Integrating Interactive Parent Text Messaging and Oral Health Guidelines into Pediatric Community Health Centers to Reduce Early Childhood Caries

将交互式家长短信和口腔健康指南纳入儿科社区健康中心，以减少儿童早期龋齿

• 批准号: 8984333
• 负责人: BELINDA BORRELLI
• 金额: $ 62.54万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-18 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8984333
• 关键词: 6 year old; Academy; Adopted; Adoption; Adult; Affect; African American; Age; American; Budgets; Car Phone; Caries prevention; Caring; Cellular Phone; Child; Child Rearing; Childhood; Chronic; Client satisfaction; Clinic; Community Health Centers; Computer software; Cost Analysis; Data; Dental; Dental caries; Development; Diet; Diffusion; Disease; Documentation; Dose; Dyes; Education; Educational Status; Electronic Health Record; Ensure; Ethnic Origin; Evidence based program; Feedback; Fluoride Varnishes; Fluorides; Focus Groups; Fostering; Goals; Group Interviews; Guidelines; Health Personnel; Health Promotion; Health Status; Health behavior; Health behavior change; Home environment; Incidence; Income; Individual; Insurance Coverage; Intervention; Interview; Latino; Legal Guardians; Lifting; Link; Lip structure; Low income; Maps; Measures; Mediator of activation protein; Minority Groups; Modeling; Oral; Oral health; Outcome Measure; Parents; Pediatrics; Phase; Population; Prevalence; Prevention; Preventive; Preventive Intervention; Process; Provider; Publishing; Race; Randomized; Recommendation; Research; Sampling; Structure; System; Testing; Text; Textiles; Theoretical model; Time; Toothbrushing; Toothpaste; Training; United States; Visit; Work; aged; base; cost; design; early childhood; efficacy testing; experience; health disparity; health literacy; high risk; improved; innovation; intervention effect; literacy; multidisciplinary; novel; primary outcome; programs; public health relevance; racial and ethnic; response; screening; social cognitive theory; theories; toothbrush

 DESCRIPTION (provided by applicant): This application is in response to RFA-DE-15-006 "Multidisciplinary and Collaborative Research Consortium to Reduce Oral Health Disparities in Children: A Multi-level Approach." The prevalence of Early Childhood Caries (ECC) is increasing, disproportionately affecting racial and ethnic minorities (Dye, 2007). Prevention efforts for high risk groups require multi-level strategies. We will target parents/legal guardians of children (<6 years) during pediatric well-child visits at urban community health centers (CHCs), and provide a text-message based ECC prevention intervention. We will also target the pediatric providers in the CHCs to adopt oral health guidelines from the American Academy of Pediatrics (AAP) and also improve documentation within their Electronic Health Records (EHRs). Thus, our multi-level intervention includes children, parents, providers and the CHC system. 85% of adults use text messaging, with no disparities by race/ethnicity, education or income. The benefits of text message interventions include the use anywhere/anytime, low cost, scalability to large populations, ability to tailor message content and intensity, and provision of strategies in real time. CHCs are an ideal venue for oral health promotion both at an individual level (they provide care to the groups at highest risk for ECC) and at a population level (there are 90 CHCs electronically linked locally and >1,100 CHCs nationally). In Phase 1 (UH2), we will conduct focus groups and interviews with parents and CHC providers to inform the development of the oral health text message intervention, as well as assess CHC work flow to identify sustainable strategies for oral health integration and eventual dissemination. This formative work is vital to ensure cultural and environmental compatibility, as we have done previously. The text messages will be consistent with AAP guidelines, our theoretical model (Social Cognitive Theory), and our previous work. We will use the Fisher-Owens Model (2007) as an intervention planning framework. In Phase 2 (UH3), 850 parents/legal guardians of children <6 years attending our target CHCs will be randomized to receive one of two dose-equivalent text message interventions: Oral Health Texts (OHT) or Child Wellness Texts (CWT). The primary outcome variable will be ECC incidence at 24 months. We will assess mediators and moderators of the intervention effect, perform a budget impact analysis to determine the financial consequences of adoption, diffusion, and sustainability of the OHT intervention at CHCs, assess CHC changes in oral health promotion (provider practices and EHR documentation), and assess changes in both pediatric and parent oral health behaviors. This research has strong potential to be an evidence based program that could easily be adopted at low cost and low provider burden in the 1,128 CHCs in the U.S. that treat almost 4.5 million high risk children <6 years old. Our text message intervention is innovative because involves system-generated real time support, tailoring, feedback, and interactivity. Our study has theoretical significance because it integrates a testable theory with an intervention planning model to elucidate mechanisms of change at multiple levels.

 描述（由申请人提供）：本申请是对RFA-DE-15-006“减少儿童口腔健康差异的多学科和协作研究联盟：多层次方法”的回应。“幼儿龋齿（ECC）的患病率正在增加，不成比例地影响种族和少数民族（Dye，2007）。针对高危人群的预防工作需要多层次的战略。我们将针对父母/法律的监护人 在城市社区卫生中心（CHC）的儿科健康儿童就诊期间，为儿童（<6岁）提供一种基于短信的ECC预防干预。我们还将针对社区卫生中心的儿科服务提供者采用美国儿科学会（AAP）的口腔健康指南，并改进其电子健康记录（EHR）中的文档。因此，我们的多层次干预包括儿童、家长、提供者和社区卫生中心系统。85%的成年人使用短信，没有种族/民族，教育或收入的差异。短信干预的好处包括随时随地使用，成本低，可扩展到大量人群，能够定制消息内容和强度，以及提供 真实的实时策略。社区卫生中心是促进口腔健康的理想场所，无论是在个人层面（它们为ECC风险最高的群体提供护理）还是在人口层面（当地有90个社区卫生中心电子连接，全国有超过1，100个社区卫生中心）。在第一阶段（UH 2），我们将与家长和CHC提供者进行焦点小组和访谈，以了解口腔健康短信干预的发展，并评估CHC的工作流程，以确定口腔健康整合和最终传播的可持续战略。正如我们以前所做的那样，这项形成性工作对于确保文化和环境的兼容性至关重要。短信将与AAP指南，我们的理论模型（社会认知理论）和我们以前的工作一致。我们将使用Fisher-Owens模型（2007）作为干预计划框架。在第2阶段（UH 3），850名参加我们目标CHC的6岁以下儿童的父母/法律的监护人将随机接受两种剂量等效的短信干预之一：口腔健康短信（OHT）或儿童健康短信（CWT）。主要结局变量为24个月时的ECC发生率。我们将评估干预效果的中介者和调节者，进行预算影响分析，以确定OHT干预在CHCs的采用，扩散和可持续性的财务后果，评估CHC在口腔健康促进方面的变化（提供者实践和EHR文档），并评估儿科和父母口腔健康行为的变化。这项研究有很大的潜力成为一个以证据为基础的计划，可以很容易地以低成本和低供应商负担在美国1,128个CHC中采用，这些CHC治疗了近450万6岁以下的高危儿童。我们的短信干预是创新的，因为涉及系统生成的真实的时间支持，定制，反馈和交互性。我们的研究具有理论意义，因为它整合了一个可检验的理论与干预规划模型，以阐明多层次的变化机制。