Parent-Focused Intervention to Improve Oral Health in Young Children

描述(申请人提供)：幼童的龋齿比率大幅增加，特别是在少数族裔和低收入家庭中。这一增长在很大程度上是由于不良的口腔卫生和相关行为。虽然在这方面存在有希望的干预措施来促进行为改变，但这些项目几乎完全专注于教父母或孩子刷牙技巧，而不考虑行为管理和激励策略。为了解决这一差距，并响应RFA-DE-12-001，我们计划开发一种简短的以父母为重点的干预措施，解决刷牙互动的技术和行为方面的问题。基于现有的针对儿童行为问题的行为干预，这一干预将教会父母如何为孩子刷牙，以及如何管理孩子在刷牙过程中的不遵守行为，以及如何鼓励孩子过渡到独立刷牙。我们预计，这样的干预将导致儿童口腔健康得到更持久的改善，特别是在那些有特殊医疗需求或行为问题使儿童行为管理复杂化的人中。在这项治疗发展研究中，我们建议开发和测试一种观察性工具，作为确定干预目标的方法，并作为干预研究的主要结果衡量标准。参与者将包括132名24至60个月大的儿童和他们的主要照顾者，他们是从儿童牙科中心(CPD)招募的。这些数据将被用来确定测量的可靠性和有效性，检验亲子刷牙互动作为孩子、父母和家庭特征的函数的差异，并支持我们建议的干预措施的理论基础和假定的作用机制。这项研究的其他有形“产品”包括：发展了我们的调查团队，以华盛顿大学和新加坡国立卫生研究院牙医、牙科研究人员和发展心理学家之间的新合作为特色；支持通过CPD诊所招募低收入、种族多样化家庭的可行性的初步数据；以及研究规程和治疗手册，其中将根据我们研究第一阶段收集的观察数据进行干预。这些数据将为随机对照试验(RCT)测试一种新颖的、以父母为中心的行为干预改善儿童早期口腔健康的有效性提供基础。 公共卫生相关性：这项研究的重点是幼儿(2-5岁)的口腔健康，这是一个龋齿显著增加的人群。为了准备一项随机对照试验(RCT)，测试一种以父母为中心的行为干预措施，以改善幼儿的口腔健康，我们计划开发一种观察工具，用于确定干预目标(例如，促进一致刷牙的可修改的父母和孩子行为)，并作为主要结果衡量标准。这项研究具有广泛的公共卫生意义，有可能改善对口腔卫生行为的评估，促进对促进或阻碍良好口腔卫生的父母和儿童行为的理解，并有助于开发基于证据的干预措施，通过预防或针对高危人群的针对性干预试验来改善口腔健康。

DESCRIPTION (provided by applicant): The rate of tooth decay has increased substantially in young children, particularly among ethnic minorities and those from low-income families. This increase is due, in large part, to poor oral hygiene and associated behaviors. Although promising interventions exist to promote behavior change in this regard, these programs focus almost entirely on teaching parents or children tooth brushing technique, without regard for behavior management and motivational strategies. To address this gap, and in response to RFA-DE-12-001, we plan to develop a brief parent-focused intervention that addresses both the technical and behavioral aspects of tooth brushing interactions. Based on existing behavioral interventions for child behavior problems, this intervention will teach parents how to brush their child's teeth as well as how to manage child non-compliance during brushing and how to encourage the child's transition to independent tooth brushing. We anticipate that such an intervention will lead to more lasting improvements in child oral health, particularly among those with special healthcare needs or behavior problems that complicate child behavior management. In this treatment development study, we propose to develop and test an observational tool to be used as a method for identifying targets for intervention and as a primary outcome measure in intervention research. Participants will include 132 children ages 24 to 60 months and their primary caregivers, recruited from the Center for Pediatric Dentistry (CPD). These data will be used to establish the reliability and validity of the measure, to examine differences in parent-child tooth brushing interactions as a function of child, parent, and family characteristics, and to support the theoretical rationale and presumed mechanisms of action underlying our proposed intervention. Other tangible 'products' from the study include the development of our investigative team, featuring new collaborations between UW and SCH dentists, dental researchers and developmental psychologists; preliminary data to support the feasibility of recruiting low-income, ethnically diverse families through the CPD clinic; and a study protocol and treatment manual with interventions that will follow from the observational data collected in this first phase of our research. These data will provide the foundation for a randomized controlled trial (RCT) testing the efficacy of a novel, parent-focused behavioral intervention to improve early childhood oral health. PUBLIC HEALTH RELEVANCE: This study focuses on the oral health of young children (ages 2-5 years), a population in which there has been a significant increase in tooth decay. In preparation for a randomized controlled trial (RCT) testing a parent-focused behavioral intervention to improve oral health in young children, we plan to develop an observational tool that will be used to identify targets for intervention (e.g., modifiable parent and child behaviors that promote consistent tooth brushing) and as a primary outcome measure. The study has broad public health implications, with the potential to improve the assessment of oral hygienic behaviors, advance understanding of the parent and child behaviors that promote or impede good oral hygiene, and contribute to the development of an evidence-based intervention to improve oral health via prevention or targeted intervention trials with high risk groups.