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The purpose of this research project was to understand the food environment of the Fort Totten community on the Spirit Lake reservation in east-central North Dakota, as perceived by tribal members and employees at Cankdeska Cikana Community College (CCCC). According to a 2010 report from the Center for Disease Control and Prevention, the food environment includes the physical presence of food that affects a person's diet, and a connected system of food services within the community that enables procurement of food. This collaborative research project between CCCC and the North Dakota State University Extension Service utilized community-based, participatory research methodology. Participatory research strategies recognize that an outsider can work best in partnership with community representatives who are themselves experts in the research topic. Thus, the methodology enables researchers and community members to positively impact the community through collective identification of healthcare needs (Hergenrather et al., 2009). To gain a greater understanding of the food environment on the Spirit Lake reservation and maximize community participation, this research project employed a technique known as Photovoice, a method which enables people to share the rich contexts of their everyday lives by narrating the stories relating to photographs that they take. The strategy documents the research topic, hence shifting participants from a passive role to that of empowered activists (Thomas & Irwin, 2013). Photovoice is a group process that engages people in telling stories through photography, and builds on the Native tradition of storytelling (Markus, 2012). Photovoice allows those with limited power--due to poverty, language barriers, race/ethnicity, gender, or culture--to use photographs to capture environmental factors that may place them at risk for various health conditions (Findholt et al., 2011; Teti et al., 2013).

Oral health is essential to overall health; however, structural obstacles influence older rural residents' oral health outcomes, especially those from disadvantaged backgrounds in the South. Poor oral health is typically attributed to individual choices, shifting the focus from the inconspicuous community influences, making it more difficult for older rural people to obtain oral healthcare. This qualitative study explores how older adults in rural Georgia understand the community's role in shaping their oral health. Twenty-two older adults were interviewed from five rural communities in southeast Georgia. Participants defined their community in geographic terms. Community barriers and self-reliance emerged as themes of how living in a rural community affects oral health. The concepts of community and one's oral health were perceived as distinct. Participants did not see how where they lived could matter to their oral health, even when they identified critical community barriers to oral health. In collaboration with rural healthcare systems, social workers can support healthy self-reliance, moving beyond a health individualism lens, by helping bolster older adults' social supports, an essential function of social relationships that positively influences a sense of community. Additionally, social workers can advocate for equitable policies to create opportunities for rural communities to support and maintain oral health. [ABSTRACT FROM AUTHOR]

Aims: To assess the differential item functioning (DIF) of the Jaw Functional Limitation Scale (JFLS) due to gender, age, and language (English vs Spanish). Methods: JFLS data were collected from a consecutive sample of 2,115 adult dental patients from HealthPartners dental clinics in Minnesota. Participants with missing data were excluded, and analyses were performed using data from 1,678 participants. Whether the item response theory (IRT) model assumptions of essential unidimensionality and local independence held up for the JFLS was examined. Then, using Samejima's graded response model, the IRT log-likelihood ratio approach was used to detect DIF. The magnitude and impact of DIF based on Raju's noncompensatory DIF (NCDIF) cutoff value of 0.096, Cohen's effect sizes, and test (or scale) characteristic curves were also assessed. Results: Essential unidimensionality was confirmed, but locally dependent items were found on the JFLS. A few items were flagged with statistically significant DIF after adjustment for multiple comparisons. The NCDIF indices associated with all DIF items were < 0.096, and they had small effect sizes of ≤ 0.2. The differences between the expected scores shown in the test characteristic curves were little to none. Conclusion: The present results support the use of the JFLS summary score to obtain psychometrically robust score comparisons across English- and Spanishspeaking, male and female, and younger and older dental patients. Overall, the magnitude of DIF was relatively small, and the practical impact minimal. [ABSTRACT FROM AUTHOR]

Objectives: a) To evaluate the item and scale properties of the Oral Health Literacy Adults Questionnaire (OHL‐AQ) in an adult general population. b) To determine precision or accuracy of the respondents' estimated scores along the Oral Health Literacy (OHL) spectrum using item response theory (IRT) modeling. Methods: Survey data were collected from a convenience sample of 405 adult attendees of the 2014 Minnesota State Fair. We used the two‐parameter logistic (2PL) model for the item response theory (IRT) analyses of OHL‐AQ data and calibrated items to estimate model‐based item difficulty and discrimination parameters. Item and scale properties were also assessed by plotting and interpreting item characteristic curves (ICCs), test characteristic curve (TCC), and test information function (TIF). Results: Based on interpretation of model coefficients, statistical testing, and model fit criteria, we deemed the 2PL model superior and selected this model to examine item and scale properties. Scale reliability was shown to be good through the test information function (TIF). TIF from our analysis showed that higher levels of OHL were measured less precisely than lower levels of OHL. Conclusion: We demonstrated OHL‐AQ as a whole has promising psychometric properties. However, for equiprecise measurement across the scale range, the scale needs more items for measuring higher levels of OHL. [ABSTRACT FROM AUTHOR]

Objectives: To investigate differential item functioning across the Spanish and English versions of the Orofacial Esthetic Scale (OES). Methods: OES data were collected from a consecutive sample of a total of 622 adult dental patients (311 English‐ and 311 Spanish‐speaking adults) from HealthPartners dental clinics in Minnesota. We inspected boundary characteristic curves (BCCs) based on item response theory (IRT) in English speakers and Spanish speakers to examine differential item functioning (DIF). Using the Samejima's graded response model, we used the item response theory log‐likelihood ratio (IRTLR) approach to test whether DIF was statistically significant. Results: Inspection of the BCCs did not reveal substantial differences in item difficulty and discrimination between English speakers and Spanish speakers. When IRTLR tests were performed for the seven OES items, no item was flagged with significant DIF after P‐values were adjusted for multiple comparisons. Conclusions: Pooling of Orofacial Esthetic Scale (OES) data from English and Spanish‐speaking dental patients for analysis and interpretation is supported by the absence of differential item functioning (DIF) across the two language groups. [ABSTRACT FROM AUTHOR]