Changing Oral Health Norms and Hygiene Practices among Vulnerable Older Adults

描述(由申请人提供)：减少弱势、低收入老年人和残疾成年人之间持续存在的口腔健康差距是《健康人2020》的中心目标，也是州卫生部门和地区机构在老龄问题上的优先事项。对口腔健康以及预防和治疗选择的有限知识、语言的文化差异和对口腔健康问题的看法，以及结构性障碍加在一起，增加了弱势群体的口腔健康差距。这项题为“改变弱势老年人的口腔健康规范和卫生做法”的提案旨在通过开发和试点一种双层(建筑和个人)认知/行为干预措施(Pro-GoH：有利于良好的口腔健康)来解决这些问题，以减少居住在康涅狄格州中部公共资助的老年住房中的弱势老年人、低收入、少数族裔和残疾人在口腔健康方面的显著和持续的差异。所提出的干预模式是基于Fishbein的改进的理性行动理论，称为行为预测的整合模型(IM)，通过改编的动机访谈和实践掌握(AMI-PM)来操作。居住在社区的62岁及以上的低收入、残疾人和少数族裔成年人中，有相当大比例居住在低收入老年人住房中。众所周知，他们属于最容易患抑郁症、慢性病、初级保健不足以及口腔和其他健康差距的人群。成功的试点干预将为基于RE-AIM方法在康涅狄格州中部地区安置弱势老年人和残疾成年人的其他建筑物进行更大规模的疗效试验奠定基础。拟议试点研究的目的是：1)进行形成性研究，2)在典型的低收入老年住宅中进行个人和建筑物层面的干预试点，3)评估试点的个人层面和建筑物层面干预程序的可行性、可接受性和保真度，4)进行个人层面的结果评估，使用干预前和干预后评估，将治疗大楼和匹配的对照大楼的参与者进行比较，以及5)编写标准操作程序(SOP)、评估措施和干预手册，用于康涅狄格州的广泛临床试验。

DESCRIPTION (provided by applicant): Reducing persistent oral health disparities among vulnerable low income older adults and adults with disabilities is a central objective in Healthy People 2020 and is a priority of state health departments and area agencies on aging. Limited knowledge of oral health and prevention and treatment alternatives, cultural differences in language and perception of oral health problems, and structural barriers combine to increase oral health disparities in vulnerable populations. This proposal, entitled "Changing Oral Health Norms and Hygiene Practices among Vulnerable Older Adults" aims to address these issues by developing and pilot testing a bi-level (building and individual) cognitive/behavioral intervention (Pro-GOH: Pro-Good Oral Health) to reduce significant and persistent disparities in oral health among vulnerable older low income, minority and disabled adults residing in publicly funded senior housing in Central Connecticut. The proposed intervention model is based on Fishbein's modified theory of reasoned action called Integrated Model (IM) of Behavioral Prediction operationalized through Adapted Motivational Interviewing and Practice-to-Mastery (AMI-PM). A substantial percentage of community-residing low income, disabled and minority adults aged 62 and over live in low income senior housing. They are known to be among those most vulnerable to depression, chronic diseases, inadequate primary care, and oral and other health disparities. A successful pilot intervention will provide the basis for a larger efficacy trial based on the RE-AIM approach in other buildings housing vulnerable older adults and adults with disabilities in the Central Connecticut area. The aims of the proposed pilot study are to: 1) Conduct formative research, 2) Conduct a pilot of the intervention at the individual and building level in a typical low income senior residence, 3) Evaluate the pilot individual-level and building-level intervention processes for feasibility, acceptability and fidelity, 4) Conduct an individual level outcome evaluation comparing participants in the treatment building with a matched control building, using a pre and two post intervention assessments, and 5) Prepare Standard Operating Procedures (SOP), evaluation measures and intervention manuals for use in a broad clinical trial in Connecticut.