In the United States, children from diverse ethnic groups and those with low socioeconomic status are at a significantly increased risk for early childhood caries. Despite the efforts focused on decreasing early childhood caries in American Indian (AI) populations, these children have the highest incidence of dental caries of any ethnic group, with four times the cases of untreated dental caries compared to white children. This qualitative formative assessment was conducted in two AI communities. Semi-structured interviews (n = 57) were conducted with caregivers and providers to understand the social and community contexts in which oral health behaviors and practices occur from the perspective of the caregivers, oral health care providers, and social service providers in the communities. The analysis was informed by the social determinants of health framework. The key social determinants of pediatric oral health relevant to our study communities included limited access to: oral health promoting nutritious foods, transportation for oral health appointments, and pediatric specialty care. This formative assessment provided locally and contextually relevant information to shape the development of an oral health clinical trial intervention to address early childhood caries in these two communities.

Background: The literature shows inconclusive results from utilizing motivational interviewing (MI) in indigenous populations to address early childhood caries (ECC). Great Beginnings for Healthy Native Smiles (GBHNS) (NIDCR U01DE028508), a community focused oral health (OH) intervention, was utilized alongside adapted MI techniques to promote OH care and education at home. Methods: The intervention was conducted by local Community Health Representatives (CHRs) from the two partnered indigenous communities. Reflecting on the years-long MI training and CHRs’ concerns, GBHNS conducted post-intervention semi-structured interviews with all MI staff regarding their experiences with MI. This paper uses participant observation, semi-structured interviewing, and inductive and deductive qualitative coding and analysis. Results: Thematic analysis was used to explore lessons learned and future research recommendations for interventions considering the use of MI. Generally considered a person-centered approach, MI reinforces Western psychological frameworks and practices which may disrupt local communicative practices and values. Conclusions: Specifically, interdisciplinary pre-intervention community assessments are recommended to ensure acceptability, relevance and appropriateness through attention to local communicative practices.