ORAL HEALTH CARE PROFESSIONAL RESPONSE TO DOMESTIC VIOLENCE

家庭暴力造成的身体伤害通常出现在面部、头部和颈部。因此，口腔保健专业人员在解决这一重大公共卫生问题方面发挥着重要作用。最近的研究表明，许多口腔保健专业人员没有意识到头部和颈部损伤与家庭暴力之间的这种重要关系，也不确定他们在与患者解决这一问题方面所扮演的角色。此外，其他研究表明，许多口腔保健专业人员对向家庭暴力受害者提供帮助感到不舒服。在一项随机对照试验中，我们建议开发和测试教育和行为改变干预的有效性，旨在帮助口腔保健专业人员有效地克服不愿识别和治疗家庭暴力受害者，并对他们在照顾这一患者群体方面的知识、态度和行为产生积极的改变。这项工作的最终目标是帮助防止寻求牙科治疗的家庭暴力受害者受到进一步的暴力和口腔创伤的影响。研究对象将从北加州所有执业、在办公室工作的牙医和牙齿卫生员中招募，并随机分配到试验组或控制组。所有受试者将被要求在三个测量点--测试前、测试后(干预结束后立即)和六个月的随访--完成口腔健康专业书面调查。这项调查询问了牙医和牙科卫生师在识别、评估和干预家庭暴力受害者方面的知识、态度和做法。实验组参与者将接受有针对性的教育和行为改变干预，该干预基于本研究团队和其他研究团队证明成功的干预措施，但也包含独特的元素。干预措施的组成部分将包括1)个性化的测试前分数反馈(与所有受试者的“理想”反应或平均反应进行比较)；2)以技能为基础的课程，包括研讨会模块和基于互联网的自学模块；3)牙科记录提示卡(插入试验组所有新患者的牙科记录中)，提供一份方便的家庭暴力评估问题清单、有关社区援助计划的转介信息以及为受害者提供确认和支持的提示；4)以实践为导向的时事通讯，探讨口腔保健专业人员对在牙科保健环境中识别和帮助家庭暴力受害者的一些障碍的看法，并提出消除或减少这些障碍的方法。主要结果衡量标准将是牙医和牙齿卫生员在治疗和帮助家庭暴力受害者方面的知识、态度和行为，这是由口腔保健专业人员书面调查衡量的。

Physical injuries from domestic violence commonly appear in the areas of the face, head, and neck. For this reason, oral health care professionals have an important role to play in addressing this major public health problem. Recent studies have revealed that many oral health care professionals are unaware of this significant relationship between head and neck injuries and domestic violence, and are uncertain of their role in addressing this issue with their patients. Furthermore, other studies suggest that many oral health care professional feel uncomfortable offering assistance to domestic violence victims. In a randomized, controlled trial, we propose to develop and test the effectiveness of an educational and behavioral change intervention designed to help oral health care professionals effectively overcome reluctance to identify and treat victims of domestic violence, and to effect positive changes in their knowledge, attitudes, and behaviors with respect to caring for this patient population. The ultimate goal of this undertaking is to help prevent victims of domestic violence who seek dental care from being subjective to further violence and oral trauma. Research subjects will be recruited from among all practicing, office- based dentists and dental hygienists in Northern California and randomly assigned to either an Experimental or a Control Group. All subjects will be asked to complete the Oral Health are Professional Written Survey at each of three measurement points--pre-test, post-test (immediately following conclusion of an intervention), and six-month follow-up. This survey asks about dentists' and dental hygienists knowledge, attitudes, and practices regarding identifying, assessing, and intervening with patients who are victims are domestic violence. Experimental Group participants will receive a targeted educational and behavioral change intervention based upon interventions shown to be successful by this research team and by others, but incorporating unique elements as well. The components of the intervention will include 1) individualized feedback of pretest scores (compared against either an "ideal" response or the average response of all subjects); 2) Skills-based Course consisting of a seminar module and an internet-based, self-study module; 3) Dental Record Reminder Cards (to be inserted into the dental record of all new patients of subjects in the Experimental Group) that provide a handy checklist of domestic violence assessment questions, referral information regarding community-based assistance programs and tips for providing validation and support to victims; and, 4) Practice-oriented newsletters exploring oral health care professionals' perceptions of some of the barriers to identifying and aiding victims of domestic violence in a dental care setting, and suggesting ways to remove or reduce these barriers. The main outcome measures will be dentists' and dental hygienists' knowledge, attitudes, and behaviors regarding treating and assisting patients who are victims of domestic violence as measured by the Oral Health Care Professional Written Survey.