Listening for the right oral health message in Maine

By Becca Matusovich

Becca is executive director of the Partnership for Children’s Oral Health, a statewide network of organizations and individuals united by the shared mission of transforming Maine into a state where we meet the oral health needs of all children and families, prioritize prevention, and address oral health as a key element of overall health and well-being.

One of the best ways to persuade others is with your ears — by listening to them. 

— former U.S. Secretary of State, Dean Rusk

Here in Maine, the Partnership for Children’s Oral Health was fortunate to partner with CDHP last fall on a project to explore what kinds of messages on key oral health policies would resonate best with state policymakers. The timing for this project was excellent. We were in the midst of a gubernatorial election that would result in a new governor, one way or another, since our previous governor was termed out.  As a relatively new alliance of stakeholders, we were just getting our footing and had not determined yet what policy strategies to focus on. This state-based project would expand on evidence that CDHP had gained from similar, national-level research it commissioned in 2017.

Gaining local insights

Our project with CDHP uncovered some very valuable insights into ways to frame our key messages about oral health policies.

We jumped at the chance to collaborate with CDHP to host two focus groups as a way to clarify what messages might be most effective in advocating for better oral health policy in our state. The focus groups were held in different parts of the state, reflecting different aspects of Maine’s economic and political environments. In each case, a local market research firm assisted with recruiting 12-15 participants who fit a screening profile of people we called “influencers.” We were looking for people who were civically engaged and politically active in their own communities or networks, the type who are likely to speak up and express their views with their local and state policymakers.  

The focus groups were designed for us to learn from these influencers about their perspectives on oral health issues — both the challenges they saw and potential solutions they thought might hold the most appeal across the political spectrum. We explored a range of specific messages about some of those policy solutions to learn which ones they thought would be likely to resonate most with Maine policymakers. For example, our participants felt that it would be very important to raise policymakers’ awareness that tooth decay is a chronic disease, which can be prevented, treated, and managed just like other chronic diseases. 

I’ve always been a big fan of focus groups. Every single time I have been involved in one I have learned more than I expected. Our project with CDHP uncovered some very valuable insights into ways to frame our key messages about oral health policies. It also surfaced the rationale behind why these particular points resonated with Mainers, and illuminated some common threads of experience among the participants. Many had themselves experienced hurdles accessing dental care or had a family member, friend, employee, or neighbor who had faced barriers to good oral health. 

Making the most of resources and opportunities

These insights also helped us think about how to customize to our particular state context the key elements of an oral health messaging toolkit produced by the Frameworks Institute. One of Frameworks’ recommendations is to demonstrate various ways in which “the system” poses obstacles for parents who want to protect their children’s oral health. As a result of our CDHP collaboration, we have become better at highlighting this message. We now have talking points at the ready to explain that barriers such as a lack of fluoridated water in their community; not being able to get time off work to take children to the dentist; or struggling to find a dentist who will take Medicaid make it more challenging for parents to help their children stay cavity-free. 

Two products from this project were extremely useful as we worked on our top policy priorities in our most recent legislative session:

• A full report of the focus group findings, and
• A special two-page Messaging Guide for Maine Oral Health Advocates. 

The latter “quick guide” has especially been a great go-to document as we crafted various fact sheets and talking points. In fact, at one point I was working on a fact sheet and found myself struggling with how to word some specific, traditional data points. Then, I turned back to our new Messaging Guide. It had such good talking points in it as examples that I ended up deleting the whole section that was giving me trouble and dropped in a short list of bullets that I pulled directly from the guide. Problem solved! It might not always be that simple, but I know I’ll continue to turn to this trusted, evidence-based resource for guidance.

The serendipitous impacts of the focus groups have evolved in ways we never could have predicted.  But part of policy change work is about being nimble and prepared to seize opportunities, even when they are unexpected. One of our focus group participants was, at the time, a first-time candidate for the Maine Legislature. She was generally aware of dental access issues as a social worker, a public health administrator, and also as a small business owner. Yet the focus group conversation ignited her deep, latent passion for these issues. Having witnessed her concern for Mainers’ oral health, it was very easy to picture her as a strong partner who would act on these issues. So, we reconnected with her after she won her legislative race. She has now become one of our most active legislative champions for oral health, gladly stepping up to sponsor a critical oral health bill during this most recent session of the legislature.  We certainly could not have designed for this exciting result, but it proves that you just never know what kinds of new relationships and ripple effects can start with a single conversation.

Maine’s legislative session has recently wrapped up, and we are very excited that our policy priorities gained significant traction in the session. Our efforts ultimately focused on restoring some oral health staffing capacity in both our Medicaid agency and our state public health agency, expanding funding for school-based oral health services, and establishing an adult comprehensive Medicaid benefit. Although we didn’t get everything we had hoped for, we are pleased that several bills passed with key steps in the right direction. I attribute no small part of that success to our focus group project and all that we learned in the process. There is just no substitute for really listening and I’m grateful to CDHP for the opportunity to listen and learn together!