Applying Community-Based Participatory Research Principles to Global Oral Health: A Case Study from Costa Rica

Figures & data

Table 1. Final themes with representative quotations describing determinants of oral health in La Casona, Costa Rica.

Final Theme	Representative Quotation
Protective Factors
Health Education	“In La Casona’s school there are very capable children…and even parents have enough knowledge because they have been holding workshops, the public health school has worked a lot on that and the truth is that it has improved a lot”
	“Many…cultural habits have changed and in the schools. This is an effort that we are trying to do in the Costa Rican Dental Association….We are trying [to implement]…a rule in the Ministry of Education that school teachers have to give a chance [for] children to brush their teeth after the different snacks…”
Financial Status	“These indigenous people are categorized as in extreme poverty. They have right for subsidies…”
Structural Influences on Health	“In Coto Brus, the building of the clinic was…in 110^th place in order of buildings [that would be built in the health system. It would take about] ten years [to build the clinic]. We skipped this and the Spanish Embassy gave us the money [to build the clinic]…I went to knock at the door of the Spanish Embassy. I will never forget that…The Spanish have always thought that they have the responsibility to give back…specifically to the indigenous populations”
	“Dentist for indigenous territory (protective), permanent EBAIS (health center), healthcare providers visit schools, EBAIS has primary care doctor, sometimes there is a traditional healer in the EBAIS…”
Diet and Nutrition	“Healthy school meals; mostly vegetarian, a coconut fruit…beans, plantains or banana, it could be cacao”
	“If they plant [food crops] themselves, which they usually do, they tend to plant crops such as beans, green bananas and sweet bananas…plantain, yucca…depending on the season”
Sociocultural Characteristics	“Traditional healer in the EBAIS*… help[s] us as a mediator, right? to transmit that information to the population”
	“…their mother takes care of them all day”
Environmental Factors	“Those who live near the villages can have access to drinking water”
Risk Factors
Health Education	“Information can be provided and it’s probably been provided, it’s just … they have other priorities so I would think I don’t think oral health ranks high in their priorities”
Financial Status	“They do not have the money to buy toothbrush or dental floss; Government subsidy used for packaged food, Coca-Cola, soft drinks”
	“[a grandmother caring for four young children] told me is that we do not have toothbrushes. I either buy food, what can be done, which is not much money that is counted, right? money to buy food or buy toothbrushes, then it is a very complicated situation because she told me what do I do? Do I feed or buy this soap and basic hygiene tools for cleaning?”
Structural Influences on Health	“If the emergency cannot be attended in the EBAIS … is taken to the hospital … .20 km to 22 km distance … if it is a serious emergency, the ambulance can take them, if it is not something serious they have to travel by bus, by foot, by taxi”
Diet and Nutrition	“Mini-market with cariogenic snacks; scholarship (government food subsidy)…to buy candy and snacks, coca cola, tropical juice, picaritas, tortillas… chips, corn chips…cakes”
	“[Some mothers are] breastfeeding many times a day until three of four years of age”
	“They go to grocery stores a lot and buy junk food and what do they buy? packets… small packages and things like that, fried things…little bags, small bags. People who live nearest to the small shops, they go to them and buy small snacks for children, which is not very nutritious. But before there were the small shops they used to have more nutritious meals.”
Sociocultural Characteristics	“The Mamatata religion say that if they do those kinds of habits how to brush their teeth is like being a white person. Then they do not allow it they do not agree with the non-indigenous customs; After eating, the dads do not tell them they have to brush their teeth; sometimes parents do not take children to health centers and some of them prefer to use traditional medicine”
Environmental Factors	“Rainy season river flooding; If they are far away in the indigenous territory it will be very difficult for them and they will have a look for natural water sources”

*Equipos Básicos de Atención Integral en Salud (EBAIS): basic team and clinic for primary health care in the communities. Sometimes people refer to the EBAIS as the individual clinic place where they receive primary care.

Figure 1. Framework for analyzing protective and risk factors for oral health designed for La Casona Indigenous community in Coto Brus, Costa Rica.

Pulpería: is a small market with an assortment of items.

Equipos Básicos de Atención Integral en Salud (EBAIS): basic team and clinic for primary health care in the communities. Sometimes people refer to the EBAIS as the individual clinic place where they receive primary care.