Oral Health Promotion During Prenancy in a Group Prenatal Care Model

说明(申请人提供)：怀孕通常是口腔健康(OH)问题增加的标志，但牙科护理利用率，特别是在服务不足的妇女中；表明大多数低收入孕妇没有得到牙科护理。改善孕妇的口腔健康：1)保护她们自己的口腔健康；2)有可能改善她们的整体健康，减少其子女的早期儿童龋齿；以及3)可能减少不利的生育后果。尽管几个国家组织建议妇女在怀孕期间接受牙科保健和婴儿口腔保健的前瞻性指导，但许多妇女，特别是那些服务不足地区的妇女，不太可能接受这些重要的预防性保健服务。该项目的目的是开发和试行一种互动的教育和行为口腔健康促进(OHP)干预措施，以改善参加旧金山湾区集体产前护理计划CenteringPregnancy(CP(R))的低收入妇女的母婴口腔健康状况、知识、态度和行为。CP(R)是一种创新的团体护理模式，目前在全国拥有200多个团体，旨在提供全面的产前护理，并通过评估、教育和支持提高妇女的健康意识。OHP的开发将以社会认知理论为指导，将使用先行模式进行规划，并坚持CP(R)的基本护理组成部分：评估、教育和支持。研究包括两个阶段：第一阶段：发展和培训；第二阶段：中试和评估。第一阶段的目标是：1)与CP(注册商标)工作人员和参与者共同开发OHP课程，以解决诱发(知识、态度)、促成(技能培养、环境)和强化(反馈)OHP因素；2)与CP(注册商标)社区协商，制定可接受的研究程序，以评估OHP干预措施；以及3)培训8名CP(注册商标)工作人员，以进行OHP试点干预。第二阶段的目标是：4)在2个CP(R)地点(n=50名CP(R)参与者)进行OHP干预的试点测试，并检查OH状态和OH相关结果在事后的变化；以及5)在没有OHP干预的2个CP(R)地点(n=50 CP(R)参与者)中评估相同的OH因素的变化，以评估由于怀孕、没有OHP的CP(R)计划和其他长期因素造成的变化。我们将通过现场研究、牙科检查和自我报告来评估OH状态。我们将通过问卷调查的方式对母婴的卫生保健知识、态度和行为进行评估。如果成功，这些结果将被用于开发一项全面的临床研究研究(RO1)，该研究将正式测试OHP干预在改善孕妇及其子女口腔健康方面的效果。公共卫生相关性：许多妇女在怀孕期间得到的口腔保健不足，特别是低收入和服务不足群体中的妇女。如本R21申请所建议，为接受产前护理的妇女开发口腔健康促进干预措施，在成熟的、创新的集体产前护理模式下，以怀孕为中心(CP(R))可能提供机会，促进妇女的口腔健康及其子女的口腔健康，并改善她们一生中的一般健康。拟议申请的结果有望提供提交R01申请以正式测试口腔健康促进干预效果所需的初步数据，如果成功，将在国内和国际CP(R)计划以及其他产前护理小组中广泛实施。

DESCRIPTION (provided by applicant): Pregnancy is often a time marked by increased oral health (OH) concerns, yet dental care utilization rates, especially among underserved women; indicate that most low-income pregnant women do not receive dental care. Improving the oral health of pregnant women: 1) safeguards their own oral health; 2) has the potential to improve their overall health and decrease early childhood caries in their children; and 3) may reduce adverse birth outcomes. Although several national organizations recommend that women receive dental care and anticipatory guidance for infant oral health care during pregnancy, it is unlikely that many women, particularly those in underserved areas, are receiving these important preventive health services. The purpose of this project is to develop and pilot test an interactive educational and behavioral oral health promotion (OHP) intervention to improve maternal and infant OH status, knowledge, attitudes, and behaviors for low-income women attending a group prenatal care program, CenteringPregnancy (CP(R)), in the San Francisco Bay Area. With a growing number of groups, currently more than 200 nationally, CP(R) is an innovative group care model designed to provide comprehensive prenatal care and to advance women's sense of health awareness through assessment, education, and support. The OHP development will be guided by the Social Cognitive Theory, will use the PRECEDE PROCEED model for planning, and adhere to the essential care components of CP(R): assessment, education, and support. The study includes two phases: Phase 1: DEVELOPMENT & TRAINING and Phase 2: PILOT TEST & EVALUATION. Phase I aims are to: 1) develop, with CP(R) staff and participants, an OHP curriculum that will address predisposing (knowledge, attitudes), enabling (skills building, environmental), and reinforcing (feedback) OH factors; 2) consult with CP(R) community to develop acceptable research procedures to evaluate the OHP intervention; and 3) train 8 CP(R) staff to conduct the OHP pilot intervention. Phase II aims are: 4) pilot test the OHP intervention in 2 CP(R) sites (n= 50 CP(R) participants) and examine pre-post changes in OH status and OH-related outcomes; and 5) evaluate changes in same OH factors in 2 CP(R) sites (n= 50 CP(R) participants) without the OHP intervention to assess changes due to pregnancy, the CP(R) program without OHP, and other secular factors. We will assess OH status through on-site study dental exams and self- reports. We will assess OH knowledge, attitudes, and behaviors about maternal and infant OH through questionnaires. If successful, these results will be used to develop a full-scale clinical research study (RO1), which would formally test the efficacy of the OHP intervention in improving the oral health of pregnant women and their children. PUBLIC HEALTH RELEVANCE: Many women receive inadequate oral health care during pregnancy, especially those in low-income and underserved groups. As proposed in this R21 application, the development of an oral health promotion intervention for women receiving their prenatal care within a well-established, innovative, group model of prenatal care, CenteringPregnancy (CP(R)) may provide the opportunity to advance women's oral health and the oral health of their children, as well as improve their general health across the life span. The results of the proposed application will hopefully provide the preliminary data needed to submit an R01 application to formally test the efficacy of the oral health promotion intervention, which if successful, could be implemented widely in CP(R) programs nationally and internationally, as well as other prenatal care groups.