Developing Topical Fluoride Hesitancy Measures for Causal Modeling and Intervention Research

局部氟化物有助于防止龋齿，是儿童和青少年牙科就诊的常规部分。 然而，对氟化物的安全性、必要性和有效性的担忧导致了氟化物的产生。 犹豫不决，导致一些父母拒绝为孩子进行氟化物治疗。我们的数据显示，13%的 父母在看牙医或就医时拒绝外用氟化物，这与疫苗拒接率相似。许多 更多的父母可能会接受氟化物，但犹豫不决。根据牙医的说法，氟化物的犹豫不决和拒绝 越来越多的问题，但许多牙医没有意识到向所有人提供氟化物的普遍方法 不管有没有患龋齿的风险，孩子们可能是造成这个问题的原因之一。说服犹豫不决和拒绝 为了让父母接受氟化物，牙医依赖家长式的教育方法，这种方法在很大程度上对 改变父母的信仰或行为。这是因为单纯的教育忽视了一个具体的原因(S) 家长对氟化物的问题犹豫不决。当改变父母行为的努力失败时，一些牙医对此不屑一顾 从医的患者和大多数牙医都避免在接下来的时间里向犹豫不决的父母谈论氟化物 避免冲突的探访。基于行为风险的方法可以帮助牙医解决氟化物的犹豫不决和 在临床实践中拒绝。将需要经过验证的措施来评估这些方法，但这些措施 目前还不存在。在这项措施发展研究中，我们将解决这一关键差距。我们将使用 理解氟化物犹豫和拒绝的健康信念模型和扩展的平行加工模型 并开发两种用于研究和临床环境的测量方法。其目的是：(1)建设 局部氟化物犹豫不决/拒绝的理论模型；(2)开发和验证两种测量方法-a 用于识别犹豫/拒绝氟化物的父母的筛查工具和用于识别 外用氟化物犹豫/拒绝的原因(S)；(3)决定氟化物犹豫/拒绝行为的稳定性。研究完成后，下一步将是设计一项行为临床试验，其中包括多管齐下的方法，解决父母氟化物的具体原因(S)-犹豫/拒绝，以及卫生保健提供者使用的适当沟通策略，包括孩子的龋齿风险。我们的长期目标是改善高危儿童和青少年的口腔健康结果，否则他们可能没有机会受益于氟化物，从而解决降低龋齿发生率和实现健康公平的日益增长的威胁。这项拟议的研究涉及2020年健康人S口腔健康目标1和8，以及医疗保险和医疗补助口腔健康中心关于获得高质量牙科护理的倡议。通过将牙科作为实验室，拟议的工作广泛适用于理解和解决公共卫生中的类似问题，如疫苗拒绝接种和其他现象 涉及复杂健康信息的交流、父母对这些信息的解释、对健康风险和益处的看法，以及与卫生保健相关的决策。

Topical fluorides help prevent tooth decay and are a routine part of dental visits for children and adolescents. However, concerns about the safety, necessity, and effectiveness of fluorides have resulted in fluoride hesitancy, leading some parents to refuse fluoride treatment for their children. Our data indicate that 13% of parents refuse topical fluoride during dental or medical visits, which is similar to vaccine refusal rates. Many more parents may accept fluoride but are hesitant. According to dentists, fluoride hesitancy and refusal are growing problems, but many dentists do not realize how universal approaches of providing fluoride to all children regardless of caries risk may have contributed to the problem. To convince hesitant and refusing parents to accept fluoride, dentists rely on paternalistic educational approaches that are largely ineffective at changing parents’ beliefs or behaviors. This is because education alone ignores the specific reason(s) why a parent is hesitant about fluoride. When efforts to change parent behaviors fail, some dentists dismiss these patients from their practices and most dentists avoid talking about fluoride to hesitant parents at subsequent visits to avoid conflict. Behavioral risk-based approaches could help dentists to address fluoride hesitancy and refusal in clinical practice. Validated measures will be needed to assess such approaches, but such measures currently do not exist. In this measure development study, we will address this critical gap. We will use the Health Belief Model and the Extended Parallel Process Model to understand fluoride hesitancy and refusal behaviors and to develop 2 measures for use in research and clinical settings. The Aims are to: (1) Construct a theoretical model of topical fluoride hesitancy/refusal; (2) Develop and validate 2 measures – a screening tool to identify fluoride hesitant/refusing parents and a diagnostic instrument to identify the reason(s) for topical fluoride hesitancy/refusal; and (3) Determine the stability of fluoride hesitancy/refusal behaviors. After the study is completed, the next step will be to design a behavioral clinical trial that incorporates a multi-pronged approach that addresses the specific reason(s) a parent is fluoride- hesitant/refusing and appropriate communication strategies used by health providers that incorporate a child’s caries risk. Our long-term goal is to improve oral health outcomes in high-risk children and adolescents who may otherwise not have an opportunity to benefit from fluorides, thereby addressing a growing threat to reducing dental caries rates and achieving health equity. The proposed study addresses Healthy People 2020’s Oral Health Objectives 1 and 8, and the Centers for Medicare and Medicaid Oral Health Initiative on Access to Quality Dental Care. By using dentistry as a laboratory, the proposed work is broadly applicable in understanding and addressing similar issues in public health like vaccine refusal and other phenomena involving communication of complex health information, interpretation of this information by parents, perceptions of health risks and benefits, and health care-related decision making.