Nishtam Niwiipitan (My First Teeth): Oral Health Digital Stories from Urban Indigenous Parents

Abstract

Purpose:

To develop oral health–related digital story videos through interviews with Indigenous parents who shared their experiences in dealing with early childhood caries (ECC) in their children.

Methods:

Indigenous parents in Winnipeg, Manitoba, Canada, were recruited from community programs from October to December 2019 as part of the Nishtam Niwiipitan (My First Teeth), a community-based participatory research study that builds on an ECC intervention. A twofold qualitative narrative approach to data collection was used: 1) interviewing participants and creating digital stories and 2) taking part in the postfilming feedback interviews. Participants were interviewed via video in a semistructured format sharing their experiences and attitudes about caring for children with ECC and the challenges faced seeking dental care for the disease. The stories were drawn from parents in 3 predetermined groups: those with 1) children who had undergone dental surgery under general anesthesia, 2) children who had received silver diamine fluoride as an alternative to surgery to manage ECC, and 3) caries-free children. Prior to editing, the narrated stories were transcribed verbatim and analyzed thematically. The postfilming interview transcripts were also analyzed and coded for key themes.

Results:

Six parents and 1 grandparent, all of whom self-identified as Indigenous (First Nations or Métis) and cared for children aged <6 y, created the digital stories. Three key themes emerged from the postfilming interviews: ability to share, ability to help, and ability to change. Participants felt important, optimistic, and motivated throughout the process of making their digital stories.

Conclusion:

Digital storytelling offered First Nations and Métis parents a unique opportunity to share their experiences caring for children with ECC with the wider public. These videos can be incorporated into oral health promotion and ECC intervention programs as a culturally appropriate method for reaching Indigenous families.

Knowledge Transfer Statement:

The use and development of digital storytelling for oral health promotion have great potential for spreading awareness and sharing knowledge with Indigenous parents/caregivers about their children’s oral health and care practices. This health promotion tool is congruent with Indigenous ways of knowing, as Indigenous communities have a long tradition of oral history. The videos produced for this study will assist with oral health promotion efforts to address the high rates of early childhood caries in Indigenous communities in Canada.

Introduction

Early childhood caries (ECC), or tooth decay in children’s baby teeth, is a serious dental public health problem in Indigenous communities across Canada (First Nations, Métis, and Inuit) (Schroth et al. 2005; Lawrence et al. 2009; Schroth et al. 2009; First Nations Information Governance Centre 2012; Schroth et al. 2013; First Nations Information Governance Centre 2018; Holve et al. 2021). Some studies have suggested that the prevalence of ECC varies from population to population, with disadvantaged children, particularly those in low socioeconomic groups, being the most vulnerable (Reading and Wien 2009; First Nations Information Governance Centre 2012; Lawrence et al. 2016; Pierce et al. 2019; Tsai and Lawrence 2022). Oftentimes, cases of ECC are severe enough to require rehabilitative day surgery under general anesthesia (GA) (Schroth et al. 2016; Collado et al. 2017; Holve et al. 2021). Many of the studies noted here also indicate that the social determinants of health are the most common risk factors associated with the high rates of disease in vulnerable populations.

Approaches that have demonstrated effectiveness against ECC in lower-risk populations have not translated consistently to Indigenous communities (First Nations Information Governance Centre 2012; Holve et al. 2021). However, there is evidence that providing dental care to mothers during pregnancy, applying fluoride varnish to children’s teeth, and offering oral health education through motivational interviewing can have a positive impact on childhood oral health (Lawrence et al. 2008; Harrison et al. 2010; Harrison et al. 2012; Braun et al. 2016; Jamieson et al. 2018). Connection to traditional culture has also been identified as a strong predictor of improved health and well-being among Indigenous peoples (Cidro 2012; Greenwood and De Leeuw 2012; Hayward et al. 2021; Sanchez-Pimienta et al. 2021).

Oral culture is an integral part of Indigenous communities where education and knowledge are passed down from one generation to the next through storytelling. These stories are rich and multilayered and convey the essence of Indigenous culture and identity, exploring the history, customs, rituals, and practices as well as life experiences of the tellers and their communities (Archibald 2008; Kovach 2009; Cidro 2012; Nindibaajimomin 2014; Yasuda 2018). Storytelling as a research methodology is not new in Indigenous community-based research, but digital storytelling has recently emerged as a participatory, learner-centered multimedia approach that is an effective strategy to promote health and well-being (Gubrium 2009; Briant et al. 2016; Fletcher and Mullett 2016). Digital storytelling is an arts-based method and engaging process for the development of different health interventions (Gubrium 2009; Fletcher and Mullett 2016; Rieger et al. 2018), with great promise for oral health promotion. Digital storytelling can also be a tool for community-based participatory research, allowing new knowledge to emerge that is mediated by Indigenous perspectives and that returns this knowledge to communities as Indigenously informed (Gubrium 2009; Lambert 2013). The stories can influence Indigenous healthiness and resilience by offering a means of owning and being able to tell one’s story, thereby reclaiming one’s culture, language, and history (Gubrium 2009; Nindibaajimomin 2014; Park et al. 2021; Rieger et al. 2021). The digital storytelling method promotes community connection and cultural continuity: 2 factors associated with reducing negative health outcomes for the Indigenous peoples and their communities (Fletcher and Mullett 2016).

To date, no oral health–related digital stories have been developed based on investigating parents’ views and experiences with ECC and providing oral health care to their children. A qualitative method was undertaken to explore Indigenous parents’ perspectives on oral health care for their children and to share their stories and experiences about managing the disease. The purpose of this study was to interview First Nations and Métis parents to create oral health–related digital story videos that can be shared with other Indigenous child caregivers as part of oral health promotion and ECC intervention programs.

Methods

In the fall of 2019, Indigenous caregivers of young children participated in a digital storytelling project, nested in an ECC preventive study called the Nishtam Niwiipitan (My First Teeth; in Anishinaabe language), which integrated Indigenous digital storytelling with silver diamine fluoride (SDF) and fluoride varnish interventions to reduce the number of young children requiring hospital dental treatment under GA. The digital storytellers were First Nations and Métis parents or grandparents who resided in the city of Winnipeg, Manitoba, Canada.

A qualitative narrative approach within a constructivist framework, specifically a community-based participatory research approach, was used as the foundation to produce the videos of each storyteller. Community-based participatory research allows for respectful research with Indigenous peoples and for community members to lead the study and use the results as soon as they are ready for dissemination (Blue Bird Jernigan et al. 2020; Hayward et al. 2021). This particular study design gave parents/grandparents the opportunity to share their personal stories through the making of digital storytelling videos, which could then be used in their communities to disseminate important information about ECC while offering that advice from an Indigenous perspective.

Information about the study was disseminated to community programs from October to December 2019, and potential participants who showed interest were contacted and recruited on the basis of their indigeneity and the age (<6 y) and oral health status of their children. A maximum variation sampling method was used, and the storytellers were selected to elicit the widest range of perspectives possible about their children’s oral health experience. Participants were recruited strategically to fit different profiles so that videos could be developed that encouraged parents/grandparents to keep their children caries/cavity-free. Specifically, potential participants were recruited if they fit 1 of 3 profiles of parents participating in the larger Nishtam Niwiipitan (My First Teeth) study: they had 1) children who had dental surgery under GA, 2) children who underwent SDF treatment, or 3) children who were cavity-free. The intent was to produce at least two 5- to 8-min interview-style digital story videos per profile, and recruitment and interviews continued until data saturation was reached. Semistructured in-person interviews were conducted with the participants (storytellers) at a local film studio in Winnipeg. Interviews were video and audio recorded. The narrated data were transcribed verbatim and analyzed thematically by J.L. prior to the videos being edited. Quotes used in the Results section reflect the authentic communication of participants as transcribed. Participants also consented to being quoted directly for the published document and the digital story videos.

Ethics approval for the study was obtained from the University of Manitoba Biomedical Research Ethics Board (protocol approval HS22153 [H2018:367]). Written informed consent for participation in the study and the publication of digital stories was gained from parents/grandparents upon enrollment in the study. All those who participated had the opportunity to review their videos before publication. As primary data collector, the research coordinator (J.L.), recruited parents/grandparents for the interview-style video and the interview feedback component of the qualitative study. As part of this process, participants were invited to create a digital story by sharing their experiences about getting oral health care for their children, the challenges that they faced, and how they attempted to overcome those challenges.

All 3 researchers are non-Indigenous. R.J.S. and H.P.L. supervised J.L. R.J.S. and H.P.L. are senior oral health investigators who have lived experience conducting research with Indigenous communities in a manner that is respectful of Indigenous self-determination and research governance.

One-on-one coaching for participants was provided in preparation for filming the videos. To build the narrative for each video, in-depth interviews were used to stimulate discussion. These audio- and video-recorded interviews were guided by 12 questions developed by the project team (Table 1). Questions addressed various oral health concerns, such as oral health knowledge and perceived importance, and personal experiences, routines, and challenges while caring for their own oral health and that of their children. The questions were open-ended so that participants could respond in any way that they chose, including reframing the questions or bringing up additional thoughts. The digital stories were then developed in response to the questions in the in-depth interviews. As indicated earlier, the responses were transcribed, and an analysis was made about what was said thematically, meaning that interview transcripts were examined numerous times to identify recurring themes prior to the videos being edited. The total original length of the interviews ranged from 30 to 50 min per participant and, once edited, was condensed to 5- to 8-min digital story videos containing what we believed to be the key themes or messages.

Table 1.

Interview Guide for Making the Digital Story.

Interview Questions
1) Was oral health (your teeth and care for your mouth) ever a concern for you and/or for your child? If so, how? Why?
2) Do you think it is important for children to have healthy baby teeth? Why or why not?
3) Are you currently happy with your child’s teeth?
4) What are your current oral health care routines and practices with your babies or young children?
5) Do you have any information available to you regarding care for baby teeth? If so, where do you receive it from?
6) Are there/were there any challenges or barriers that you face when caring for your children’s teeth?
7) (With tooth decay): Specifically, are you able to overcome these barriers to accessing care? If so, how? OR (Cavity-free): If there were no barriers/challenges, what helped you avoid these barriers/challenges?
8) What would you say about how your overall dental experience is like? How about your child’s dental experience?
9) How have your personal journeys influenced your children’s baby teeth and the way that you care for them?
10) (With tooth decay): Is there anything that would help you to better take care of your children’s teeth? OR (Cavity-free): What are you doing/have been doing with/for your child for them to be cavity-free?
11) What kind of programs would you like to see in your community that would incorporate Indigenous traditions and values but would also address the oral health of your children?
12) (With tooth decay): If there was one thing you could do to improve your oral health, what do you think that would be? OR (Cavity-free): Are you satisfied with your oral health routine that you are doing with your child or do you think you can always add/improve on your current routine? If so, what would that be?

The digital storytelling videos were filmed at the Inner City Youth Alive: Story Studio (2019), a studio that is part of a local community program designed as a safe space where people can share their stories for the purpose of healing and connecting with others in this urban Indigenous community. On the day when they were filmed, the storytellers were encouraged to bring or later send via email project-relevant photographs and/or videos or any other image of their choosing to be incorporated in their digital stories. Part of creating a digital story is relating the personal narrative to images, sounds, video clips, audio clips, artwork, and other props that can be used to better illustrate the story (Nindibaajimomin 2014). For example, one storyteller brought the child’s toothbrush and toothpaste and demonstrated how she brushed her child’s teeth. Another brought a cell phone video of the child’s visit to the dentist.

After the filming and video editing were completed, all participants were asked to check and approve their digital story videos and were given a copy of their video to keep. None of the participants complained or asked for the final version of the videos to be reedited. The participants felt satisfied with the result of their digital story videos. Each storyteller received a gift card for their participation in the study. Following production, participants were followed up with semistructured interview questions about their experiences creating their digital story videos (Table 2). This postvideo interview, which was audio recorded, was conducted to determine whether participants believed that digital storytelling was an effective method of oral health promotion and education. The audio recordings were transcribed and analyzed by J.L., and following an in-depth review of the transcripts, the coding of key themes was carried out. The themes were shared with the other authors until consensus was reached on the most important themes. While this research was located within the contextual enterprise of Western research production, throughout the entire video-making and interview processes, techniques such as triangulation, audit trail, and member checking were carried out to enhance trustworthiness and credibility of the video editing that produced the final digital stories.

Table 2.

Guide for the Postfilming Interview.

Interview Questions
1) Do you feel that creating the digital stories allowed you to share your own personal story about your oral health care experiences? If so, how?
2) Do you feel that digital storytelling allows for truth-telling since it is coming directly from your own experiences?
3) How did you feel once you shared your stories?
4) Do you feel as though the digital storytelling workshop provided a comfortable and supporting space for you to share your stories?
5) Do you want to share your story so that others can learn from your experiences and make better decisions when caring for their oral health and their children’s oral health?
6) Do you feel a sense of importance by creating and telling these stories?
7) How do you feel people will react in response to seeing your digital story?
8) Do you feel as though sharing your digital stories can influence oral health care in your community?
9) Have you created or built any relationships in the process of creating your stories?
10) Do you reel that your thoughts and opinions were valued in the digital storytelling workshop?
11) Will you change the way you care for your teeth and your child’s teeth because of your involvement in the process of creating your digital stories?

Results

Six parents and 1 grandparent who self-identified as Indigenous (First Nations or Métis) with young children (age <6 y) participated in this qualitative study (Figure). All 7 participants were included (none were excluded), and all took part in the postvideo interview component. Most participants were First Nations mothers who had at least 1 child (maximum, 6 children). To recapitulate, the entire process consisted of 2 parts: the making of the digital story videos and the video-making feedback interview.

Figure.

Images of participants in digital story videos.

Part 1: Making of the Digital Story Videos

During the digital story filming process, 5- to 8-min videos were made from the one-on-one in-depth interviews with the parent/grandparent according to the 3 categories noted earlier: 1) children who had dental surgery under GA, 2) children who underwent SDF treatment, and 3) children who were caries-free (also referred to as cavity-free). These videos can be accessed and viewed on YouTube at https://www.youtube.com/playlist?list=PLhwt9uzBPOMK6TcoldmG8bwHWUCg5UkZU.

The digital story videos revealed that parents of caries-free children were aware of the importance of primary teeth and how “baby” teeth are connected to overall health through information gleaned intergenerationally from family members, via online sources, or from primary care workers at community centers or local health professionals (i.e., pediatricians or dentists/dental hygienists). They shared how taking care of baby teeth, especially once the teeth erupted, was important, and they expressed self-satisfaction with their children’s current oral health care routines. The following quotes reflect some of their responses to the interviewer’s questions on those routines (see Table 3 for more quotes):

Developing good habits when they are younger and getting them to that routine right from the get-go, I think it’s such an important life skill that they take with them always and I see that with my kids. . . . To me, it’s just like a cascade of events. If things aren’t healthy in the mouth, it affects just everything. Social well-beings, psychological well-being, and just the physical well-being. (mother of 2 caries-free children)

I used a wet cloth to clean the gums when he was a baby. . . . When he was a toddler, I let him brush his teeth but then after I brush his teeth right after he brushes his teeth just to make sure I get all the spots and the places he missed. (mother of 1 cavity-free child)

Their teeth are probably 9 out of 10, you know what I mean? So, it’s something to be happy about when the dentist tells you. . . . I took the bottles away pretty sooner, like a lot sooner, a year sooner [than his other children]. Their soothers they, those too like a year sooner. I got them off a lot quicker than I did my first boy because even though they whine and stuff, I knew that giving them just the bottle would even with a little bit of water and stuff instead of milk sometime and stuff. (father of 3 children, some caries-free and some who had dental extractions)

Table 3.

Participants’ Comments by Themes from Digital Story Videos.

Theme	Comments
Cavity-free children	It’s important. You have to start taking care of their teeth when their teeth start showing or even before their teeth starts showing. (mother of 1 cavity-free child) I am so proud to say that they are cavity-free, I’m proud to say that I never gave up because my kids. . . . They fought, they cried, they did all that, they resisted, but I just tried to use techniques, the tools that I would educate others about. (mother of 2 caries-free children)
SDF treatment	I am glad that we did this. . . . I feel better knowing that she didn’t have to go under. . . . The only thing is that her teeth [are] going to be black now, not the whole tooth but you know just that little part. But I’m glad that it’s going to stop the cavities. (mother of 1 child who received SDF treatment) A little bit, tiny bit I felt a little guilty because I was like, man they look like they just had a bunch of Oreo cookies. . . . But because I learned a little bit about [SDF treatment] it will be fine. It’s okay . . . I’ve seen other little kids with so much black stuff on their teeth and for my boys it’s just a few spots here and there. But I am glad that we did it for them. (mother of 6 SDF-treated children and children who had dental surgery under GA)
Dental surgery with or without GA	I’ve felt scared. Like I didn’t know what to expect. . . . She was 18 months when she got that done. You don’t know what’s going to happen. So, it’s just nerve wracking when you are just sitting out and waiting to see what’s happening. . . . You feel a little guilty thinking I could’ve prevented this somehow you know what I mean? You go through your mind what could I have done different that would’ve prevented it? (grandparent of 1 child who had dental surgery under GA) It was like heartbreaking I guess because I didn’t know what was going on. I knew she was asleep but like I wasn’t there to you know watch her and make sure she is safe. . . . Now they are getting their adult teeth and I’m like these are what you are going to have for the rest of your life, so you need to take care of them. . . . They improved some with having their teeth brushed. . . . I don’t want them to go through [the] pain and dental problems. (mother of 6 SDF-treated children and children who had dental surgery under GA) They brush their teeth; they floss with some nagging if I have to [chuckles]. We do, they do see the dentist regularly, like for their regular check-ups. (mother of 1 child who had dental surgery under GA)

GA, general anesthesia; SDF, silver diamine fluoride.

Parents whose children went through the SDF treatment or those whose children had dental surgery under GA shared that they had some feelings of fear and guilt about their children’s ECC. These parents also mentioned that their oral health care routines with their children had either changed or improved since the children had undergone the procedures.

Now they are getting their adult teeth and I’m like these are what you are going to have for the rest of your life, so you need to take care of them. . . . They improved some with having their teeth brushed. . . . I don’t want them to go through pain and dental problems. (mother of 6 SDF-treated children and children who had dental surgery under GA)

Along with the similarities in oral health care behaviors shared by the participants, there were variations in their experiences and stories. A few participants were critical of some aspects of the oral care that their children received. One grandparent reported that she could not remember caries being present in her community in the 1980s and 1990s, but she was now seeing more and more children with caries who were undergoing dental surgery. Another parent explained how she had to overcome a challenging relationship with a dentist who would not provide the requested care for her child, though she eventually found a dentist who was more open to working with her family. Other storytellers described the challenges accessing dental care that are particular to First Nations in Canada, including being “on treaty,” which means that their treaty rights do not cover certain dental procedures and they are required to pay for them “out of pocket.” Creating the digital story videos showcased these differences, thereby providing dental professionals with a means to better understand the dental care experiences of their Indigenous patients.

Part 2: Video-Making Feedback Interview

Through the interview and the video-making process, participants were able to voice their stories and create their personalized videos. Based on the postfilming feedback received from all 7 participants, 3 notable themes emerged. One theme was related to their ability to share personal stories and help others with those stories, thereby bringing change to their communities.

Ability to Share

According to the follow-up interviews conducted after the digital stories were made, participants felt positive about sharing their personal stories.

I felt very good to give my opinion about how to take care of my son’s teeth or my child’s teeth and my teeth in the future so that they don’t have any cavities, tooth decay, or any problems in the future. (mother of 1 cavity-free child)

It’s always good to get the message out there of my perspective and kind of how my perspective came to be that I am part Indigenous, but I am also an oral health professional so it’s you know, it’s part of who I am and because of my job too so. (mother of 2 cavity-free children)

It feels good to let other people know of what’s going on out there and to explain what you went through and everything. That will help them to get a better understanding of it. (grandparent of 1 child who underwent dental surgery under GA)

It felt good. It made me realize a lot too . . . me actually having to explain and let others know I guess my own story and it helped me realize a little bit more on what is going or helping this problem that I wanted to solve. So, I guess just hearing me say it out loud kind of the deal. (mother of 1 child who received SDF treatment)

Ability to Help

Most of the parents and the grandparent felt that it was important to be a part of a project where they could voice their opinions and spread awareness of oral health in young children. The participants also hoped that they could help other parents, grandparents, and caregivers who may view their videos in the future. Parents whose children underwent SDF treatment or had dental surgery under GA also shared what they learned through their experiences and were committed to not making the same mistakes again.

I believe that my opinions are valuable so that it helps other people to think about child’s oral health and on how to look after their teeth, take care of their teeth, taking them to the dentist every 6 months, and brush your teeth every morning and night, and to avoid any sugar, chocolate, and candy. (mother of 1 cavity-free child)

Maybe other people seeing people who are similar to them that they would be able to, I guess get information . . . maybe I might have an answer here and there that you know that they wouldn’t have thought of or there was a question in there that they may or may have not thought to ask. (mother of 1 child who underwent dental surgery under GA)

I can see how it would be very impactful to hear somebody else speak who you can relate to and be like, Hey, that’s just like me, they are going through the same struggles. (mother of 2 caries-free children)

I think they want to listen and find out what I did to make their teeth better for them. . . . I’m probably using words and stuff for describing it a bit better than they could understand with a doctor’s big words. (father of 3, some caries-free and some who had dental extractions)

I feel better off letting other people know that there is help out there. . . . Hopefully, they will listen and take care of their children or their grandchildren and make sure that they are doing right with their teeth. (grandmother of 1 child who had dental surgery under GA)

Sharing my story to help others make their own decisions, not based off of what I have gone through, but to gather their own experience and you know, be able to tell that to others. . . . I don’t know how important my story might be; I think it’s more the awareness that I could bring. (mother of 1 child who had dental surgery under GA)

I’m hoping some will relate to it and not feel so I guess bad, or you know? No parent wants to see their kids or hear that they need to go under and go in for surgery. So, I am really hoping that it does help them. (mother of 1 child who received SDF treatment)

Parents whose children received the SDF treatment expressed that non-GA pathway options should be promoted more often when managing caries. They shared that additional information should be provided to parents/grandparents and other caregivers so that they can be made aware of all the treatment options available for their children. These parents also indicated that the videos would encourage parents/caregivers to take an interest in new nonsurgical approaches to managing ECC rather than relying solely on the “traditional” GA approach. Some of the responses about treatment included the following:

They never heard of anything like this. Most of the time so far, almost everybody I’ve told [about the SDF treatment] they were really surprised . . . and they liked that idea instead of having their kids to be put under or you know, having to watch their kids go through all of this pain and yeah. (mother of 1 child who received SDF treatment)

If you don’t want to have your kids’ teeth blackened or taken out, start taking care of them a lot sooner than [when they are] 1-year-old even. Or just be consistent with brushing every day. . . . The pain that comes with neglecting your teeth is not worth it. . . . If the parents can find out a lot sooner, even with the resources that they have to access and help with dental care, it would be good. (mother of 6 SDF-treated children and children who had dental surgery under GA)

Ability to Change

Many participants believed that viewing videos such as the ones that they helped develop would result in increased oral health awareness and understanding. They also believed that more information about children’s oral health care, such as that provided through the interventions, would bring about improvements to children’s oral health in not only their communities but other Indigenous communities across Canada. Many hoped that the digital stories would affect others and change the way that they care for their children’s oral health:

I hope [the video] encourages parents and caregivers to look after their child’s teeth more. . . . I want people to be more aware of how to take care of their child’s teeth and oral health. (mother of 1 cavity-free child)

I hope people will respond positively. . . . I think in this day and age this type of digital story telling could reach more people. This type of technology and everybody’s daily use of technology I think is a really good combination for more people hearing the message. (mother of 2 caries-free children)

People can watch and learn and basically understand what’s going on through other people, their own kind of people explaining it to them what’s going on. (grandparent of 1 child who had dental surgery under GA)

It’s coming from our people . . . the ones that we know and can trust. . . . People understand that baby teeth are important. Hopefully they listen. (father of 3, some caries-free and some who had dental extractions)

I don’t know if it will [help] but there is always that hope that people will and can be influenced by [the videos]. Being informative; that there is just another perspective, right? It’s not coming from a dentist or a doctor or you know; it’s coming from people. (mother of 1 child who had dental surgery under GA)

I hope that they learn from it. I hope that they think, Oh man, that mama bear waited way too long and I’m not going to be like that. I’m going to take care of their teeth a lot sooner. . . . I hope that . . . it encourages them to make a change. (mother of 6 children who had SDF treatment and dental surgery under GA)

Seeing people with no teeth when they get older and how difficult it is for them to eat and, you know, even just to smile. I don’t want [my children] to end up being like that when they are older. (father of 3 children, some caries-free and some with dental extraction)

Discussion

Our aim was to work together with Indigenous parents and to listen to their experiences to develop videos that can be used to promote early childhood oral health and prevent ECC. Our findings suggest that the digital storytelling process is an experiential and effective way to motivate positive change and create discussions about oral health care behaviors in Indigenous communities. As far as we know, this is the first qualitative study on the digital story video-making process by Indigenous community members that focuses on early childhood oral health and ECC. Participants were aware of how the overall well-being of their children was affected by ECC as well as the difficulties associated with preventing and managing the disease. Dental surgery under GA tends to create fear and anxiety for many parents and caregivers of young children (Amin et al. 2006; Schroth et al. 2016; Collado et al. 2017). To reduce such fears, there is a growing interest in new approaches and treatment options that are less invasive and nonsurgical, such as SDF treatment for caries arrest. However, at present, Indigenous parents’ acceptance of SDF as a treatment option is contingent on having more information and assurance that it will help their children avoid ECC treatment under GA (Kyoon-Achan et al. 2020). We intentionally included 1 video that shared a mother’s experience with the SDF treatment for her child to inform and to allay any concerns about the application procedure.

Feedback provided after the participants’ filming experience was important and proved informative. Parents whose children received dental treatments (SDF or dental surgery under GA) communicated that the process of creating the digital story videos was self-motivating in bringing about behavioral changes where their children’s teeth and oral health were concerned; it also allowed them to motivate others to change their oral health behaviors. Although there is no mention in the literature of digital storytelling being used for oral health promotion, there have been studies that found an increase in oral health–related knowledge and beliefs through the use of storytelling interventions, though not via digital media (Archibald 2008; Kovach 2009; Cidro 2012; Heaton et al. 2018; Heaton et al. 2019). The involvement of Indigenous parents and 1 grandparent in creating these oral health–related digital story videos was a very positive experience for all involved. The participants all expressed that this method of oral health promotion was informative, educational, and a culturally safe tool for addressing ECC and oral health care in young children. The videos allowed the participants to share their personal experiences so that others might be able to relate and learn from those experiences. In the journey of making the videos, some participants were able to reflect on their oral health care behaviors through the interview-guiding questions that were asked.

The use of digital stories is a relatively new, groundbreaking tool for any health promotion that can be used by a range of communities (Gubrium 2009). The digital stories may be a particularly appropriate tool for health promotion in 1) communities with strong oral history traditions that might have lower literacy rates and where life learning can occur through storytelling (Rieger et al. 2018; Yasuda 2018; Park et al. 2021; Rieger et al. 2021) and 2) communities working to improve connection and/or intergenerational knowledge exchange (Fletcher and Mullett 2016). Therefore, in communities that are rich in oral tradition but have poor literacy and economic opportunities, digital storytelling projects can be useful for health promotion. Iseke (2013) highlighted the practicality of the process of digital storytelling for building community relationships, especially in Indigenous communities.

The participatory research methodology allowed Indigenous parents to create stories that were relevant to their own experiences, capturing their true voices, as opposed to a structured approach to digital storytelling that might limit those same voices. The importance of one’s history and culture were featured in these digital stories as a key health-promoting factor. Until recently, Indigenous peoples had far fewer opportunities than others to tell their stories and to be heard outside their communities. The storytellers reported that because the videos were made by Indigenous people living off reserve in an urban area, rather than by health care professionals, they believed that this form of oral health promotion can have a much greater impact on their communities than traditional forms, such as posters, pamphlets, and fact sheets.

When specifically asked about the community impact of their stories, the majority expressed their desire to help others by sharing information about their personal experiences. Through this opportunity, participants hoped to show others facing similar circumstances that they were not alone. The potential power of digital storytelling was supported when permissions were granted by the participants to share their digital story videos on YouTube for educational and outreach purposes that extend well beyond their communities. Through the increasing use of the internet and social media, digital storytelling can provide an ideal format for sharing one’s story with other Indigenous communities and the wider Canadian population. Overall, the ability to access digital products and the engaging nature of the digital story make this methodology a valuable tool for health promotion (Fletcher and Mullett 2016; Park et al. 2021; Rieger et al. 2021). Digital stories can provide empathy, strength, and encouragement to the target audience (Briant et al. 2016), and the quality of health care can be improved through the use of digital stories to assist in bridging communication between providers and patients (Park et al. 2021). It can also be used as a knowledge translation tool for key stakeholders, such as patients, caregivers, policymakers, and other health care professionals (Park et al. 2021).

This study is not without some limitations. Even though the sample size was small (we had only 7 participants), we managed to create 7 digital story videos and categorize them into 3 themes. Another limitation is that participants’ views may not be generalizable to all members of their communities or to other Indigenous communities in Manitoba or elsewhere in Canada. In trying to keep the questions consistent with the interview guide throughout for all participants, some questioning based on specific categories was also limited. Other obvious limitations of digital storytelling involve computer technology and literacy requirements, as well as internet access, particularly in rural and remote communities where internet access can be intermittent or unavailable. At the same time, there are several advantages to using modern technology for telling stories. Stories that were created through digital storytelling can be shared instantly and simultaneously with remote communities that might have limited access to care. Last, concerns have been raised in American Indian and Alaskan Native populations about the decline of storytelling and the oral tradition in their communities, which hinders the translation of oral health knowledge, including methods for ECC prevention (Heaton et al. 2018). The decline of the oral tradition is, in fact, due to the arrival of modern technology and digital communications, which has weakened the acceptability of the oral delivery of health messaging among the younger generation (Heaton et al. 2018). However, by the blending of traditional oral storytelling, digital technology, and existing oral health messaging, we are honoring traditional Indigenous cultural ways of knowing and doing, and we are tailoring those ways to the modern digital age.

Conclusion

The digital storytelling method facilitated interactions and engaged Indigenous parents in creating a digital representation of oral health in general and their experiences caring for children with ECC in particular. The video-making process and the feedback that resulted provide a critical reflection on personal, historical, and cultural ideas about oral health and what it means to Indigenous parents. Our evidence suggests that digital storytelling is a relevant oral health promotion tool in Indigenous communities, where strong oral history traditions already exist. The incorporation of digital storytelling as an adjunct to ECC interventions has the potential to result in greater awareness and improved early childhood oral health behaviors among parents, increased use of dental services, and reduced incidence of preventable oral disease in the target population.

Author Contributions

J. Lee, contributed to conception and design, data acquisition, analysis, and interpretation, drafted and critically revised the manuscript; R.J. Schroth, H.P. Lawrence, contributed to conception and design, data analysis and interpretation, drafted and critically revised the manuscript.