Family Intervention with Caregivers of Children with Dental Needs

对有牙科需要的儿童的照顾者进行家庭干预

• 批准号: 8926935
• 负责人: Suchitra S. Nelson
• 金额: $ 64.18万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-12 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8926935
• 关键词: 11 year old; 9 year old; Acute; Address; African American; Appointment; Behavior Therapy; Behavioral; Caregivers; Caries prevention; Caring; Characteristics; Child; Chronic Disease; Cities; Clinic; Cognitive; Collaborations; Communities; Complex; County; Data; Data Analyses; Data Collection; Dental; Dental Care; Dental Care for Children; Dental caries; Dentists; Double-Blind Method; Effectiveness; Eligibility Determination; Emotional; Enrollment; Event; Family; Fluoride Varnishes; Goals; Grant; Health; Health Services Accessibility; Health Status; Healthy People 2020; Hispanics; Home environment; Informal Social Control; Intention; Intervention; Intervention Trial; Laws; Letters; Logistic Regressions; Low income; Mediating; Mediation; Medicaid; Medical; Minority; Modeling; Ohio; Oral health; Oregon; Parents; Perception; Phase; Population; Prevalence; Prevention program; Prevention trial; Primary Dentition; Private Practice; Process; Public Health; Questionnaires; Randomized; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Reporting; Resources; Rural; Schools; Site; Telephone; Testing; Thinking; Time; TimeLine; Tooth structure; Transportation; Universities; Visit; Washington; Writing; arm; base; behavior influence; burden of illness; care seeking; cost effective; critical period; demographics; design; elementary school; follow-up; fourth grade; health disparity; illness perceptions; improved; inner city; innovation; kindergarten; meetings; permanent tooth; primary outcome; programs; restoration; screening; second grade; social; success; theories; three-arm study; trend; urgent care

DESCRIPTION (provided by applicant): Dental caries (tooth decay) in 2--11 year olds is increasing especially among poor and minority populations, and it is unlikely that Healthy People 2020 goals will be met. Dental screening of children in elementary schools has been mandated in 12 states and endorsed by US organizations and WHO. In spite of enthusiasm for the concept, screening and standard referral letters have been ineffective in getting parents/caregivers to take children to the dentist. Caregiver-level engagement or action is necessary to motivate follow-up on child- level interventions at schools. Thus, we propose an experimental intervention based upon the Common Sense Model of Self-Regulation (CSM) to address parent/caregiver illness perception (cognitive representation: identity, consequences, controllability, cause, timeline; and emotional representation) and navigation of resources to increase receipt of dental care for children with restorative dental needs. The Specific Aims of the proposed multi-site double-blind Phase III randomized controlled clinical trial (RCT) study are: (1) Utilizing a three arm design, to evaluate the new CSM theory-driven referral letter alone or the new CSM referral letter + Dental Information Guide (DIG: facts about dental caries, hints for getting dental care, making appointments and Medicaid access, transportation and dentists availability resources) compared to a standard referral letter to increase receipt of dental care among inner-city urban African American, and rural Hispanic and White elementary school children; (2) To assess changes in parent/caregiver illness representation/perception and behavioral intention between the beginning and end of school year to understand the underlying mechanisms of the new vs. standard referral approach resulting in receipt of dental care. There will be 2 study sites: Ohio (East Cleveland City School District); Oregon (Jefferson County School District 509-J and Morrow County School District). All K-4th grade children and caregivers will be recruited through school district events. Children will be screened at beginning of the school year to determine caregiver eligibility for participation in the RCT. A total of 660 caregivers whose children have restorative dental needs will be randomized to the 3 study arms, and intervention letters will be sent home. Data collection includes: child baseline screening and follow-up dental exam at the study exit 7 mos later to determine if the child received care; caregiver illness perception questionnaire revised for dental (IPQ-RD) and a caregiver questionnaire at 3 time points (baseline, one-month after receipt of intervention letters exit). Data analysis for aim 1 includes a multivariate logistic regression model with adjustment for baseline characteristics; and aim 2 includes a generalized causal mediation analysis to delineate the mechanism (or paths) through which interventions impact dental care receipt. This behavioral intervention has the potential to change the public health standard of practice for screening by utilizing a cost- effective, easily transportable, and sustainable approach. The RCT is a collaboration of Case Western Reserve University and University of Washington Northwest Center to Reduce Oral Health Disparities.

描述（由申请人提供）：2--11岁的年轻人尤其是在穷人和少数群体中，龋齿（牙齿腐烂）正在增加，而健康的人2020目标不可能得到满足。在12个州授权对小学的儿童进行牙科筛查，并得到美国组织和谁的认可。尽管对该概念充满热情，但筛查和标准推荐信仍然无效地让父母/照顾者带孩子去牙医。护理人员级别的参与或行动对于激励学校的儿童级别干预措施是必要的。因此，我们提出了一种基于自我调节（CSM）的常识模型（CSM）的实验干预措施，以解决父母/护理人员疾病感知（认知表示：身份，后果，可控性，原因，时间表，时间表和情感表示）和资源导航以增加对有恢复性牙科需求的儿童牙科护理的收到的资源。 The Specific Aims of the proposed multi-site double-blind Phase III randomized controlled clinical trial (RCT) study are: (1) Utilizing a three arm design, to evaluate the new CSM theory-driven referral letter alone or the new CSM referral letter + Dental Information Guide (DIG: facts about dental caries, hints for getting dental care, making appointments and Medicaid access, transportation and dentists availability resources) compared to a standard referral letter增加城市城市非裔美国人以及西班牙裔和白人小学儿童的牙科护理的收到； （2）评估学年开始和结束之间的父母/照顾者疾病表示/感知和行为意图的变化，以了解新的与标准转诊方法的基本机制，从而获得牙科护理。将有两个研究地点：俄亥俄州（东克利夫兰市学区）；俄勒冈州（杰斐逊县学区509-J和莫罗县学区）。所有K-4年级的儿童和看护人将通过学区活动招募。孩子将在开始时被筛选 确定护理人员参与RCT的资格的学年。总共有660名儿童有恢复性牙齿需求的护理人员将被随机分配到3个研究臂上，干预信将被发送回家。数据收集包括：在研究出口7 MO的研究中，儿童基线筛查和随访牙科检查，以确定儿童是否接受了护理；护理人员疾病感知问卷调查了牙科（IPQ-RD）和护理人员问卷，在3个时间点（基线，收到干预信后的一个月后）。 AIM 1的数据分析包括一个多元逻辑回归模型，并调整了基线特征； AIM 2包括一般的因果中介分析，以描述干预措施影响牙科护理收据的机制（或路径）。这种行为干预有可能通过利用具有成本效益，易于运输和可持续的方法来改变筛查公共卫生的实践标准。 RCT是Case Western Reserve University和Washington Northwest Center的合作，以减少口腔健康差异。