ALL SMILES MATTER: THE ROLE OF THEORY AND FRAMEWORKS IN ADVOCACY TO ADVANCE ORAL HEALTH EQUITY THROUGH POLICY Open Access

Greenlea Taylor, Judy (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/th83m015t?locale=en
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Abstract

Despite major improvements in oral health for the population as a whole, oral health disparities are profound in the United States. Access to oral health services remains a major public health issue in the United States. Dental professional organizations have made improving access to oral health care and decreasing oral health disparities a major focus of their research efforts and national agendas. The Patient Protection and Affordable Care Act (ACA) marked a historic expansion of health care access and is a significant step in eliminating health disparities nationwide, making health insurance more accessible and affordable for Americans by expanding Medicaid, yet there are still challenges with implementation. Provisions for adult oral health care and provider access is very limited. There is an emerging body of evidence that shows the practice of oral health advocacy has advanced, however its theoretical groundings have not. This is certainly not for a lack of theories of policy processes, but for a lack of application to advocacy. Theoretically-grounded oral health advocacy is a key public health strategy not only to make policy systems work better, particularly for vulnerable and underserved populations, but also to counteract the efforts of opposing interest groups to implementation of good public health practice. The purpose of this modified systematic literature review and general literature review was to identify policy process theories/frameworks successfully applied that informed understanding of the linkages between the policy process, advocacy activities and outcomes in public policy action to improve public health issues such as oral health equity. Inthe preliminary review of the literature, there were five theories/frameworks encountered that revealed most promising and relevant to this study: 1) The Advocacy Coalition Framework, 2) Multiple Streams Theory, 3) Messaging and Frameworks Theory 4) Media Influence Theory and (5) The Racial Equity Framework. Although oral health disease compounded with health equity issues is a complex intricate public health issue, the results from this research revealed that policy process theory can play a vital role in informing advocacy activities and understanding the linkages between the policy process and positive outcomes to improve public health.

Table of Contents

CHAPTER 1: INTRODUCTION .............................................................1

Problem Statement.............................................................................4

Conceptual Framework and Theoretical Foundation...................................6

Advocacy Coalition Framework......................................................9

Multiple Streams Theory (Agenda Setting)......................................10

Messaging and Frameworks Theory...............................................11

Media Influence Theory (Agenda Setting).......................................13

Racial Equity Framework.............................................................13

Purpose Statement.............................................................................15

Research Question..............................................................................15

Significance Statement........................................................................15

CHAPTER 2: BACKGROUND ...............................................................16

The Impact of Oral Disease..................................................................16

Healthy Public Policy...........................................................................19

The Policy Process..............................................................................21

The Role of Advocacy in the Legislative Arena..........................................23

The Application of Theory.....................................................................24

Summary and Study Relevance..............................................................25

CHAPTER 3: METHODOLOGY ..............................................................26

Population..........................................................................................26

Research Questions..............................................................................26

Literature Search Method.......................................................................27

Data Extraction and Quality Assurance.....................................................30

Analysis Plan.......................................................................................30

Limitations..........................................................................................30

CHAPTER 4: RESULTS .........................................................................32

Results...............................................................................................32

Key Findings........................................................................................33

CHAPTER 5: DISCUSSION...................................................................47

Discussion...........................................................................................47

Implications.........................................................................................49

Conclusion...........................................................................................51

REFERENCES......................................................................................52 LIST OF TABLES Table 1 Description of Components of the Policy Triangle............................. 8 Table 2 Policy Process ..........................................................................22 Table 3 Key Search Terms..................................................................... 28 Table 4 Inclusion Criteria Exclusion Criteria.............................................. 29 Table 5 Policy Context........................................................................... 34 Table 6 Theory/ Framework in Study........................................................34 Table 7 Public Health Issue in Study........................................................ 34 Table 8 Case Study and Policy Outcomes...................................................35 Table 9 Summary of Findings................................................................. 36 Table 10 Summary of Streams................................................................42 Table 11 Policy Engagement Strategies.................................................... 50 LIST OF FIGURES Figure 1 Conceptual Framework for Public Policy Analysis..............................7 Figure 2 Inclusion and Exclusion Criteria .................................................. 29 Figure 3 Overview of Literature Search Summary........................................33 Figure 4 Advocacy Coalition Framework.................................................... 43 Figure 5 AFC and Oral Health Promotion ....................................................43 Figure 6 AFC and Tobacco .......................................................................44 Figure 7 ACF and Nutrition...................................................................... 44 LIST OF APPENDICES Appendix 1 Racial Equity Framework Guiding Principles and Questions.............56 Appendix 2 PICO Worksheet.................................................................... 58 Appendix 3 Qualitative Assessments- Critical Review Form........................... 59 Appendix 4 Search Strategy.................................................................... 63

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