Public Health Nurses as Oral Health Advocates: A Feasibility Study

描述（由申请人提供）：有充分的证据表明，母亲的口腔健康状况与她的孩子的口腔健康直接相关，特别是在围产期。这种关系是复杂的，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。幼儿龋齿（ECC）是一种最常由母亲传染给儿童的传染性慢性疾病，是母婴关系的一个主要例子。儿童越早感染变形链球菌（MS），这种细菌主要与龋齿有关，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蛀牙的母亲，更有可能患多发性硬化症，更有可能感染他们的孩子，更有可能在更早的年龄感染他们的孩子。家访计划是专门为服务不足的人制定的；据估计，每年有100多万处于危险中的儿童在家中接受保健服务。家访模式提供了一个理想的场所，以纳入旨在降低ECC患病率的口腔健康促进活动，因为1)这些计划已经针对口腔疾病风险最高的儿童，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有更少的时间限制。基于慢性护理模式的原则，本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。具体目的包括：1)确定以患者为中心的咨询和ECC预防为重点的口腔健康促进模式是否可以作为围产期家访计划的一部分，由护士有效地提供；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。本研究的长期目标是利用这些结果设计和测试多方面的干预措施，以预防ECC，其中包括以患者为中心的咨询和家访环境中的氟化物清漆应用。利用这一提供战略来解决高危妇女和儿童的口腔卫生需求，如果在其他环境中加以推广，可能会对消除口腔疾病和消除口腔卫生差距产生深远影响。

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.