Family intervention with caregivers of children with urgent dental needs

描述(申请人提供)：2至11岁儿童的龋齿在全国范围内正在增加，特别是在贫困人口和少数族裔人口中，实现2020年健康人的目标是不太可能的。公立小学的儿童牙科筛查已在12个州强制进行，并得到了美国和国际组织的支持。然而，尽管人们对这一概念充满热情，但筛查和转介作为让父母和照顾者带孩子去看牙医的工具一直效果不佳。这项应用是为了支持第二阶段随机临床试验的规划，以评估在市中心有紧急/恢复性需求的小学儿童中增加牙科就诊(接受护理)的转诊方法的有效性。被测试的干预依赖于两个理论框架--自我调节常识模型(CSM)和计划行为理论(TPB)，这两个理论可以与以学校为基础的计划中的儿童层面干预措施结合使用。R34研究的目标将分两个阶段进行：(1)试验阶段，验证修订后的患龋病知觉问卷(IPQ-RD)，干预措施的可接受性和交付情况，干预措施的调解人和主持人；社区组织和提供者的重点小组，以确定实验干预措施中应包括的有利资源；以及测试实验干预措施的适当性/准确性；(2)规划阶段，主要致力于提交U01报告所需的主要规划活动，包括制定研究方案、操作手册、机构审查委员会应用程序及其相关材料。R34的样本大小包括从俄亥俄州克利夫兰市区学区的5所小学中招募的120名幼儿园、一年级和二年级儿童的照顾者，以及来自几个社区机构或提供者的10到20名关键线人。数据收集包括对照料者和社区/提供者告密者的焦点小组进行半结构化的一对一访谈和问卷答复。数据分析将对定性数据采用混合方法设计(扎根理论和理论驱动)，对定量数据采用描述性/分析性统计。这种行为方法有可能通过利用一种经济高效、易于运输和可持续的转诊方法来改变筛查项目的公共卫生实践标准。跨学科研究团队包括凯斯西储大学社区牙学系和华盛顿大学西北减少口腔健康差距中心的教职员工。 与公共卫生相关：拟议的研究针对转诊过程提出了一种创新的行为方法，以解决三个照顾者问题--(1)无龋乳牙对保护恒牙的重要性；(2)将龋齿视为一种慢性病，而不是急性或发作性疾病；(3)导航牙科护理资源。这种行为方法还有可能改变许多州法律要求的学校筛查项目的公共卫生实践标准。

DESCRIPTION (provided by applicant): Tooth decay in 2 to 11 year olds is increasing nationally especially among poor and minority populations, and it is unlikely that Healthy People 2020 goals will be met. Dental screening of children in public elementary schools has been mandated in 12 states and endorsed by U.S. and international organizations. Nevertheless, in spite of enthusiasm for the concept, screening and referral has been ineffective as a tool to get parents and caregivers to take children to the dentist. This application is to support planning of a Phase II randomized clinical trial to assess the effectiveness of a referral approach to increase dental attendance (for receipt of care) among inner-city urban elementary school children with urgent/restorative needs. The intervention to be tested relies on two theoretical frameworks -Common Sense Model of Self-Regulation (CSM), and the theory of Planned Behavior (TPB) that could be used in conjunction with child-level interventions in a school-based program. The objectives of the R34 study will occur in two phases: (1) pilot phase to validate the modified illness perception questionnaire -Revised (IPQ-RD) for dental caries, acceptability and delivery of the intervention, mediators and moderators for accessing care; focus groups of community organizations and providers to identify enabling resources to be included in the experimental intervention; and testing the experimental intervention regarding appropriateness/accuracy of educational materials; (2) planning phase primarily devoted to the major planning activities required for a U01 submission including development of the study protocol, manual of operations, and Institutional Review Board application and its associated materials. The sample size for the R34 includes 120 caregivers of KG, first, and second grade school children recruited from among 5 elementary schools in an urban inner-city school district in Cleveland, OH, and 10 to 20 key informants from several community agencies or providers. Data collection involves semi-structured one-to-one interviews and questionnaire responses for caregivers and focus groups for community/provider informants. Data analysis will utilize a mixed method design (grounded theory and theory driven) for qualitative data, and descriptive/analytical statistics for quantitative data. This behavioral approach has the potential to change the public health standard of practice for screening programs by utilizing a cost-effective, easily transportable, and sustainable referral approach. The transdiscipilinary research team includes faculty from Department of Community Dentistry at Case Western Reserve and the Northwest Center to Reduce Oral Health Disparities at the University of Washington. PUBLIC HEALTH RELEVANCE: The proposed study addresses an innovative behavioral approach to the referral process never attempted before to address three caregiver issues - (1) importance of caries-free baby teeth for protection of permanent teeth (2) viewing dental caries as a chronic disease rather than acute or episodic; and (3) navigation of resources for dental care access. This behavioral approach also has the potential to change the public health standard of practice for school screening programs required by law in many states.