Developing Topical Fluoride Hesitancy Measures for Causal Modeling and Intervention Research

为因果建模和干预研究制定局部氟化物犹豫措施

• 批准号: 10237416
• 负责人: Donald Leslie Chi
• 金额: $ 34.36万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10237416
• 关键词: Address; Adolescent; Advisory Committees; Awareness; Behavior; Behavior Therapy; Behavioral; Belief; Benefits and Risks; Child; Child Health; Clinical; Clinical Trials; Communication; Complex; Conflict (Psychology); Data; Decision Making; Dental; Dental Care; Dental caries; Dentistry; Dentists; Development; Diagnostic; Education; Effectiveness; English Language; Ensure; Evidence based treatment; Exhibits; Feedback; Fluoride Varnishes; Fluorides; Foundations; Future; Goals; Grant; Health; Health Insurance; Health Personnel; Healthcare; Healthy People 2020; Home; Income; Intervention; Intervention Studies; Interview; Laboratories; Length; Liquid substance; Low income; Measures; Medicaid; Medical; Medicare/Medicaid; Methods; Modeling; National Institute of Dental and Craniofacial Research; Oral health; Outcome; Parents; Patients; Perception; Physicians; Prevention; Preventive; Preventive care; Preventive dental care; Preventive service; Primary Prevention; Process; Public Health; Reporting; Research; Resistance; Risk; Safety; Screening procedure; Subgroup; Testing; Theoretical model; Time; Toothpaste; Topical Fluorides; Vaccines; Validity and Reliability; Visit; Water fluoridation; Work; base; behavioral clinical trial; causal model; checkup examination; clinical practice; cognitive interview; design; effectiveness measure; field study; health belief; health communication; health equity; health inequalities; high risk; improved; instrument; prevent; programs; systematic review; theories; therapy design; vaccine hesitancy

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.

局部氟化物有助于预防蛀牙，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氟化物 这导致一些父母拒绝为他们的孩子进行氟化物治疗。我们的数据显示， 父母在看牙医或就医时拒绝使用局部氟化物，这与拒绝接种疫苗的比例相似。许多 更多的家长可能会接受氟化物，但犹豫不决。据牙医说，氟化物犹豫和拒绝是 越来越多的问题，但许多牙医没有意识到如何普遍的方法，提供氟化物给所有 儿童无论患龋的风险可能有助于这个问题。说服犹豫和拒绝 父母接受氟化物，牙医依靠家长式的教育方法，在很大程度上是无效的， 改变父母的信仰或行为。这是因为教育本身忽视了一个人为什么会有这样的具体原因。 父母对氟化物犹豫不决。当改变父母行为的努力失败时，一些牙医会放弃这些努力。 病人从他们的做法和大多数牙医避免谈论氟化物犹豫不决的父母在随后的 避免冲突。基于行为风险的方法可以帮助牙医解决氟化物犹豫， 拒绝在临床实践中。需要有经过验证的措施来评估这些办法，但这些措施 目前不存在。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 健康信念模式与平行过程延伸模式对氟化物犹豫与拒绝行为之探讨 行为，并制定2项措施，用于研究和临床环境。目标是：（1）建立 局部氟化物犹豫/拒绝的理论模型;（2）制定并验证2项措施- a 筛选工具，以确定氟化物犹豫/拒绝父母和诊断工具，以确定 局部氟化物犹豫/拒绝的原因;（3）确定氟化物犹豫/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，该试验采用多管齐下的方法，解决父母使用氟化物的具体原因-犹豫/拒绝以及健康提供者使用的适当沟通策略，包括儿童的龋齿风险。我们的长期目标是改善高风险儿童和青少年的口腔健康结果，否则他们可能没有机会从氟化物中受益，从而解决减少龋齿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年健康人群的口腔健康目标1和8，以及医疗保险和医疗补助口腔健康倡议中心关于获得优质牙科护理的计划。通过使用牙科作为实验室，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，如疫苗拒绝和其他现象 涉及复杂的健康信息的沟通，父母对这些信息的解释，对健康风险和益处的看法，以及与医疗保健相关的决策。