Good Oral Health: a Bi-level Intervention to Improve Older Adult Oral Health

描述（由申请人提供）：本申请将nidcr资助的一项成功的双层面口腔健康自我管理试点项目扩展到六座建筑，该项目在居住在一栋老年住宅楼的老年人/残疾人中进行，并使用改进的分数因子设计对其进行评估。理论框架是基于Fishbein的理性行为修正理论，即行为预测的集成模型（IM）。它通过适应性动机访谈，一种互动的定制认知方法和实践到精通（AMI-PM）来实现。干预包括两个组成部分：1)面对面的AMI-PM管理；2)有针对性的建筑水平运动，包括掌握实践原则（CA-PM）。具体目的是：1)测试双水平干预的两个主要组成部分，通过差异测序来改善临床口腔卫生结果。2)明确影响临床口腔卫生结果的认知和行为机制。随着时间的推移，评估行为和临床结果的影响和可持续性。干预将分三个周期进行，每个周期150名参与者，总N=450。每个周期将包括两栋建筑，根据大小和种族/语言组成相匹配，为老年人和残疾人提供住房。在一种情况下，将引入个人层面的干预，然后是群体层面的干预。在第二种情况下，团体层面的干预先于个人层面的干预。调查和临床措施在基线，并在给药后的第一和第二部分。该设计将能够比较个体与组水平成分的短期疗效（T1 - T2）以及干预措施的短期和长期疗效（T3 - 3个月）。6个月后T4的临床测量将评估效果的可持续性。主要结局指标是牙龈指数和菌斑评分，这两项指标在初步研究中均有显著改善。重要的是干预措施的潜力，通过口腔健康促进倡议，在他们居住的地方解决严重的口腔健康差距，以及能力

DESCRIPTION (provided by applicant): This application will extend a successful NIDCR-funded bi-level oral health self-management pilot conducted among older/disabled adults residing in one older adult residential building to six buildings and evaluate it using a modified fractional factorial design. The theoretical framework is based on Fishbein's modified theory of reasoned action called the Integrated Model (IM) of Behavioral Prediction. It is operationalized through Adapted Motivational Interviewing, an interactive tailored cognitive approach, and Practice-to-Mastery (AMI-PM). The intervention includes two components: 1) a face to face administration of the AMI-PM; and 2) a targeted building-level campaign that includes principles of practice to master (CA-PM). The specific aims are to: 1) Test the two main components of a bi-level intervention to improve clinical oral hygiene outcomes in relation to one another, and through differential sequencing. 2) Identify cognitive and behavioral mechanisms contributing to clinical oral hygiene outcomes. 3) Assess impact and sustainability of behavioral and clinical outcomes over time. The intervention will be carried out in three cycles of 150 participants each for a total of N=450. Each cycle will include two buildings matched by size and ethnic/linguistic composition housing older adults and those with disabilities. In one condition, the individual leve intervention will be introduced followed by the group level intervention. In the second condition, the group level intervention will precede the individual level. Survey and clinical measures taken at baseline, and following the administration of the first and second components. This design will enable comparison of the short term efficacy of the individual versus group level component (T1 - T2) and the shorter and longer term efficacy of the interventions (T3 - 3 months). Clinical measures at T4, 6 months later, will evaluate sustainability of effect. Primary outcome measures are gingival index and plaque score, both of which improved significantly in the pilot study. Significance lies in the potential of the intervention to address critical disparities in oral healh through oral health promotion initiatives in the locations where they reside as well as the ability to evaluate the intervention efficiently using a design alternative to the RCT.