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奥尔兹儿童的龋齿（蛀牙）正在增加，特别是在贫困和少数民族人口中，不太可能实现2020年健康人的目标。12个州已授权对小学儿童进行牙科筛查，并得到美国组织和世卫组织的认可。尽管人们对这一概念充满热情，但筛查和标准的转诊信在让父母/照顾者带孩子去看牙医方面一直是无效的。必须有照顾者一级的参与或行动，以激励学校对儿童一级的干预措施采取后续行动。因此，我们提出了一个实验性干预的基础上的常识模型的自我调节（CSM），以解决父母/照顾者的疾病感知（认知表征：身份，后果，可控性，原因，时间轴;和情感的表示）和导航的资源，以增加接受牙科护理的儿童修复牙齿的需要。本多中心、双盲、III期随机对照临床试验（RCT）研究的具体目的是：（1）采用三组设计，单独评价新CSM理论驱动的转诊信或新CSM转诊信+牙科信息指南（DIG：关于龋齿的事实，获得牙科护理的提示，预约和医疗补助，交通和牙医可用性资源）与标准转诊信相比，以增加内城城市非裔美国人和农村西班牙裔和白色小学儿童接受牙科护理的机会;（2）评估父母/照顾者疾病陈述的变化/在学年开始和结束之间的感知和行为意图，以了解新的与标准转诊方法的潜在机制导致接受牙科护理。将有2个研究中心：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年级的儿童和照顾者将通过学区活动招募。儿童将在开始时进行筛查 以确定护理人员是否有资格参加RCT。共有660名儿童有牙齿修复需求的护理人员将被随机分配到3个研究组，并将干预信件寄回家。数据收集包括：儿童基线筛查和7个月后研究退出时的随访牙科检查，以确定儿童是否接受护理;在3个时间点（基线，收到干预信件退出后1个月）修订的牙科护理人员疾病感知问卷（IPQ-RD）和护理人员问卷。目标1的数据分析包括一个多变量逻辑回归模型，并对基线特征进行了调整;目标2包括一个广义因果中介分析，以描述干预措施影响牙科护理接受的机制（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的公共卫生实践标准。该随机对照试验是凯斯西储大学和华盛顿大学西北中心的合作，以减少口腔健康差异。