Public Health Nurses as Oral Health Advocates: A Feasibility Study

描述(由申请人提供)：有充分的文件证明，母亲的口腔健康状况与其子女的口腔健康直接相关，特别是在围产期。这种联系是复杂的，母亲的口腔健康状况以及母亲的知识、态度和健康行为都会影响儿童的口腔健康。幼儿龋病(ECC)是一种最常见的母婴传播的传染性慢性疾病，是母婴联系的一个典型例子。儿童感染变形链球菌(MS)的时间越早，儿童患龋齿的风险就越大。口腔健康状况较差的母亲，特别是存在未经治疗的龋齿的母亲，更有可能患多发性硬化症，更有可能感染她们的孩子，更有可能在更小的年龄感染他们的孩子。家访方案是专门为服务不足而制定的；据估计，处于危险中的儿童和每年有100多万儿童在家中接受保健。家访模式提供了一个理想的场所来结合旨在降低ECC患病率的口腔健康促进活动，因为1)这些项目已经针对牙病风险最高的儿童，2)健康促进是他们的主要目标之一，3)卫生专业人员提供预防服务，4)家庭卫生保健提供者比诊所提供者时间限制更少。基于慢性护理模式的原则，这项探索性研究旨在评估公共卫生护士将口腔健康促进活动纳入正在进行的产前和产后家访计划的可行性。具体目标包括：1)确定护士是否可以有效地提供以患者为中心的咨询和ECC预防的口腔健康促进模式，作为正在进行的围产期家访计划的一部分；2)确定护士在家庭环境中准确评估口腔健康状况的能力；以及3)确定患者对护士提供的口腔健康促进的接受程度。这项研究的长期目标是利用这些结果来设计和测试一种多方面的干预措施来预防ECC，该干预措施在家访环境中结合了以患者为中心的咨询和氟化物清漆应用。使用这一交付战略来满足高危妇女和儿童的口腔健康需求，如果在其他环境中复制，可能会对消除口腔疾病和口腔健康差距产生深远影响。

DESCRIPTION (provided by applicant): It has been well documented that a mother's oral health status is directly related to the oral health of her children, especially during the perinatal period. This association is complex, with maternal oral health status as well as maternal knowledge, attitudes and health behaviors all affecting the child's oral health. Early childhood caries (ECC), an infectious, chronic disease most commonly transmitted from mother to child, is a prime example of the maternal-child link. The earlier a child is infected with Mutans Streptococcus (MS), the bacteria primarily associated with dental caries, the greater the child's risk of developing dental caries. Mothers who have poorer oral health, especially the presence of untreated dental decay, are more likely to have higher rates of MS, more likely to infect their child and more likely to infect their child at an earlier age. Home visiting programs were specifically developed to reach underserved; at risk children and annually over 1 million children are estimated to receive health care in their homes. The home visiting model offers an ideal venue to incorporate oral health promotion activities aimed at reducing ECC prevalence since 1) these programs already target children at highest risk for dental disease, 2) health promotion is one of their primary aims, 3) health professionals provide preventive services and 4) home-based health care providers have less time constraints than clinic based providers. Building on the tenets of the chronic care model, this exploratory study is designed to assess the feasibility of public health nurses incorporating oral health promotion activities into an ongoing pre and post natal home visiting program. The specific aims include: 1) to determine if an oral health promotion model, with a focus on patient-centered counseling and ECC prevention, can be effectively delivered by nurses as part of an ongoing perinatal home visiting program; 2) to determine nurses' ability to accurately assess oral health status, in a home setting, and 3) to determine patient acceptance of oral health promotion being delivered by nurses. The long term goal of this study is to use these results to design and test a multifaceted intervention to prevent ECC that incorporates both patient centered counseling and fluoride varnish applications in a home visiting setting. Using this delivery strategy to address the oral health needs of high risk women and children, when replicated in other settings, could potentially have far reaching impact in eliminating oral disease and oral health disparities.