Oral health disparities are wide and increasing for rural Southern African-Americans. This project trained 13 experienced Community Health Advisors (CHAs) from Uniontown, Alabama, in the basics of oral health, including regular dental visits, and assigned them to spread this information among their fellow community members.

We tested whether a 1-year CHA-based oral health education intervention was associated with increased routine/preventive use of available dental services as measured by pre-post self-report, relative to a comparison community. We also hypothesized that any detected association between the intervention and use of dental services was mediated by attitudes toward dental visits.

No direct association was found between the intervention and use of dental services; however, a post hoc analysis revealed an indirect association between intervention and use, via attitudes toward the cost of a dental visit.

It can be concluded that a CHA-based intervention successfully influenced community attitudes toward dental visits, and these attitudes were, in turn, positively associated with use of dental services. While the data did not indicate a direct effect of the intervention on the use-of-services outcome, it appears the intervention may have indirectly affected this outcome via attitudes. More rigorous outcome-based evaluations of CHA-based interventions generally are needed.