Good Oral Health: a Bi-level Intervention to Improve Older Adult Oral Health

描述（由申请人提供）：本申请将扩展一个成功的NIDCR资助的双层口腔健康自我管理试点，在居住在一个老年人住宅楼的老年人/残疾人中进行，并使用修改后的部分析因设计进行评估。该理论框架是基于Fishbein的修改后的理性行动理论，称为行为预测的综合模型（IM）。它是通过适应性动机面试，互动定制的认知方法，和实践掌握（AMI-PM）操作。干预包括两个组成部分：1）面对面的AMI-PM管理; 2）有针对性的建筑物级运动，包括实践掌握（CA-PM）的原则。具体目标是：1）测试双水平干预的两个主要组成部分，以改善彼此相关的临床口腔卫生结果，并通过差异排序。2)识别有助于临床口腔卫生结果的认知和行为机制。3)评估行为和临床结果随时间的影响和可持续性。干预将分三个周期进行，每个周期150名参与者，共计N = 450。每个周期将包括两座大小和种族/语言组成相匹配的建筑物，供老年人和残疾人居住。在一种情况下，将引入个人层面的干预，然后再引入团体层面的干预。在第二种情况下，小组一级的干预将先于个人一级。在基线时以及第一和第二组分给药后进行的调查和临床测量。该设计将能够比较个体与组水平组分（T1-T2）的短期疗效以及干预措施的短期和长期疗效（T3 - 3个月）。6个月后T4时的临床测量将评价效果的可持续性。主要结果指标是牙龈指数和菌斑评分，这两项指标在试点研究中均显著改善。重要性在于通过在他们居住的地方开展口腔健康促进活动以及提高他们的能力， 使用随机对照试验的替代设计有效评价干预。

DESCRIPTION (provided by applicant): This application will extend a successful NIDCR-funded bi-level oral health self-management pilot conducted among older/disabled adults residing in one older adult residential building to six buildings and evaluate it using a modified fractional factorial design. The theoretical framework is based on Fishbein's modified theory of reasoned action called the Integrated Model (IM) of Behavioral Prediction. It is operationalized through Adapted Motivational Interviewing, an interactive tailored cognitive approach, and Practice-to-Mastery (AMI-PM). The intervention includes two components: 1) a face to face administration of the AMI-PM; and 2) a targeted building-level campaign that includes principles of practice to master (CA-PM). The specific aims are to: 1) Test the two main components of a bi-level intervention to improve clinical oral hygiene outcomes in relation to one another, and through differential sequencing. 2) Identify cognitive and behavioral mechanisms contributing to clinical oral hygiene outcomes. 3) Assess impact and sustainability of behavioral and clinical outcomes over time. The intervention will be carried out in three cycles of 150 participants each for a total of N=450. Each cycle will include two buildings matched by size and ethnic/linguistic composition housing older adults and those with disabilities. In one condition, the individual leve intervention will be introduced followed by the group level intervention. In the second condition, the group level intervention will precede the individual level. Survey and clinical measures taken at baseline, and following the administration of the first and second components. This design will enable comparison of the short term efficacy of the individual versus group level component (T1 - T2) and the shorter and longer term efficacy of the interventions (T3 - 3 months). Clinical measures at T4, 6 months later, will evaluate sustainability of effect. Primary outcome measures are gingival index and plaque score, both of which improved significantly in the pilot study. Significance lies in the potential of the intervention to address critical disparities in oral healh through oral health promotion initiatives in the locations where they reside as well as the ability to evaluate the intervention efficiently using a design alternative to the RCT.