Developing a Computerized-Adaptive Test of Parental Health Knowledge

描述（由申请人提供）：蛀牙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民族和低社会经济地位群体的儿童身上。良好的饮食和口腔卫生习惯，以及为父母和孩子使用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中蛀牙和其他口腔健康状况的患病率，关键是要有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。儿科医生的预期指导仍然是家长的重要信息来源。然而，临床接触的时间限制和不同家长独特的信息需求表明，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。具体而言，如果在即将到来的访问之前，可以使用简短而精确的措施来评估家长在相关内容领域的知识，则可以生成家长特定知识概况，以帮助临床医生根据家长的特定需求定制指导。计算机化自适应测试（CAT）是一种基于项目反应理论（IRT）的测量方法，其中选择的项目适合受试者的能力水平，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。鉴于蛀牙对幼儿的影响和日益严重的趋势，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（如伤害预防和儿童发展）将在今后的项目中发展。拟议的项目将：1)制定有关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表现评估纳入问题；3)开发了实验CAT原型，并对CAT评分效度进行了中试测试。牙科、儿科和测量专家将根据证据来源提出知识问题。可读性是通过评估阅读水平来评估的。与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。因子分析和IRT分析将用于检验心理测量的表现。CAT分数的初步有效性将通过模拟研究和已知的小组测试（在父母健康素养和教育小组之间）进行评估。用于分析的数据将来自350名儿童主要照顾者的自我管理调查，这些儿童主要照顾者来自华盛顿特区两家儿科初级保健机构，服务于不同种族/民族和社会经济人群。

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.