Changing Oral Health Norms and Hygiene Practices among Vulnerable Older Adults

描述（由申请人提供）：减少弱势低收入老年人和残疾成年人之间持续存在的口腔健康差距是《健康人2020》的核心目标，也是州卫生部门和地区机构在老龄化问题上的优先事项。对口腔健康以及预防和治疗替代方案的知识有限，语言和对口腔健康问题的认知上的文化差异，以及结构性障碍，共同增加了弱势群体的口腔健康差距。这项名为“改变弱势老年人的口腔健康规范和卫生习惯”的提案旨在通过开发和试点测试双层面（建筑和个人）认知/行为干预（Pro-GOH: Pro-Good口腔健康）来解决这些问题，以减少居住在康涅狄格州中部公共资助的老年住房中的弱势老年人、低收入群体、少数民族和残疾成年人在口腔健康方面的显著和持续差异。本文提出的干预模型是基于Fishbein修正的理性行为理论，即行为预测的综合模型（IM），该模型通过适应性动机访谈和从实践到精通（AMI-PM）进行操作。在社区居住的62岁及以上的低收入、残疾和少数族裔成年人中，有相当一部分人住在低收入老年人住房中。众所周知，他们是最容易受到抑郁症、慢性病、初级保健不足以及口腔和其他健康差距影响的人群。一个成功的试点干预将为在康涅狄格中部地区其他居住弱势老年人和残疾成年人的建筑物中开展基于RE-AIM方法的更大规模的有效性试验提供基础。拟议试点研究的目的是：1)进行形成性研究，2)在典型低收入老年住宅的个人和建筑层面进行干预试点，3)评估试点个人层面和建筑层面的干预过程的可行性、可接受性和保真度，4)进行个人层面的结果评估，将治疗楼的参与者与匹配的对照楼的参与者进行比较，使用干预前和干预后的两次评估。5)准备标准操作程序（SOP），评估措施和干预手册，用于康涅狄格州的广泛临床试验。

DESCRIPTION (provided by applicant): Reducing persistent oral health disparities among vulnerable low income older adults and adults with disabilities is a central objective in Healthy People 2020 and is a priority of state health departments and area agencies on aging. Limited knowledge of oral health and prevention and treatment alternatives, cultural differences in language and perception of oral health problems, and structural barriers combine to increase oral health disparities in vulnerable populations. This proposal, entitled "Changing Oral Health Norms and Hygiene Practices among Vulnerable Older Adults" aims to address these issues by developing and pilot testing a bi-level (building and individual) cognitive/behavioral intervention (Pro-GOH: Pro-Good Oral Health) to reduce significant and persistent disparities in oral health among vulnerable older low income, minority and disabled adults residing in publicly funded senior housing in Central Connecticut. The proposed intervention model is based on Fishbein's modified theory of reasoned action called Integrated Model (IM) of Behavioral Prediction operationalized through Adapted Motivational Interviewing and Practice-to-Mastery (AMI-PM). A substantial percentage of community-residing low income, disabled and minority adults aged 62 and over live in low income senior housing. They are known to be among those most vulnerable to depression, chronic diseases, inadequate primary care, and oral and other health disparities. A successful pilot intervention will provide the basis for a larger efficacy trial based on the RE-AIM approach in other buildings housing vulnerable older adults and adults with disabilities in the Central Connecticut area. The aims of the proposed pilot study are to: 1) Conduct formative research, 2) Conduct a pilot of the intervention at the individual and building level in a typical low income senior residence, 3) Evaluate the pilot individual-level and building-level intervention processes for feasibility, acceptability and fidelity, 4) Conduct an individual level outcome evaluation comparing participants in the treatment building with a matched control building, using a pre and two post intervention assessments, and 5) Prepare Standard Operating Procedures (SOP), evaluation measures and intervention manuals for use in a broad clinical trial in Connecticut. PUBLIC HEALTH RELEVANCE: The proposed study's primary significance lies in the potential of this experimental intervention to address significant disparities in oral health and consequent morbidity or reduced quality of life among vulnerable, low- income and primarily minority older adults and those with disabilities through prevention in the locations where they reside. The intervention could provide a model for programs to reduce oral health disparities across Connecticut and nationally.