Spring 2014

Not Just Talk

Nicole Holland is on a mission to improve health literacy

By Jacqueline Mitchell

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Nicole Holland says it is "hard to tease culture out as a separate component of our health literacy discussion." Photo: Kelvin Ma

Nicole Holland was still a dental student working in the clinics when she began to see the bigger picture. She dutifully taught her patients how to take care of their teeth at home, but they usually didn’t follow through. She figured there had to be a better way to reach them.

The majority of dental disease is preventable, she says, so “where is that disconnect?”

That’s the question Holland, who once had envisioned a purely clinical career, is determined to answer as Tufts School of Dental Medicine’s first director of health communication, education and promotion. She earned a D.D.S. from New York University College of Dentistry and a master’s degree in health communication from Tufts School of Medicine in 2012.

Educating patients about the importance of home care is one step toward oral health literacy. But Holland, an assistant professor in the department of public health and community service, wondered how dentists can best bridge the gap between what patients know and what they do. With support from her 2013–14 Tisch College Faculty Fellowship, which encourages Tufts faculty to integrate active citizenship into their work, Holland is looking at oral health literacy from all angles.

National Survey

She started with a survey of 56 of the nation’s accredited dental schools, asking in which courses and in which years of training health communication appears in their curricula, how it’s taught and how students’ understanding of the issue is assessed. Closer to home, Holland is trying to get a handle on the best ways for Tufts dental students to learn about health literacy.

So far that has meant assigning the incoming first-years some summer reading. Before they step foot on campus, members of the class of 2017 were asked to read The Immortal Life of Henrietta Lacks, by Rebecca Skloot, the story of how cervical cancer cells taken from a poor black woman without her knowledge have led to myriad medical breakthroughs. Holland and Robert Kasberg, associate dean of admissions and student affairs, organized small discussion groups in which students discussed the book.

“The students picked up, without my prodding, the issues related to dentistry—the need for ethics and professionalism and health literacy,” says Holland. The class of 2018 will read Anne Fadiman’s book The Spirit Catches You and You Fall Down, which examines the clash of cultures within the health-care system.

“It is hard to tease culture out as a separate component of our health literacy discussion,” says Holland. “I always stress to the students that health literacy goes beyond the ability to read. It is defined as the ability to obtain, process and understand health information so one can then make appropriate health decisions. Low health literacy has been linked to poorer health outcomes.”

Two opportunities to work with Tufts’ Chinatown neighbors could give Holland the chance to evaluate the effectiveness of students’ health communication skills in bridging the cultural divide and promoting health literacy. Starting this fall, Sampan, New England’s bilingual Chinese-English newspaper, will run a series of articles about oral health written by Tufts dental students; current first-year students have already been given their assignments. Holland is also working with the Asian American Civic Association (AACA), which runs Sampan, to develop an oral health workshop that will be a component of AACA’s English as a Second Language classes.

Then it will be up to Holland to assess both what Tufts dental students and their ESL students gain from these experiences. She’ll start by evaluating how well the workshop integrated with and contributed to the rest of the dental curricula. From there, Holland hopes this pilot project could expand into a larger scale, community-based research project that would measure the long-term impact on everyone involved. The dental profession is just beginning to gather this kind of data, and it is a high priority both for the ADA and at Tufts.

Holland also plans to examine how pop culture affects people’s attitudes about oral health. “People live their lives based on their assumptions and beliefs, but where are those coming from?” she asks.

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