions, the feasibility of implementing such interventions, and their acceptability for addressing a problem or issue using the Priority Rating System for Public Health Programs (PEARL) Framework, a tool for assessing the socioeconomic, legal, and political viability of various interventions.11 The framework looks at the following:

  P = Propriety; is an intervention suitable?
  E = Economics; does it make economic sense to address this problem?
  A = Acceptability; will the community agency accept an emphasis on this problem, and will they accept the proposed intervention?
  R = Resources; are funding and other resources available or potentially available?
  L = Legality; do the current laws allow the intervention to be implemented, and if not, is it worthwhile to expend time, energy, and resources working for legislative and regulatory change?

Finally, consider a review of current best practices; this can provide essential information and guidance about interventions that are effective in actual practice, including information about the effectiveness of emerging interventions such as the use of fluoride varnish in young children. It is important to make use of the experiences of others involved in promoting community oral health so that time, energy, and other resources are not wasted. Included in Appendix C are tables that display effective community and individual preventive measures for tooth decay prevention and a comparison of five effective community tooth-decay-prevention programs.

The Healthy People 2010 Web site contains information, toolkits, and worksheets that can be helpful in determining priorities.

Overall, this assessment will provide information that can be used to determine how best to use available time, energy, and resources in working to develop, integrate, expand, or enhance community oral health programs.

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Table of Contents Appendices AACDP References Home Appendices References Conclusion Step 6 Step 5 Step 4 Step 3 Step 2 Executive Summary Overview Step 1 Acknowledgements