Family Intervention with Caregivers of Children with Dental Needs

描述（由申请人提供）：2- 11岁儿童的龋齿（蛀牙）正在增加，特别是在贫困和少数民族人群中，2020年健康人目标不太可能实现。12个州已强制要求对小学儿童进行牙科筛查，并得到美国各组织和世卫组织的认可。尽管人们对这一概念充满热情，但筛查和标准的推荐信在让父母/照顾者带孩子去看牙医方面一直无效。照顾者层面的参与或行动是必要的，以激励后续儿童层面的干预在学校。因此，我们提出了一种基于自我调节常识模型（CSM）的实验性干预，以解决父母/照顾者的疾病感知（认知表征：身份、后果、可控性、原因、时间线和情感表征）和资源导航，以增加具有修复性牙科需求的儿童接受牙科护理的机会。提出的多中心双盲III期随机对照临床试验（RCT）研究的具体目的是：(1)利用三组设计，评估新的CSM理论驱动的转诊信单独或新的CSM转诊信+牙科信息指南（DIG）；关于龋齿的事实，获得牙科护理的提示，预约和医疗补助，交通和牙医可用资源)与标准推荐信进行比较，以增加市中心城市非洲裔美国人，农村西班牙裔和白人小学儿童的牙科护理接收；(2)评估父母/照顾者在学年开始和学年结束期间的疾病表现/感知和行为意图的变化，以了解新与标准转诊方法导致接受牙科护理的潜在机制。将有两个研究地点：俄亥俄州（东克利夫兰市学区）；俄勒冈州（杰斐逊县学区509-J和莫罗县学区）。所有k -4年级的孩子和照顾者将通过学区活动招募。儿童将在开始时接受筛查

DESCRIPTION (provided by applicant): Dental caries (tooth decay) in 2--11 year olds is increasing especially among poor and minority populations, and it is unlikely that Healthy People 2020 goals will be met. Dental screening of children in elementary schools has been mandated in 12 states and endorsed by US organizations and WHO. In spite of enthusiasm for the concept, screening and standard referral letters have been ineffective in getting parents/caregivers to take children to the dentist. Caregiver-level engagement or action is necessary to motivate follow-up on child- level interventions at schools. Thus, we propose an experimental intervention based upon the Common Sense Model of Self-Regulation (CSM) to address parent/caregiver illness perception (cognitive representation: identity, consequences, controllability, cause, timeline; and emotional representation) and navigation of resources to increase receipt of dental care for children with restorative dental needs. The Specific Aims of the proposed multi-site double-blind Phase III randomized controlled clinical trial (RCT) study are: (1) Utilizing a three arm design, to evaluate the new CSM theory-driven referral letter alone or the new CSM referral letter + Dental Information Guide (DIG: facts about dental caries, hints for getting dental care, making appointments and Medicaid access, transportation and dentists availability resources) compared to a standard referral letter to increase receipt of dental care among inner-city urban African American, and rural Hispanic and White elementary school children; (2) To assess changes in parent/caregiver illness representation/perception and behavioral intention between the beginning and end of school year to understand the underlying mechanisms of the new vs. standard referral approach resulting in receipt of dental care. There will be 2 study sites: Ohio (East Cleveland City School District); Oregon (Jefferson County School District 509-J and Morrow County School District). All K-4th grade children and caregivers will be recruited through school district events. Children will be screened at beginning of the school year to determine caregiver eligibility for participation in the RCT. A total of 660 caregivers whose children have restorative dental needs will be randomized to the 3 study arms, and intervention letters will be sent home. Data collection includes: child baseline screening and follow-up dental exam at the study exit 7 mos later to determine if the child received care; caregiver illness perception questionnaire revised for dental (IPQ-RD) and a caregiver questionnaire at 3 time points (baseline, one-month after receipt of intervention letters exit). Data analysis for aim 1 includes a multivariate logistic regression model with adjustment for baseline characteristics; and aim 2 includes a generalized causal mediation analysis to delineate the mechanism (or paths) through which interventions impact dental care receipt. This behavioral intervention has the potential to change the public health standard of practice for screening by utilizing a cost- effective, easily transportable, and sustainable approach. The RCT is a collaboration of Case Western Reserve University and University of Washington Northwest Center to Reduce Oral Health Disparities.