Integrating Social and Systems Science Approaches to Promote Oral Health Equity

描述（由申请人提供）：人口结构的变化，包括老龄化和更多的种族和民族多样化的人口，再加上医疗政策环境的持续变化，都要求牙科专业重新定位和扩大其重点。挑战包括为有复杂医疗和社会需求的患者提供更全面的护理，同时改善服务不足人群获得护理的机会。在未来几年，牙科的实践预计将包括筛查和监测慢性疾病，如高血压和糖尿病，这些慢性疾病与牙齿脱落和牙周病等累积性口腔疾病有关。与此同时，公众对牙科的期望将要求该领域制定战略，以管理目前没有得到适当护理的群体（包括老年人）的口腔健康。基于agent的建模、系统动力学和地理信息系统等计算技术的进步，推动了一系列关于多个尺度（如社区、人际和个人）和维度（如社区尺度的建筑环境和社会背景）对健康行为和结果的影响的研究。然而，由于能够结合这些方法的软件平台直到最近才出现，这些方法通常只是孤立地应用。特别是，很少有实证工作研究多尺度因素如何影响种族和少数民族老年人的口腔健康和求医行为。先前对在服务不足的城市社区老年人中心（以下简称城市少数民族老年人中心参与者）参加的种族和少数民族老年人进行的研究发现，牙齿脱落水平低于美国全国样本。为了从这些老年人中学习到什么是有效的，具体的目标和假设是：(1)了解城市少数民族老年中心的参与者如何利用社区规模的卫生和牙科保健等服务来增强他们的口腔健康；(2)探讨人际层面因素对城市少数民族老年中心参访人员的就诊行为和口腔健康状况的影响；(3)考察城市少数民族老年中心参会者在牙科环境中接受高血压和糖尿病筛查的文化可接受性；(4)对目标1、2和3中城市少数民族老年中心参与者在社区、人际和个人尺度上获得的因素知识进行建模，以加强社区和诊所为基础的口腔卫生服务提供，改善口腔健康结果。这些目标与美国国立卫生研究院通过资助机会公告PAR-11-314的研究目标一致，即利用与人类行为、社会科学和健康相关的系统科学方法开发应用项目。这些目标的成功完成将有助于理解社区资产如何影响家庭和同伴的互动，并有助于成人年龄段的口腔健康促进和求医行为。

DESCRIPTION (provided by applicant): Demographic shifts that include an aging and more racially and ethnically diverse population coupled with ongoing changes in the healthcare policy environment are demanding that the dental profession both redirect and expand its focus. Challenges include providing more comprehensive care for patients with complicated medical and social needs, while improving access to care for underserved population groups. In the coming years, the practice of dentistry is expected to include screening for, and monitoring of, chronic diseases such as hypertension and diabetes related to cumulative oral conditions such as tooth loss and periodontal disease. Meanwhile, expectations for dentistry by the public will require the field to develop strategies to manage the oral health of groups not now receiving adequate care, including older adults. Recent methodological developments enabled by computational advances, such as agent-based modeling, system dynamics, and geographic information systems, have spurred a body of research on the effects of multiple scales (e.g., community, interpersonal, and individual) and dimensions (e.g., built environment and social context at the community scale) on health behaviors and outcomes. Yet, because software platforms capable of combining these approaches have only recently become available, the methods have generally been applied only in isolation. In particular, little empirical work has examined how factors at multiple scales contribute to oral health and care-seeking behaviors for racial and ethnic minority older adults. Previous research conducted with racial and ethnic minority older adults who attend senior centers in underserved urban neighborhoods (hereafter referred to as urban minority senior center attendees) found lower levels of tooth loss than in US national samples. In order to learn from what is working well in this older adult population, the specific aims and hypotheses are to: (1) understand how urban minority senior center attendees utilize services such as health and dental care at the community scale to enhance their oral health; (2) identify how factors at the interpersonal scale enhance care-seeking behaviors and improve the oral health outcomes of urban minority senior center attendees; (3) examine the cultural acceptability of screening for hypertension and diabetes in the dental setting at the individual scale for urban minority senior center attendees; and (4) model the knowledge gained about factors at the community, interpersonal, and individual scales for urban minority senior center attendees in Aims 1, 2, and 3 to enhance community- and clinic-based oral health service delivery and improve oral health outcomes. These aims are consistent with the research objectives of the National Institutes of Health through Funding Opportunity Announcement PAR-11-314 to develop applied projects utilizing systems science methodologies relevant to human behaviors, social sciences, and health. Successful completion of these aims will aid in understanding how community assets shape familial and peer interactions and contribute to oral health promotion and care seeking behaviors as adult's age.