Promoting Behavioral Change for Oral Health in American Indian Mothers and Childr

促进美洲印第安母亲和儿童口腔健康的行为改变

• 批准号: 8662557
• 负责人: Terrence S. Batliner
• 金额: $ 33.46万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至 2017-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8662557
• 关键词: Age; Age-Months; American Indians; Behavior; Behavior Therapy; Behavioral; Birth; Caries prevention; Child; Clinic; Clinical; Clinical Trials Design; Communities; Community Participation; Community Services; Control Locus; Dental; Dental Hygienists; Dental caries; Development; Educational Intervention; Effectiveness; Effectiveness of Interventions; Family; Fluoride Varnishes; Fluorides; Future; General Population; Goals; Head Start Program; Health; Health Promotion; Health Services; Health behavior; Health education; Home environment; Incidence; Indian reservation; Intervention; Mediator of activation protein; Methodology; Mothers; Mouth Diseases; Newborn Infant; Oral health; Outcome; Outcome Measure; Pamphlets; Participant; Pattern; Pregnancy; Pregnant Women; Prenatal care; Prevention; Prevention approach; Prevention strategy; Preventive; Preventive Intervention; Protocols documentation; Provider; Randomized; Randomized Controlled Trials; Reporting; Research; Research Design; Reservations; Self Efficacy; Services; Shapes; Specialist; Stress; Testing; Time; Training; Visit; Woman; Work; base; behavior change; comparison group; cost effectiveness; disorder prevention; early childhood; experience; group intervention; health belief; health disparity; health knowledge; motivational enhancement therapy; northern plains; optimism; prevent; prevention service; primary outcome; programs; randomized trial; secondary outcome

The goal of RC1 is to demonstrate that the incidence of early childhood caries (ECC) in an American Indian (Al) reservation community can be reduced through the use of Motivational Interviewing (Ml) to change maternal oral health behaviors. The specific aims are: 1) to develop culturally relevant health education and promotional materials for use in ECC prevention with an Al community; 2) to manualize an oral health Ml intervention for pregnant women/mothers of newborns; and 3) to test this intervention in a randomized trial. All of the women, ages 15 or older, who are receiving prenatal care in the clinics of a large Northern Plains Al reservation, will be asked to participate in this trial, and all will be provided with the oral health promotion materials and aids, which will be developed using community participation strategies. For the demonstration trial, approximately 600 women will be randomly assigned to the Ml group, or the control condition. For those in the Ml group, oral health visits will be made to their homes prenatally and immediately after birth, then at 6, 12, 24, and 36 months of age. Children will be followed for 3 years, and caries assessments will be conducted by calibrated dental hygienists within 3 months of each child's 1st, 2nd, and 3rd birthday. The primary outcome will be annual increase in caries incidence. Secondary outcome measures will focus on caries patterns and cost-effectiveness of the program. A variety of mediators/moderators also will be examined, including such issues as mother's oral health knowledge and beliefs, stress, self-efficacy, and locus of control. AI/AN children have 3 times more untreated decay than children in the general population, and access to both preventive services and professional dental treatment are inadequate. The decision was made not to pair clinical/pharmacologic approaches with Ml in order to provide a definitive test of the most universally available strategy for prevention-that is, home oral disease prevention behaviors. If the effectiveness of Ml for preventing ECC can be demonstrated, future studies might look at adaptations for community implementation. It is anticipated that lessons from this study can be used to adapt the final protocol for RC3, which is focused on the provision of oral health prevention services (including fluoride varnish) by specially trained Al community oral health specialists working in Head Start Centers. There are implications for use with other clinical approaches to prevention as well. A major strength of this study is the extent to which involvement by representatives of the participant community, as well as Al health service providers, is shaping the development of materials and the design of the research protocol. This participation is expected to be a major asset for dissemination activities as well.

RC 1的目标是证明，在美国印第安人（Al）保留社区的幼儿龋齿（ECC）的发病率可以通过使用动机访谈（MI）改变母亲的口腔健康行为。具体目标是：1）开发与文化相关的健康教育和宣传材料，用于与Al社区一起预防ECC; 2）为孕妇/新生儿母亲制定口腔健康MI干预措施;以及3）在随机试验中测试这种干预措施。所有在大型北方平原Al保留地诊所接受产前护理的15岁或以上妇女将被要求参加本试验，所有人都将获得口腔健康促进材料和辅助工具，这些材料和辅助工具将采用社区参与策略开发。对于示范试验，将大约600名妇女随机分配到MI组或对照条件。对于Ml组中的那些，将在产前和出生后立即对其家中进行口腔健康访问，然后在6、12、24和36个月大时进行。儿童将被随访3年，龋齿评估将在每个儿童的1岁、2岁和3岁生日的3个月内由校准的牙科医生进行。主要结果将是龋齿发病率的年增长率。次要结果的措施将集中在龋齿模式和成本效益的计划。各种调解人/主持人也将进行检查，包括母亲的口腔健康知识和信念，压力，自我效能和控制点等问题。AI/AN儿童未经治疗的龋齿是普通人群儿童的3倍，预防服务和专业牙科治疗都不足。决定不将临床/药理学方法与MI配对，以便提供最普遍可用的预防策略的确定性测试，即家庭口腔疾病预防行为。如果可以证明MI预防ECC的有效性，未来的研究可能会考虑社区实施的适应性。预计本研究的经验教训可用于调整RC 3的最终方案，RC 3的重点是由在Head Start中心工作的经过专门培训的Al社区口腔健康专家提供口腔健康预防服务（包括氟化物保护漆）。这对其他临床预防方法的使用也有影响。这项研究的一个主要优势是参与者社区的代表以及Al保健服务提供者的参与程度，正在塑造材料的开发和研究协议的设计。预计这种参与也将成为传播活动的一项重要资产。