Developing a Novel eHealth Application for Oral Systemic Issues during Pregnancy

描述（由申请人提供）：口腔疾病是一种“无声的流行病”，因为它的流行和错过了预防机会。有证据表明，口腔系统病因（包括牙周病（PD）的影响）与生命过程中的一系列健康结局和合共病（例如，不良妊娠和分娩结局；幼儿携带；整个成年期的慢性病）之间存在联系。怀孕是一生中一个敏感时期，增加了母亲及其后代口腔健康状况不佳的风险。虽然研究表明大约40%的孕妇患有PD，但只有23-35%的孕妇报告在怀孕期间看过牙医。随后，由美国妇产科医师学会（ACOG）和美国牙科协会（ADA）认可的提供者指南，赋予了在怀孕期间接受口腔健康教育、评估和治疗的重要性。然而，在怀孕期间进行积极口腔保健的障碍包括：a)孕妇对怀孕期间口腔保健的风险/益处存在误解；B)产前保健提供者在产前保健访问期间没有对患者的口腔健康问题进行评估、建议或转诊；c)产前和口腔保健提供者之间缺乏沟通和患者病例管理。缺乏对指导方针的熟悉，低自我效能和环境限制（例如，缺乏时间；其他资源）也有记录。因此，迫切需要解决这一差距转化为循证研究产前护理实践。我们的长期目标是在怀孕期间加强口腔系统预防工作，从而潜在地降低整个生命过程中健康状况不佳的风险。该项目的目标是开发和确定消费者驱动的电子保健应用程序的可用性和可行性，该应用程序将有助于在产前检查期间将口腔保健指南转化为实践。这将通过以下目标实现：(1)评估临床系统与电子健康应用程序的互操作性，并通过基于实施研究和创新传播综合框架维度的基于消费者的研究，确定利益相关者（产前提供者、口腔健康提供者、诊所人员）之间的关键特征和特征；(2)基于Aim 1、咨询委员会输入的信息、信息-动机-行为技能（IMB）和简短动机访谈结构/机制，开发并预测试一个互动原型；(3)进行可用性和可行性评估，评估可接受性和对提供者IMB结构变化的初步影响，包括根据指南的实践行为。这一创新、及时和理论驱动的项目有可能将与妊娠相关的口服系统证据转化为实践，并促进专业间合作，从而减少医疗保健系统中的差距。多学科团队拥有技能和专业知识，以确保目标的成功实现，并确保这种新颖的干预导致改变当前实践范式的适销产品。

DESCRIPTION (provided by applicant): Oral disease is a "silent epidemic" because of its prevalence and missed prevention opportunities. Evidence has established connections between oral-systemic etiologies, including the effects of periodontal disease (PD), and a range of health outcomes and co-morbidities across the lifecourse (e.g., adverse pregnancy and birth outcomes; early childhood carries; chronic conditions throughout adulthood). Pregnancy represents a sensitive period in the lifecourse increasing risk for poor oral health among mothers and their offspring. Although research indicates approximately 40% of pregnant women experience PD, only 23-35% of pregnant women report visiting a dentist during pregnancy. Subsequently, provider guidelines, endorsed by the American College of Obstetricians and Gynecologists (ACOG) and the American Dental Association (ADA), confer the importance of receiving oral health education, assessment, and treatment during pregnancy. However, barriers to positive oral healthcare practices during pregnancy include: a) misconceptions among pregnant women about risks/benefits of oral healthcare during pregnancy; b) prenatal providers not assessing, advising or referring patients on oral health issues during prenatal care visits; and c) lack of communication and patient case management between prenatal and oral health providers. Lack of familiarity with guidelines, low self-efficacy and environmental constraints (e.g., lack of time; other resources) has also been documented. Thus, it is imperative to address this gap in translating evidence-based research into prenatal care practice. Our long-term goal is to increase oral-systemic prevention efforts during pregnancy, thus potentially decreasing risk for poor health across the lifecourse. The objective of this project is to develop and determine the usability and feasibility of a consumer-driven eHealth application that will facilitate the translation of the oral healthcare guidelines into practice duing prenatal visits. This will be achieved through the following aims: (1) assess clinical system for interoperability with the eHealth application and identify key characteristics and features among stakeholders (prenatal providers; oral health providers; clinic personnel) through consumer-based research based on dimensions of the Consolidated Framework for Implementation Research and Diffusion of Innovations; (2) develop and pretest an interactive prototype based on information derived from Aim 1, advisory board input, and Information-Motivation-Behavioral Skills (IMB) and Brief Motivational Interviewing constructs/mechanisms; and (3) conduct usability and feasibility to evaluate the acceptability and preliminary impacts on changes in providers' IMB constructs, including practice behaviors per the guidelines. This innovative, timely and theory-driven project has the potential to translate pregnancy-related oral-systemic evidence into practice and facilitate inter-professional collaborations, thus decreasing gaps in the healthcare system. The multi-disciplinary team has the skills and expertise to ensure aims are successfully achieved and that this novel intervention leads to a marketable product that shifts the current practice paradigm.