Oral Health Promotion (OHPROM) Strategy for Persons with Intellectual & Developmental Disabilities

 描述(由申请人提供)：居住在集体之家的智力和/或发育障碍(IDD)患者与普通人群相比，更有可能患有糟糕的口腔卫生、不良的饮食习惯、更严重的龋齿、牙周病和全牙脱落--这是一个显著的健康差距。为了改善这一人群的口腔保健，我们正在进行分层整群第二阶段随机对照试验，以测试 针对居住在儿童之家的IDD患者的口腔健康促进(OHPROM)战略。这种干预是基于从文献中得出的行为和公共健康理论，并包括增强可持续性的特征。预计获同意的参加者包括约23名安老院经理、258名护理员，以及258名居于86间儿童之家的IDD患者。假设初步研究中观察到的流失率，预计最终参与者将是居住在80个团体之家的20名管理人员、240名照顾者和240名患有IDD的人。这些家庭由三个非营利性合作组织和ResCare的三个网站管理，ResCare是美国最大的IDD患者住宿服务提供商，位于肯塔基州和南印第安纳州的Metro Louisville地区或附近。经理负责一小群集体之家的照顾者的行为，通常是以前的照顾者，并且是受薪员工。照顾者负责确保缺乏症患者的日常个人卫生和饮食指导，他们是伙伴组织的受薪工作人员。OHPROM战略包括：(A)有计划的行动，要求照顾者签署行为合同并参与IDD患者的口腔健康行动规划；(B)照顾者能力建设，包括授课和观察性学习以及口腔保健设备；(C)通过张贴提醒海报和改变口腔卫生地点(物理环境)和行政口腔健康支持(社会环境)来适应环境；以及(D)通过照顾者辅导加强。研究的主要目标是评估住在集体之家的IDD患者的口腔健康状况的变化。第二个目标是评估近期和中期结果的变化(即变化机制)，以及这些结果在多大程度上缓和了对IDD患者口腔健康的干预效果。作为第三个目标，这项研究将评估提供给家庭管理者和照顾者的执行质量，以及干预部分与变化机制的联系。研究结果旨在通过论证基于理论的预防策略是否可以改善住在集体之家的IDD患者的口腔健康，并可能改善其他高危依赖人群的口腔健康，从而影响牙科和行为研究领域。最终，这项研究可能会在服务组织、口腔保健政策和研究组织的实践方面产生变化。推广经过测试的口腔健康策略，如果被证明是有效的，也是重要的；因此，为扩散建立基础设施也是研究的优先事项。

 DESCRIPTION (provided by applicant): People with intellectual and/or developmental disabilities (IDD) living in group homes are more likely to have poor oral hygiene, poor dietary practices, increased decay, periodontal disease, and total tooth loss than the general population-a significant health disparity. To improve the oral health care of this population, we are conducting a stratified cluster Phase 2 randomized controlled trial to test for the efficacy of an oral health promotion (OHPROM) strategy on persons with IDD living in group homes. This intervention is based on behavioral and public health theory derived from the literature and includes features to enhance sustainability. The sample of consented participants is projected to be about 23 home managers, 258 caregivers, and 258 persons with IDD who reside in 86 group homes. Assuming the attrition rate observed in a pilot study, it is projected that the final participants will be 20 managers, 240 caregivers, and 240 persons with IDD residing in 80 group homes. The homes are managed by three nonprofit partnering organizations and three sites of ResCare, the nation's largest provider of residential services to persons with IDD in or near the Metro Louisville area in Kentucky and Southern Indiana. Managers are responsible for the conduct of caregivers in a small cluster of group homes, are generally former caregivers, and are paid staff. Caregivers are responsible for ensuring daily personal hygiene and dietary guidance for persons with IDD and are paid staff of the partner organizations. The OHPROM strategy is comprised of (a) planned action that entails caregivers signing a behavioral contract and engaging in oral health action planning for persons with IDD, (b) caregiver capacity- building that includes didactic and observational learning as well as oral health devices, (c) environmental adaptations with reminder posters and change of oral hygiene location (physical environment) and administrative oral health support (social environment), and (d) reinforcement through caregiver coaching. The primary study objective is to assess change in oral health status of persons with IDD living in group homes. A second objective is to assess change in proximal and intermediate outcomes (i.e., mechanisms of change) and the extent to which these outcomes moderate the intervention effects on the oral health of persons with IDD. As a third objective, the study will assess implementation quality as delivered to home managers and caregivers and the association of intervention components with the mechanisms of change. The study results are intended to affect the fields of dentistry and behavioral research by demonstrating whether a theory-based prevention strategy can improve the oral health of persons with IDD living in group homes and may also improve the oral health of other at-risk dependent populations. Ultimately, the study may produce changes in service organizations, oral health care policies, and practices of the study organizations. Diffusion of the tested oral health strategy, if proven efficacious, is also important; thus, creating infrastructure for diffuson is also a study priority.