Promoting Behavioral Change for Oral Health in American Indian Mothers and Childr

促进美洲印第安母亲和儿童口腔健康的行为改变

基本信息

批准号：
8467587
负责人：
Terrence S. Batliner
金额：
$ 51.14万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
资助国家：
美国
起止时间：
至
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/8467587
关键词：
Age Age-Months American Indians Behavior Behavior Therapy Behavioral Birth Caries prevention Child Clinic Clinical Clinical Trials Design Communities Community Participation Community Services Control Locus Dental Dental Hygienists Dental caries Development Educational Intervention Effectiveness Effectiveness of Interventions Family Fluoride Varnishes Fluorides Future General Population Goals Head Start Program Health Health Promotion Health Services Health behavior Health education Home environment Incidence Indian reservation Intervention Mediator of activation protein Methodology Mothers Mouth Diseases Newborn Infant Oral health Outcome Outcome Measure Pamphlets Participant Pattern Pregnancy Pregnant Women Prenatal care Prevention Prevention approach Prevention strategy Preventive Preventive Intervention Protocols documentation Provider Randomized Randomized Controlled Trials Reporting Research Research Design Reservations Self Efficacy Services Shapes Specialist Stress Testing Time Training Visit Woman Work base behavior change comparison group cost effectiveness disorder prevention early childhood experience group intervention health belief health disparity health knowledge motivational enhancement therapy northern plains optimism prevent prevention service primary outcome programs randomized trial secondary outcome

项目摘要

The goal of RC1 is to demonstrate that the incidence of early childhood caries (ECC) in an American Indian (Al) reservation community can be reduced through the use of Motivational Interviewing (Ml) to change maternal oral health behaviors. The specific aims are: 1) to develop culturally relevant health education and promotional materials for use in ECC prevention with an Al community; 2) to manualize an oral health Ml intervention for pregnant women/mothers of newborns; and 3) to test this intervention in a randomized trial. All of the women, ages 15 or older, who are receiving prenatal care in the clinics of a large Northern Plains Al reservation, will be asked to participate in this trial, and all will be provided with the oral health promotion materials and aids, which will be developed using community participation strategies. For the demonstration trial, approximately 600 women will be randomly assigned to the Ml group, or the control condition. For those in the Ml group, oral health visits will be made to their homes prenatally and immediately after birth, then at 6, 12, 24, and 36 months of age. Children will be followed for 3 years, and caries assessments will be conducted by calibrated dental hygienists within 3 months of each child's 1st, 2nd, and 3rd birthday. The primary outcome will be annual increase in caries incidence. Secondary outcome measures will focus on caries patterns and cost-effectiveness of the program. A variety of mediators/moderators also will be examined, including such issues as mother's oral health knowledge and beliefs, stress, self-efficacy, and locus of control. AI/AN children have 3 times more untreated decay than children in the general population, and access to both preventive services and professional dental treatment are inadequate. The decision was made not to pair clinical/pharmacologic approaches with Ml in order to provide a definitive test of the most universally available strategy for prevention-that is, home oral disease prevention behaviors. If the effectiveness of Ml for preventing ECC can be demonstrated, future studies might look at adaptations for community implementation. It is anticipated that lessons from this study can be used to adapt the final protocol for RC3, which is focused on the provision of oral health prevention services (including fluoride varnish) by specially trained Al community oral health specialists working in Head Start Centers. There are implications for use with other clinical approaches to prevention as well. A major strength of this study is the extent to which involvement by representatives of the participant community, as well as Al health service providers, is shaping the development of materials and the design of the research protocol. This participation is expected to be a major asset for dissemination activities as well.

RC1 的目标是证明，通过使用动机访谈 (Ml) 改变母亲的口腔健康行为，可以降低美洲印第安人 (Al) 保留社区中儿童早期龋齿 (ECC) 的发病率。具体目标是： 1) 开发与文化相关的健康教育和宣传材料，用于与阿尔社区一起预防 ECC； 2) 为孕妇/新生儿母亲实施口腔健康机器学习干预； 3) 在随机试验中测试这种干预措施。所有在北平原阿尔保留地的诊所接受产前护理的所有 15 岁或以上的妇女都将被要求参加这项试验，并向所有人提供口腔健康促进材料和辅助工具，这些材料和辅助工具将利用社区参与策略来制定。对于示范试验，大约 600 名女性将被随机分配到 M1 组或对照组。对于 M1 组的儿童，将在产前和出生后立即到家中进行口腔健康检查，然后在 6、12、24 和 36 个月大时进行口腔健康检查。儿童将被跟踪 3 年，并且由经过校准的牙科保健员在每个儿童 1 岁、2 岁和 3 岁生日后的 3 个月内进行龋齿评估。主要结果是龋齿发病率逐年增加。次要结果指标将侧重于龋齿模式和该计划的成本效益。还将检查各种中介/调节因素，包括母亲的口腔健康知识和信念、压力、自我效能和控制源等问题。 AI/AN 儿童未经治疗的龋齿数量是普通儿童的 3 倍，并且获得预防服务和专业牙科治疗的机会不足。决定不将临床/药理学方法与 M1 结合起来，以便为最普遍可用的预防策略（即家庭口腔疾病预防行为）提供明确的测试。如果可以证明 M1 对于预防 ECC 的有效性，未来的研究可能会考虑社区实施的适应性。预计这项研究的经验教训可用于调整 RC3 的最终方案，该方案的重点是由在启蒙中心工作的经过专门培训的阿尔社区口腔健康专家提供口腔健康预防服务（包括氟化物清漆）。与其他临床预防方法一起使用也有影响。这项研究的一个主要优势是参与者社区代表以及阿尔健康服务提供者的参与程度，正在影响材料的开发和研究方案的设计。这种参与预计也将成为传播活动的重要资产。