Interactive Parent-targeted Text Messaging in Pediatric Clinics to Reduce ECC

儿科诊所中针对家长的交互式短信可减少 ECC

• 批准号: 9530844
• 负责人: BELINDA BORRELLI
• 金额: $ 119.98万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9530844
• 关键词: 6 year old; Academy; Adopted; Adoption; Adult; Affect; African American; Age; American; Behavior; Budgets; Car Phone; Caries prevention; Caring; Cellular Phone; Child; Childhood; Chronic; Client satisfaction; Clinic; Community Health Centers; Community Healthcare; Computer software; Cultural Sensitivity; Data; Dental; Dental caries; Development; Diet; Diffusion; Disease; Documentation; Dose; Education; Educational Status; Electronic Health Record; Ensure; Ethnic Origin; Evidence based program; Feedback; Fluoride Varnishes; Fluorides; Focus Groups; Fostering; Goals; Group Interviews; Guidelines; Health Personnel; Health Promotion; Health Status; Health behavior; Health behavior change; Home environment; Incidence; Income; Individual; Insurance Coverage; Intervention; Interview; Latino; Legal Guardians; Lifting; Link; Lip structure; Low income; Measures; Mediator of activation protein; Minority Groups; Modeling; Oral; Oral health; Outcome Measure; Parents; Pediatrics; Phase; Population; Prevalence; Prevention; Preventive; Preventive Intervention; Process; Provider; Publishing; Race; Randomized; Recommendation; Recruitment Activity; Research; Sampling; Structure; System; Testing; Text; Textiles; Theoretical model; Time; Toothbrushing; Toothpaste; Training; United States; Visit; Work; aged; base; cost; design; early childhood; efficacy testing; ethnic minority population; experience; health disparity; health literacy; high risk; high risk population; improved; income disparities; innovation; intervention effect; literacy; multidisciplinary; novel; primary outcome; programs; public health relevance; racial disparity; racial minority; response; screening; social cognitive theory; tailored messaging; theories

 DESCRIPTION (provided by applicant): This application is in response to RFA-DE-15-006 "Multidisciplinary and Collaborative Research Consortium to Reduce Oral Health Disparities in Children: A Multi-level Approach." The prevalence of Early Childhood Caries (ECC) is increasing, disproportionately affecting racial and ethnic minorities (Dye, 2007). Prevention efforts for high risk groups require multi-level strategies. We will target parents/legal guardians of children (<6 years) during pediatric well-child visits at urban community health centers (CHCs), and provide a text-message based ECC prevention intervention. We will also target the pediatric providers in the CHCs to adopt oral health guidelines from the American Academy of Pediatrics (AAP) and also improve documentation within their Electronic Health Records (EHRs). Thus, our multi-level intervention includes children, parents, providers and the CHC system. 85% of adults use text messaging, with no disparities by race/ethnicity, education or income. The benefits of text message interventions include the use anywhere/anytime, low cost, scalability to large populations, ability to tailor message content and intensity, and provision of strategies in real time. CHCs are an ideal venue for oral health promotion both at an individual level (they provide care to the groups at highest risk for ECC) and at a population level (there are 90 CHCs electronically linked locally and >1,100 CHCs nationally). In Phase 1 (UH2), we will conduct focus groups and interviews with parents and CHC providers to inform the development of the oral health text message intervention, as well as assess CHC work flow to identify sustainable strategies for oral health integration and eventual dissemination. This formative work is vital to ensure cultural and environmental compatibility, as we have done previously. The text messages will be consistent with AAP guidelines, our theoretical model (Social Cognitive Theory), and our previous work. We will use the Fisher-Owens Model (2007) as an intervention planning framework. In Phase 2 (UH3), 850 parents/legal guardians of children <6 years attending our target CHCs will be randomized to receive one of two dose-equivalent text message interventions: Oral Health Texts (OHT) or Child Wellness Texts (CWT). The primary outcome variable will be ECC incidence at 24 months. We will assess mediators and moderators of the intervention effect, perform a budget impact analysis to determine the financial consequences of adoption, diffusion, and sustainability of the OHT intervention at CHCs, assess CHC changes in oral health promotion (provider practices and EHR documentation), and assess changes in both pediatric and parent oral health behaviors. This research has strong potential to be an evidence based program that could easily be adopted at low cost and low provider burden in the 1,128 CHCs in the U.S. that treat almost 4.5 million high risk children <6 years old. Our text message intervention is innovative because involves system-generated real time support, tailoring, feedback, and interactivity. Our study has theoretical significance because it integrates a testable theory with an intervention planning model to elucidate mechanisms of change at multiple levels.

 描述(申请人提供)：本申请是对RFA-DE-15-006“减少儿童口腔健康差距的多学科和合作研究联盟：多层次方法”的回应。儿童早期龋病(ECC)的患病率正在增加，对种族和少数民族的影响不成比例(Dye，2007)。针对高危人群的预防工作需要多层次的战略。我们将以父母/法定监护人为目标 在城市社区卫生中心(CHC)儿科健康儿童就诊期间对儿童(6岁)进行监测，并提供基于短信的ECC预防干预。我们还将针对儿童健康中心的儿科提供者采用美国儿科学会(AAP)的口腔健康指南，并改进其电子健康记录(EHR)中的文档。因此，我们的多层次干预包括儿童、父母、提供者和CHC系统。85%的成年人使用短信，没有种族/民族、教育或收入的差异。短信干预的好处包括随时随地使用、低成本、可扩展到大量人群、能够定制消息内容和强度，以及提供 实时的策略。社区卫生中心是促进口腔健康的理想场所，无论是在个人层面(它们为罹患ECC风险最高的群体提供护理)，还是在人口层面(有90家社区卫生中心和全国1,100家社区卫生中心通过电子方式连接)。在第一阶段(UH2)，我们会进行焦点小组讨论及与家长和社区健康中心提供者面谈，向他们介绍口腔健康短信干预的发展，以及评估社区健康中心的工作流程，以找出可持续的策略，把口腔健康纳入整体服务，并最终推广。这项形成工作对于确保文化和环境的兼容性至关重要，就像我们以前所做的那样。短信将与AAP指南、我们的理论模型(社会认知理论)和我们之前的工作保持一致。我们将使用Fisher-Owens模型(2007)作为干预规划框架。在第二阶段(UH3)，850名儿童父母/法定监护人将随机接受两种剂量相等的短信干预措施之一：口腔健康短信(OHT)或儿童健康短信(CWT)。主要的结果变量将是24个月时的ECC发生率。我们将评估干预效果的调解人和调解人，进行预算影响分析，以确定在CHC采用、传播和持续实施OHT干预的财务后果，评估CHC在口腔健康促进方面的变化(提供者实践和EHR文档)，并评估儿科和家长口腔健康行为的变化。这项研究有很大的潜力成为一项基于证据的计划，可以很容易地以低成本和低提供者负担在美国的1128家CHC中采用，这些CHC治疗了近450万6岁的高危儿童。我们的短信干预是创新的，因为它涉及系统生成的实时支持、定制、反馈和互动。我们的研究具有理论意义，因为它将可测试性理论与干预计划模型相结合，在多个层面上阐明了变化的机制。