Developing a Novel eHealth Application for Oral Systemic Issues during Pregnancy

描述(申请人提供)：口腔疾病是一种“无声的流行病”，因为它的流行和错过的预防机会。有证据表明，口腔系统病因，包括牙周病(PD)的影响，与整个生命过程中的一系列健康结果和共病(例如，不良妊娠和分娩结果；儿童早期携带；整个成年期的慢性病)之间存在联系。怀孕是生命过程中的敏感期，增加了母亲及其子女口腔健康不良的风险。尽管研究表明，大约40%的孕妇经历了帕金森氏症，但只有23%-35%的孕妇报告在怀孕期间去看牙医。随后，由美国妇产科医师学会(ACOG)和美国牙科协会(ADA)认可的提供者指南赋予了在怀孕期间接受口腔健康教育、评估和治疗的重要性。然而，在孕期采取积极的口腔保健做法的障碍包括：a)孕妇对孕期口腔保健的风险/益处存在误解；b)产前保健提供者在产前护理期间没有就口腔保健问题对患者进行评估、建议或转介；以及c)产前保健提供者与口腔保健提供者之间缺乏沟通和患者病例管理。不熟悉指导方针、自我效能低和环境限制(例如，缺乏时间；其他资源)也已被记录在案。因此，在将循证研究转化为产前护理实践方面解决这一差距是当务之急。我们的长期目标是在怀孕期间增加口腔系统预防努力，从而潜在地降低整个生命过程中健康不良的风险。该项目的目标是开发和确定消费者驱动的电子健康应用程序的可用性和可行性，该应用程序将促进将口腔保健指南转化为产前检查期间的实践。将通过以下目标实现：(1)评估临床系统与电子健康应用程序的互操作性，并通过以实施研究和创新扩散综合框架为基础的以消费者为基础的研究，确定利益攸关方(产前提供者、口腔健康提供者、诊所人员)的关键特征和特征；(2)根据来自目标1、咨询委员会的意见、信息-动机-行为技能(IMB)和简短的动机访谈结构/机制的信息，开发和预先测试互动原型；(3)进行可用性和可行性，以评估提供者IMB结构的可接受性和对提供者IMB结构变化的初步影响，包括根据指南的实践行为。这一创新、及时和理论驱动的项目有可能将与怀孕有关的口腔系统证据转化为实践，并促进专业间的合作，从而减少医疗保健系统中的差距。多学科团队拥有技能和专业知识，以确保成功实现目标，并确保这种新颖的干预措施导致一种改变当前实践范式的适销对路的产品。

DESCRIPTION (provided by applicant): Oral disease is a "silent epidemic" because of its prevalence and missed prevention opportunities. Evidence has established connections between oral-systemic etiologies, including the effects of periodontal disease (PD), and a range of health outcomes and co-morbidities across the lifecourse (e.g., adverse pregnancy and birth outcomes; early childhood carries; chronic conditions throughout adulthood). Pregnancy represents a sensitive period in the lifecourse increasing risk for poor oral health among mothers and their offspring. Although research indicates approximately 40% of pregnant women experience PD, only 23-35% of pregnant women report visiting a dentist during pregnancy. Subsequently, provider guidelines, endorsed by the American College of Obstetricians and Gynecologists (ACOG) and the American Dental Association (ADA), confer the importance of receiving oral health education, assessment, and treatment during pregnancy. However, barriers to positive oral healthcare practices during pregnancy include: a) misconceptions among pregnant women about risks/benefits of oral healthcare during pregnancy; b) prenatal providers not assessing, advising or referring patients on oral health issues during prenatal care visits; and c) lack of communication and patient case management between prenatal and oral health providers. Lack of familiarity with guidelines, low self-efficacy and environmental constraints (e.g., lack of time; other resources) has also been documented. Thus, it is imperative to address this gap in translating evidence-based research into prenatal care practice. Our long-term goal is to increase oral-systemic prevention efforts during pregnancy, thus potentially decreasing risk for poor health across the lifecourse. The objective of this project is to develop and determine the usability and feasibility of a consumer-driven eHealth application that will facilitate the translation of the oral healthcare guidelines into practice duing prenatal visits. This will be achieved through the following aims: (1) assess clinical system for interoperability with the eHealth application and identify key characteristics and features among stakeholders (prenatal providers; oral health providers; clinic personnel) through consumer-based research based on dimensions of the Consolidated Framework for Implementation Research and Diffusion of Innovations; (2) develop and pretest an interactive prototype based on information derived from Aim 1, advisory board input, and Information-Motivation-Behavioral Skills (IMB) and Brief Motivational Interviewing constructs/mechanisms; and (3) conduct usability and feasibility to evaluate the acceptability and preliminary impacts on changes in providers' IMB constructs, including practice behaviors per the guidelines. This innovative, timely and theory-driven project has the potential to translate pregnancy-related oral-systemic evidence into practice and facilitate inter-professional collaborations, thus decreasing gaps in the healthcare system. The multi-disciplinary team has the skills and expertise to ensure aims are successfully achieved and that this novel intervention leads to a marketable product that shifts the current practice paradigm.