Influence of Financial Incentives on Oral Disease Management in Young Children

经济激励对幼儿口腔疾病管理的影响

• 批准号: 9750049
• 负责人: STUART A GANSKY
• 金额: $ 180.95万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 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 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9750049
• 关键词: 3 year old; 5 year old; Adherence; Adopted; Adoption; Age; Award; Behavior; Behavioral; Blood Glucose Self-Monitoring; Blood Pressure; Body Weight decreased; Caregivers; Caries prevention; Child; Childhood; Cognitive Science; Collaborations; Color; Communities; Counseling; Country; County; Dental; Dental caries; Development; Disease Management; Early Intervention; Educational Intervention; Elements; Enrollment; Family; Feeling; Focus Groups; Frequencies; Gender; Geography; Gifts; Goals; Habits; Head Start Program; Health; Health Promotion; Health behavior; Health education; Incentives; Individual; Infant; Informed Consent; Intervention; Investments; Latin America; Latino; Lead; Los Angeles; Manuals; Measures; Modality; Motivation; Mouth Diseases; Office Visits; Oral health; Outcome Measure; Parents; Participant; Phase; Pilot Projects; Populations at Risk; Prevention strategy; Prevention trial; Preventive; Preventive dental care; Procedures; Protocols documentation; Qualitative Methods; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Rewards; Risk; Running; Standardization; Structure; Surveys; Target Populations; Testing; Time; Toddler; Tooth structure; Toothbrushing; Toothpaste; Visit; Water; Water fluoridation; Woman; base; behavior change; behavioral economics; behavioral outcome; cost; cost effective; cost effectiveness; design; digital; early childhood; effective intervention; evidence base; financial incentive; follow-up; high risk population; improved; incentive strategies; insight; intrinsic motivation; low socioeconomic status; multilevel analysis; nutrition; oral behavior; oral care; patient oriented; prevent; primary outcome; programs; public health relevance; recruit; residence; secondary outcome; smoking cessation; theories; trial design; voucher

 DESCRIPTION (provided by applicant): We propose an individually randomized Early Childhood Caries (ECC) controlled prevention trial to test the impact of micro-incentives (combined with infant oral care and tiered digital Anticipatory Guidance) on increasing attendance of regular oral care visits and parental adoption of ECC prevention behaviors in an at- risk population from Early Head Starts and Women and Infant and Children (WIC) programs in Los Angeles County. Previous studies have shown that mere health education is insufficient to make a lasting impact on health behaviors. Despite growing evidence that small, cost-effective interventions that leverage theories and insights from behavioral economics, which incorporate elements of cognitive psychology to understanding health behaviors, can promote behavior change, none have been applied to oral health interventions. Our proposed behavioral economics theory-driven study explores the use of micro-incentive mechanisms to motivate adoption of ECC prevention habits, and, through a phased approach, will identify the most effective micro-incentive and test its impact and cost-effectiveness. The target population of the trial is underserved Los Angeles Country children between 0 to 3 years old at enrollment and their caregivers. Both genders will be recruited. Eligible children must meet the following criteri: (1) Age 0-3 years; (2) Family geographic stability (greater Los Angeles residence); (3) Parental informed consent in English or Spanish; (4) Children registered as participants at EHS or WIC; and (5) Children at high caries risk. During the pilot phase (UH2), the study will explore the feasibility, acceptability, and appropriateness of different modalities of structuring micro-incentives and determine whether the community finds cash, noncash equivalent-value gift card/voucher, or lottery payouts acceptable through qualitative methods (focus group) and quantitative measures (surveys). The incentive size and modality likely to be effective will be used to design the UH3 phase trial. In addition, the pilot study will validate primary outcome measures, such as toothbrushing adherence and timely attendance to office visits, and will inform identification of secondary outcome measures, such as change in parental/caregiver behaviors for oral health promotion and disease management. The UH3 phase will randomize individual parents/caregivers in up to five Los Angeles County EHS and WIC centers to micro-incentives (as determined in the pilot phase) or no incentives for behavioral change and measure ECC preventive behaviors and child's oral health. The goal is to estimate the cost effectiveness and return on investment of micro-incentives in improving parent/caregiver behaviors and children's oral health.

 描述（申请人提供）：我们提出了一个单独的随机幼儿龋齿（ECC）对照预防试验，以测试微激励的影响（结合婴儿口腔护理和分层数字预期指导），提高早期启蒙和妇女、婴儿和儿童（WIC）高危人群定期口腔护理就诊率和父母采用ECC预防行为的比例在洛杉矶县的项目。以往的研究表明，单纯的健康教育不足以对健康行为产生持久的影响。尽管越来越多的证据表明，利用行为经济学的理论和见解，将认知心理学的元素纳入理解健康行为的小型，具有成本效益的干预措施可以促进行为改变，但没有一种被应用于口腔健康干预措施。我们提出的行为经济学理论驱动的研究探讨了使用微激励机制，以激励采用ECC预防习惯，并通过分阶段的方法，将确定最有效的微激励，并测试其影响和成本效益。 适用人群 试验对象为入组时0至3岁的服务不足的洛杉矶乡村儿童及其护理人员。男女都将被招募。符合资格的儿童必须符合以下标准：（1）年龄0-3岁;（2）家庭地理稳定性（大洛杉矶居住）;（3）父母以英语或西班牙语表示知情同意;（4）儿童在EHS或WIC注册为参与者;以及（5）高龋齿风险儿童。 在试点阶段（UH 2），研究将探讨可行性，可接受性，和适当的不同模式的结构微激励措施，并确定是否社区发现现金，非现金等值礼品卡/代金券，或彩票支付可接受的定性方法（焦点小组）和定量措施（调查）。可能有效的激励规模和方式将用于设计UH 3期试验。此外，试点研究将验证主要结局指标，如刷牙依从性和及时就诊，并将告知次要结局指标的确定，如父母/护理人员行为的变化，以促进口腔健康和疾病管理。 UH 3阶段将在最多五个洛杉矶县EHS和WIC中心随机分配个别父母/护理人员，以采取微激励措施（如试点阶段所确定）或不采取行为改变激励措施，并测量ECC预防行为和儿童口腔健康。 其目标是估计成本效益和投资回报的微激励措施，在改善父母/照顾者的行为和儿童的口腔健康。