Developing Topical Fluoride Hesitancy Measures for Causal Modeling and Intervention Research

为因果建模和干预研究制定局部氟化物犹豫措施

基本信息

批准号：
9982681
负责人：
Donald Leslie Chi
金额：
$ 51.74万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-01 至 2022-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9982681
关键词：
Address Adolescent Advisory Committees Awareness Behavior Behavior Therapy Behavioral Belief Benefits and Risks Child Child Health Clinical Clinical Trials Communication Complex Conflict (Psychology)Data Decision Making Dental Dental Care Dental caries Dentistry Dentists Development Diagnostic Education Effectiveness English Language Ensure Evidence based treatment Exhibits Feedback Fluoride Varnishes Fluorides Foundations Future Goals Grant Health Health Communication Health Insurance Health Personnel Healthcare Healthy People 2020 Home environment Income Intervention Intervention Studies Interview Laboratories Length Liquid substance Low income Measures Medicaid Medical Medicare/Medicaid Methods Modeling National Institute of Dental and Craniofacial Research Oral health Outcome Parents Patients Perception Physicians Prevention Preventive Preventive care Preventive dental care Preventive service Primary Prevention Process Public Health Reporting Research Resistance Risk Safety Screening procedure Subgroup Testing Theoretical model Time Toothpaste Topical Fluorides Vaccines Validity and Reliability Visit Water fluoridation Work base behavioral clinical trial causal model checkup examination clinical practice cognitive interview design effectiveness measure field study health belief health equity health inequalities high risk improved instrument prevent programs systematic review theories therapy design

项目摘要

Topical fluorides help prevent tooth decay and are a routine part of dental visits for children and adolescents. However, concerns about the safety, necessity, and effectiveness of fluorides have resulted in fluoride hesitancy, leading some parents to refuse fluoride treatment for their children. Our data indicate that 13% of parents refuse topical fluoride during dental or medical visits, which is similar to vaccine refusal rates. Many more parents may accept fluoride but are hesitant. According to dentists, fluoride hesitancy and refusal are growing problems, but many dentists do not realize how universal approaches of providing fluoride to all children regardless of caries risk may have contributed to the problem. To convince hesitant and refusing parents to accept fluoride, dentists rely on paternalistic educational approaches that are largely ineffective at changing parents’ beliefs or behaviors. This is because education alone ignores the specific reason(s) why a parent is hesitant about fluoride. When efforts to change parent behaviors fail, some dentists dismiss these patients from their practices and most dentists avoid talking about fluoride to hesitant parents at subsequent visits to avoid conflict. Behavioral risk-based approaches could help dentists to address fluoride hesitancy and refusal in clinical practice. Validated measures will be needed to assess such approaches, but such measures currently do not exist. In this measure development study, we will address this critical gap. We will use the Health Belief Model and the Extended Parallel Process Model to understand fluoride hesitancy and refusal behaviors and to develop 2 measures for use in research and clinical settings. The Aims are to: (1) Construct a theoretical model of topical fluoride hesitancy/refusal; (2) Develop and validate 2 measures – a screening tool to identify fluoride hesitant/refusing parents and a diagnostic instrument to identify the reason(s) for topical fluoride hesitancy/refusal; and (3) Determine the stability of fluoride hesitancy/refusal behaviors. After the study is completed, the next step will be to design a behavioral clinical trial that incorporates a multi-pronged approach that addresses the specific reason(s) a parent is fluoride- hesitant/refusing and appropriate communication strategies used by health providers that incorporate a child’s caries risk. Our long-term goal is to improve oral health outcomes in high-risk children and adolescents who may otherwise not have an opportunity to benefit from fluorides, thereby addressing a growing threat to reducing dental caries rates and achieving health equity. The proposed study addresses Healthy People 2020’s Oral Health Objectives 1 and 8, and the Centers for Medicare and Medicaid Oral Health Initiative on Access to Quality Dental Care. By using dentistry as a laboratory, the proposed work is broadly applicable in understanding and addressing similar issues in public health like vaccine refusal and other phenomena involving communication of complex health information, interpretation of this information by parents, perceptions of health risks and benefits, and health care-related decision making.

局部氟化物有助于防止蛀牙，并且是儿童和青少年牙科访问的常规部分。但是，对氟化物的安全性，必要和有效性的担忧导致了氟化物犹豫不决，导致一些父母拒绝为孩子的氟化物治疗。我们的数据表明13％父母在牙科或医疗就诊期间拒绝局部氟化物，这类似于疫苗垃圾率。许多越来越多的父母可能接受氟化物，但很犹豫。根据牙医的说法，氟化物的犹豫和拒绝是越来越多的问题，但许多牙医没有意识到如何为所有人提供氟化物的普遍方法儿童不论龋齿风险如何，可能导致了这个问题。说服犹豫和拒绝父母接受氟化物，牙医依靠家长式教育方法，这些方法在很大程度上无效改变父母的信念或行为。这是因为仅教育就忽略了特定原因父母对氟化物犹豫不决。当努力改变父母行为失败时，一些牙医将这些驳回从他们的实践中的患者和大多数牙医避免在随后的父母谈论氟化物访问以避免冲突。基于行为风险的方法可以帮助牙医解决氟化物的犹豫和在临床实践中拒绝。要评估此类方法需要经过验证的措施，但是这些措施目前不存在。在这项测量开发研究中，我们将解决这一关键差距。我们将使用健康信念模型和扩展的并行过程模型，以了解氟化物犹豫和拒绝行为并制定2种用于研究和临床环境的措施。目的是：（1）构造局部氟化物犹豫/拒绝的理论模型；（2）开发和验证2个测量 - a 筛选工具以识别氟化物犹豫/拒绝父母和诊断工具以识别局部氟化物犹豫/拒绝的原因；（3）确定氟化物犹豫/拒绝行为的稳定性。研究完成后，下一步将是设计一项行为临床试验，该试验结合了一种多管齐下的方法，该方法涉及父母的特定原因是氟化物犹豫/拒绝/拒绝和适当的沟通策略，而卫生提供者使用的伴随着孩子会带来风险。我们的长期目标是改善高风险儿童和青少年的口腔健康状况，否则他们可能没有机会从氟化物中受益，从而解决越来越多的威胁降低牙科携带率并实现健康平等的威胁。拟议的研究涉及2020年健康人的口腔健康目标1和8，以及有关获得优质牙科护理的Medicare和Medicaid口腔健康计划的中心。通过将牙科用作实验室，拟议的工作通常适用于理解和解决公共卫生中的类似问题，例如疫苗拒绝和其他现象涉及复杂的健康信息的沟通，父母对这些信息的解释，对健康风险和福利的看法以及与医疗保健相关的决策。