Contra Caries: Preventing ECC Using a Promotora Model for Rural Latino Families

描述(由申请人提供)：此R21申请是为了支持试点工作，审查文化上合适的、严格设计、实施和评估的、受过培训的基于社区的拉丁裔非专业卫生工作者(促进者)教育干预的可接受性和可行性。这项干预措施旨在减少由于农村拉丁裔家庭儿童早期儿童龋齿(ECC)的流行而造成的口腔健康差距。ECC(婴儿奶瓶龋齿或龋齿)是儿童最常见的传染病(卫生局局长，2000年)，也是未得到满足的主要卫生保健需求(Newacheck等人，2000年)，在低收入的农村学龄前儿童中高度流行，特别是墨西哥裔儿童。拟议的研究将分两个阶段进行。第一阶段利用焦点小组和其他定性研究方法，向推动者、参与者和社区阐述计划和评估方法的发展、完善和可接受性。该课程以社会认知理论为指导。第二阶段通过实施和评估促进者培训和试点互动口腔健康教育计划，解决可行性和保真度问题，该计划针对加利福尼亚州萨利纳斯的100名1至5岁儿童的父母，萨利纳斯是一个以拉丁裔为主的农业社区。我们的目标是通过测试前、测试后的变化(在计划完成时和完成后3个月)评估拟议的干预计划是否：1)增加父母对龋病机制和后果的了解，包括氟化物的作用的有效预防活动的知识，以及对口腔健康的理解和知识，一般包括获得和使用口腔健康专业人员；2)增加父母的知识、技能和自我效能感，了解他们在家庭中影响孩子口腔保健的作用，包括在哪里、何时和如何让孩子参加口腔服务。将评估父母的知识、态度、做法和自我效能感的变化方向和程度。将使用严格的过程和结果评价战略。除了达到规定的目标外，如果该计划为社区所接受，并且其实施是可行的，那么未来将编写RO1，以支持农村地区更大样本的拉丁裔家庭的计划，作为一项随机、严格设计的受控干预研究。公共卫生相关性：拟议的研究涉及一项适合文化的教育干预，重点是生活在农村地区的拉丁裔儿童的父母。它解决了儿童早期龋病(ECC)，这是五岁以下儿童经历的一种主要的口腔健康差距。干预措施旨在通过提高父母对ECC病因、机制和预防活动的了解，特别是改善口腔卫生(刷牙)，减少患有ECC的儿童数量。该干预提高了家长协助和更好地管理儿童口腔保健行为的能力。

DESCRIPTION (provided by applicant): This R21 application is to support pilot work examining the acceptability and feasibility of a culturally-appropriate, rigorously designed, implemented and evaluated, trained community-based Latino lay health worker (promotora) educational intervention. This intervention aims to reduce oral health disparities due to prevalence of early childhood caries (ECC) in children in rural, Latino families. ECC, (baby bottle tooth decay or cavities) the most common infectious disease of childhood (Surgeon General 2000) and a major unmet health care need (Newacheck et al 2000), is highly prevalent among low- income, rural preschool aged children, especially those of Mexican-origin. The proposed study will occur in two stages. Stage 1 addresses development, refinement and acceptability of the program and evaluation methods to promotoras, participants and the community using focus groups and other qualitative research methods. The curriculum is guided by Social Cognitive Theory. Stage 2 addresses feasibility and fidelity issues by implementing and evaluating the promotora training and pilot interactive oral health education program for 100 parents of children aged 1 to 5 years in Salinas, CA, a predominantly Latino agricultural community. We aim to assess, via pre-test post-test changes (at completion of program and 3-months after completion), whether the proposed intervention program: 1) Increases parental understanding of the mechanism and consequences of caries, knowledge of effective preventive activities including the role of fluoride, and understanding and knowledge about oral health generally including access to and use of oral health professionals, 2) Increases parental knowledge, skills and sense of self-efficacy with respect to their role in affecting their children's oral health care at home, including where, when and how to enroll children for oral services. The direction and amount of change in parental knowledge, attitude, practices and self- efficacy will be assessed. Rigorous process and outcome evaluation strategies will be used. If, in addition to meeting the stated objectives, the program is acceptable to the community and its delivery feasible, then an RO1 will be written in the future to support the program with a larger sample of Latino families in a rural location as a randomized rigorously designed, controlled intervention study. PUBLIC HEALTH RELEVANCE: The proposed research involves a culturally-appropriate educational intervention focused on parents of Latino children living in a rural area. It addresses Early Childhood Caries (ECC), a major oral health disparity experienced by children under five years of age. The intervention aims to reduce the number of children with ECC through improving parental understanding of its causes, mechanisms, and preventive activities - particularly improved oral hygiene (tooth brushing). The intervention enhances parents' ability to assist and better manage children's oral health care behaviors.