Oral Health Promotion During Prenancy in a Group Prenatal Care Model

描述（由申请人提供）：怀孕期间通常是口腔健康（OH）问题增加的时期，但牙科保健的利用率，特别是在服务不足的妇女中；表明大多数低收入孕妇没有得到牙科护理。改善孕妇口腔健康：1)维护自身口腔健康；2)有可能改善其整体健康状况并减少其子女的幼儿龋齿；3)可能减少不良分娩结局。虽然一些国家组织建议妇女在怀孕期间接受牙科护理和婴儿口腔保健的预期指导，但许多妇女，特别是服务不足地区的妇女，不太可能得到这些重要的预防性保健服务。本项目的目的是开发和试点测试一种交互式教育和行为口腔健康促进（OHP）干预措施，以改善在旧金山湾区参加集体产前护理项目CenteringPregnancy （CP(R)）的低收入妇女的母婴OH状况、知识、态度和行为。随着团体数量的增加，目前全国超过200个，CP(R)是一种创新的团体护理模式，旨在提供全面的产前护理，并通过评估、教育和支持提高妇女的健康意识。OHP的发展将以社会认知理论为指导，将使用pre - PROCEED模型进行规划，并坚持CP(R)的基本护理组成部分：评估、教育和支持。研究包括两个阶段：第一阶段：发展和培训；第二阶段：试点测试和评估。第一阶段的目标是：1)与CP(R)的工作人员和参与者一起开发OHP课程，该课程将处理诱发（知识，态度），使能（技能培养，环境）和加强（反馈）OHP因素；2)与CP(R)社区协商制定可接受的研究程序，以评估OHP干预措施；3)培训8名CP(R)员工进行OHP试点干预。第二阶段的目标是：4)在2个CP(R)站点（n= 50名CP(R)参与者）对OHP干预进行试点测试，并检查前后OH状态的变化和OH相关结果；5)评估无OHP干预的2个CP(R)部位（n= 50名CP(R)参与者）相同OH因子的变化，以评估妊娠、无OHP的CP(R)计划和其他世俗因素引起的变化。我们将通过现场研究牙科检查和自我报告来评估OH状态。我们将通过问卷调查来评估母婴OH知识、态度和行为。如果成功，这些结果将用于开展一项全面的临床研究（RO1），该研究将正式测试OHP干预措施在改善孕妇及其子女口腔健康方面的功效。公共卫生相关性：许多妇女在怀孕期间得不到充分的口腔保健，特别是那些低收入和服务不足的群体。正如本R21申请中提出的那样，在一个完善的、创新的产前护理小组模式中，为接受产前护理的妇女开发一种促进口腔健康的干预措施，CenteringPregnancy （CP(R)）可能为促进妇女的口腔健康及其子女的口腔健康提供机会，并改善她们整个生命周期的整体健康。该申请的结果有望提供提交R01申请所需的初步数据，以正式测试口腔健康促进干预的效果，如果成功，可以在国内和国际的CP(R)项目以及其他产前护理团体中广泛实施。

DESCRIPTION (provided by applicant): Pregnancy is often a time marked by increased oral health (OH) concerns, yet dental care utilization rates, especially among underserved women; indicate that most low-income pregnant women do not receive dental care. Improving the oral health of pregnant women: 1) safeguards their own oral health; 2) has the potential to improve their overall health and decrease early childhood caries in their children; and 3) may reduce adverse birth outcomes. Although several national organizations recommend that women receive dental care and anticipatory guidance for infant oral health care during pregnancy, it is unlikely that many women, particularly those in underserved areas, are receiving these important preventive health services. The purpose of this project is to develop and pilot test an interactive educational and behavioral oral health promotion (OHP) intervention to improve maternal and infant OH status, knowledge, attitudes, and behaviors for low-income women attending a group prenatal care program, CenteringPregnancy (CP(R)), in the San Francisco Bay Area. With a growing number of groups, currently more than 200 nationally, CP(R) is an innovative group care model designed to provide comprehensive prenatal care and to advance women's sense of health awareness through assessment, education, and support. The OHP development will be guided by the Social Cognitive Theory, will use the PRECEDE PROCEED model for planning, and adhere to the essential care components of CP(R): assessment, education, and support. The study includes two phases: Phase 1: DEVELOPMENT & TRAINING and Phase 2: PILOT TEST & EVALUATION. Phase I aims are to: 1) develop, with CP(R) staff and participants, an OHP curriculum that will address predisposing (knowledge, attitudes), enabling (skills building, environmental), and reinforcing (feedback) OH factors; 2) consult with CP(R) community to develop acceptable research procedures to evaluate the OHP intervention; and 3) train 8 CP(R) staff to conduct the OHP pilot intervention. Phase II aims are: 4) pilot test the OHP intervention in 2 CP(R) sites (n= 50 CP(R) participants) and examine pre-post changes in OH status and OH-related outcomes; and 5) evaluate changes in same OH factors in 2 CP(R) sites (n= 50 CP(R) participants) without the OHP intervention to assess changes due to pregnancy, the CP(R) program without OHP, and other secular factors. We will assess OH status through on-site study dental exams and self- reports. We will assess OH knowledge, attitudes, and behaviors about maternal and infant OH through questionnaires. If successful, these results will be used to develop a full-scale clinical research study (RO1), which would formally test the efficacy of the OHP intervention in improving the oral health of pregnant women and their children. PUBLIC HEALTH RELEVANCE: Many women receive inadequate oral health care during pregnancy, especially those in low-income and underserved groups. As proposed in this R21 application, the development of an oral health promotion intervention for women receiving their prenatal care within a well-established, innovative, group model of prenatal care, CenteringPregnancy (CP(R)) may provide the opportunity to advance women's oral health and the oral health of their children, as well as improve their general health across the life span. The results of the proposed application will hopefully provide the preliminary data needed to submit an R01 application to formally test the efficacy of the oral health promotion intervention, which if successful, could be implemented widely in CP(R) programs nationally and internationally, as well as other prenatal care groups.