Preventing Caries in Preschoolers: Testing a Unique Service Delivery Model in Am.

预防学龄前儿童龋齿：在美国测试独特的服务提供模式。

• 批准号: 7837732
• 负责人: David O Quissell
• 金额: $ 57.94万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-01 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7837732
• 关键词: Affect; American Indians; Caregivers; Caries prevention; Child; Communities; Community Workers; Confidentiality; Consent; Contracts; Control Groups; Dental Assistants; Dental Auxiliaries; Dental Care; Dental Hygienists; Dental caries; Doctor of Philosophy; Educational Activities; Effectiveness; Enrollment; Ensure; Evaluation; Fluoride Varnishes; Future; Goals; Hand; Head Start Program; Health Knowledge, Attitudes, Practice; Health Promotion; Health Services; Health behavior; Health education; Home environment; Human Resources; Incidence; Intervention; Measures; Mediator of activation protein; Modeling; NIH Program Announcements; Oral health; Outcome; Outcome Measure; Parents; Pattern; Pilot Projects; Population; Preschool Child; Prevention; Prevention program; Preventive; Protocols documentation; Provider; Qualifying; Randomized; Randomized Controlled Clinical Trials; Research; Research Personnel; Reservations; Resistance; Rural; Services; Shapes; Siblings; Specialist; Testing; Time; Training; Varnish; Work; community setting; comparative efficacy; cost; cost effectiveness; design; disorder prevention; health disparity; high standard; member; motivational enhancement therapy; northern plains; prevent; primary outcome; programs; prototype; secondary outcome; tribal community

The goal Of RC3 is to demonstrate the effectiveness of specially trained American Indian (Al) Community Oral Health Specialists (COHS) for delivering a caries prevention program to children enrolled in Head Start programs on a large Al reservation in the Southwest. The specific aims of the project are: 1) to develop a manualized intervention protocol for a caries prevention program delivered by COHS; 2) to implement and evaluate the feasibility and acceptability of a COHS-delivered program of oral health promotion and fluoride varnish (FV), as well as a more traditional FV program delivered by dental assistants; and 3) to compare the two programs in terms of secondary outcomes (caries patterns, cost-effectiveness, dispersion effects), as well as any differences identified by potential moderators and mediators that appear to affect outcomes. Head Start Centers (N=32) in communities across the reservation will be randomly assigned to one of the program conditions. The COHS condition will differ from the VAR condition primarily in that activities will include a proactive approach to working with children and their parents to initiate effective home oral health behaviors, as well as community educational activities. Fluoride varnishes will be provided quarterly in both programs. Children will be followed for two years, with caries assessments by calibrated dental hygienists at baseline, 1 year, and 2 years. The content of the COHS training protocol, which originally was developed in a pilot study that was implemented on a Northern Plains reservation, will be reviewed and revised with community input. This study provides a conservative evaluation of the COHS approach, which is designed to overcome resistance to cultural barriers to accessing established dental care services, and to make preventive services more widely available. Rather than comparing the COHS model with standard, higher cost, professional services, we are making a comparison with low-cost providers who will be deployed in a community setting to provide an intervention that consists primarily of a pharmacotherapeutic service (FV) that has proven efficacy for caries prevention. COHS providers, also low cost personnel, will deliver FV as well, so the central research question is whether a focus on personalized and community oral health promotion provided by someone clearly identified with the community provides a significantly greater effect on caries incidence than a low-cost pharmacotherapeutic prevention program. As questions continue to be raised about new delivery models for populations in rural and other underserved settings, this study will provide important information about the model of a prevention specialist trained in a 4-week program to work for improvement in the oral health of preschool children. It is anticipated that this study will be informed and further shaped by early results from RC1.

RC3 的目标是展示经过专门训练的美洲印第安人 (Al) 社区的有效性 口腔健康专家 (COHS) 为参加 Head Start 的儿童提供龋齿预防计划 西南部大片阿尔保留地的计划。该项目的具体目标是：1）开发 COHS 提供的龋齿预防计划的手动干预方案； 2) 实施和 评估 COHS 提供的口腔健康促进和氟化计划的可行性和可接受性 varnish (FV)，以及由牙科助理提供的更传统的 FV 程序； 3）比较 就次要成果（龋齿模式、成本效益、分散效应）而言，有两个计划，如 以及潜在主持人和调解员发现的任何似乎影响结果的差异。 保留地各社区的启蒙中心 (N=32) 将被随机分配给其中一个 计划条件。 COHS 条件与 VAR 条件的不同之处主要在于，活动将 包括积极主动地与儿童及其父母合作，启动有效的家庭口腔健康 行为以及社区教育活动。氟化物清漆将在两个地区每季度提供一次 程序。儿童将被跟踪两年，由经过校准的牙科保健员在以下地点进行龋齿评估： 基线、1 年和 2 年。 COHS 培训协议的内容最初是在 在北部平原保留地实施的一项试点研究将得到审查和修订 社区投入。本研究对 COHS 方法进行了保守评估，其设计目的是 克服获得现有牙科保健服务的文化障碍的阻力，并 更广泛地提供预防服务。不是将 COHS 模型与标准、更高的模型进行比较 成本，专业服务，我们正在与低成本提供商进行比较，这些提供商将部署在 社区环境提供主要包括药物治疗服务（FV）的干预措施 已被证明对预防龋齿有效。 COHS 提供商，也是低成本人员，将提供 FV 嗯，所以中心研究问题是是否关注个性化和社区口腔健康 由社区明确认同的人提供的促销可以提供显着更大的效果 与低成本药物治疗预防计划相比，对龋齿发生率的影响更大。随着问题不断 这项研究提出了针对农村和其他服务欠缺地区人口的新的交付模式 提供有关经过 4 周计划培训的预防专家工作模式的重要信息 改善学龄前儿童的口腔健康。预计这项研究将被告知并 RC1 的早期结果进一步决定了这一点。