Developing a Computerized-Adaptive Test of Parental Health Knowledge

描述(申请人提供)：龋齿是最常见的儿童慢性疾病，国家卫生统计中心最近的一份报告表明，学龄前儿童的问题正在恶化。此外，这种情况的负担不成比例地落在少数群体和社会经济地位较低群体的儿童身上。良好的饮食和口腔卫生习惯，以及为父母和孩子提供适当的牙科服务和治疗，对良好的口腔健康至关重要。为了减少学龄前儿童龋齿和其他口腔健康疾病的患病率，关键是让更多的父母了解主要儿童口腔健康疾病的原因和后果，以及他们可以采取的预防措施。来自儿科提供者的前瞻性指导仍然是父母的重要信息来源。然而，临床过程中的时间限制和不同父母对信息的独特需求表明，需要新的策略来提高预期指导过程的效率和以患者为中心。具体地说，如果在即将到来的访问之前有简短、准确的措施来评估父母在相关内容领域的知识，就可以生成针对父母的知识简档，以帮助临床医生根据父母的具体需求定制他们的指导。计算机化的适应性测试(CAT)是一种基于项目反应理论(IRT)的测量方法，它根据被试的能力水平来选择呈现的项目，可以为这些简短、准确的评估提供基础。本项目将为这个知识评估CAT系统开发一个原型。鉴于龋齿的影响和幼儿的恶化趋势，我们将在这个项目中重点开发一个口腔健康模块。其他模块(例如，在伤害预防和儿童发展方面)将在今后的项目中开发。拟议的项目将：1)开发关于儿童口腔健康的知识问题；2)基于可读性、可理解性、临床相关性和心理测量学表现来评估问题的收录；以及3)开发实验性CAT原型并初步测试CAT分数的有效性。牙科、儿科和测量专家将根据证据来源开发知识问题。通过评估阅读水平来评估可读性。对社会人口统计学上不同的父母群体(N=48)的认知访谈将评估其可理解性。临床专家(牙科和儿科)将审查项目的临床相关性、清晰度和证据基础。将使用因素分析和IRT分析来检验心理测量学的表现。CAT分数的初步有效性将通过模拟研究和已知的团体测试(跨越父母健康素养和教育小组)进行评估。用于分析的数据将来自对从华盛顿特区为不同种族/族裔和社会经济人口提供服务的两个儿科初级保健机构招募的350名儿童初级照顾者的自我管理调查。 与公共卫生相关：观察到学龄前儿童龋齿的高患病率和恶化趋势，以及总体口腔健康方面的差异，突出了口腔健康作为儿童主要公共卫生问题的重要性。父母口腔健康知识不足和差距的证据表明，教育父母了解其原因、后果和他们可以采取的预防行动可能是解决这一问题的重要第一步。该项目的长期目标是开发一系列适应性的父母知识评估测试，以支持提供者根据父母及其子女的需求提供个性化的预期指导，我们希望这将改善儿童的护理质量和结果。

DESCRIPTION (provided by applicant): Tooth decay is the most common chronic childhood disease and a recent report from the National Center for Health Statistics indicates that the problem is worsening among preschool children. Furthermore, the burden of this condition falls disproportionately upon children from minority and low socioeconomic status groups. Good dietary and oral hygiene practices and use of appropriate dental services and treatments for both the parent and their child are essential to good oral health. To reduce the prevalence of tooth decay and other oral health conditions among preschoolers, it is critical that more parents become knowledgeable about the causes and consequences of major child oral health diseases and actions they can take to prevent them. Anticipatory guidance from pediatric providers remains an important source of information for parents. However, time constraints during clinical encounters and the unique information needs different parents have indicate that new strategies are needed to enhance the efficiency and the patient-centeredness of the anticipatory guidance process. Specifically, if short, precise measures are available to assess parents' knowledge across relevant content areas before an upcoming visit, parent-specific knowledge profiles can be generated to help clinicians tailor their guidance to parents' specific needs. Computerized adaptive testing (CAT), a measurement approach based on item response theory (IRT) in which items selected for presentation is adapted to the subject's ability level, could provide the basis for these short, accurate assessments. This project will develop a prototype for this knowledge assessment CAT system. Given the impact of tooth decay and worsening trend among young children, we will focus on developing an oral health module in this project. Other modules (e.g., in injury prevention and child development) will be developed in future projects. The proposed project will: 1) develop knowledge questions on child oral health; 2) evaluate questions for inclusion based on readability, understandability, clinical relevance and psychometric performance; and 3) develop an experimental CAT prototype and pilot test CAT score validity. Dental, pediatric and measurement experts will develop knowledge questions based on evidenced-based sources. Readability is assessed by evaluating reading level. Cognitive interviews with a socio-demographically diverse group of parents (N=48) will assess understandability. Clinical experts (dental and pediatric) will review items for clinical relevance, clarity and evidence base. Factor and IRT analyses will be used to examine psychometric performance. Preliminary validity of CAT scores will be assessed through simulation studies and known group tests (across parental health literacy and education groups). Data for analyses will be drawn from self-administered surveys of 350 primary caregivers of children recruited from two Washington D.C. pediatric primary care practices serving diverse racial/ethnic and socio-economic populations. PUBLIC HEALTH RELEVANCE: The high prevalence and worsening trend in dental caries and disparities in overall oral health observed for preschoolers highlight the importance of oral health as a major public health problem in children. Evidence of deficits and disparities in parental oral health knowledge indicate that educating parents about the causes, consequences and the preventive actions they can take could be an important first step to addressing this problem. The long-term goal of this project is to develop a series of adaptive parental knowledge assessment tests that can support providers in individualizing anticipatory guidance to the needs of parents and their children, which we hope will improve quality of care and outcomes for children.