Interactive Parent-targeted Text Messaging in Pediatric Clinics to Reduce ECC

儿科诊所中针对家长的交互式短信可减少 ECC

基本信息

批准号：
10249444
负责人：
BELINDA BORRELLI
金额：
$ 25.9万
依托单位：
BOSTON UNIVERSITY MEDICAL CAMPUS
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-01 至 2022-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10249444
关键词：
6 year old Academy Adopted Adoption Adult Affect African American Age American Behavior Car Phone Caries prevention Caring Cellular Phone Child Childhood Chronic Client satisfaction Clinic Computer software Cultural Sensitivity Data Dental Dental caries Development Diet Diffusion Disease Documentation Dose Education Educational Status Electronic Health Record Ensure Ethnic Origin Evidence based program Feedback Fluoride Varnishes Fluorides Focus Groups Fostering Goals Group Interviews Guidelines Health Personnel Health Promotion Health Status Health behavior Health behavior change Home environment Incidence Income Individual Insurance Coverage Intervention Interview Latino Legal Guardians Lifting Link Lip structure Low income Measures Mediator of activation protein Minority Groups Modeling Neighborhood Health Center Oral Oral health Outcome Measure Parents Pediatrics Phase Population Prevalence Prevention Preventive Preventive Intervention Process Provider Publishing Race Randomized Recommendation Research Sampling Structure System Testing Text Messaging Textiles Theoretical model Time Toothbrushing Toothpaste Training United States Visit Work aged base budget impact cost design early childhood efficacy testing ethnic minority population experience health disparity health literacy high risk high risk population improved income disparities innovation intervention cost intervention effect literacy multidisciplinary novel primary outcome programs public health relevance racial disparity racial minority recruit response screening social cognitive theory tailored messaging theories

项目摘要

Abstract This application is in response to RFA-DE-15-006 "Multidisciplinary and Collaborative Research Consortium to Reduce Oral Health Disparities in Children: A Multi-level Approach." The prevalence of Early Childhood Caries (ECC) is increasing, disproportionately affecting racial and ethnic minorities (Dye, 2007). Prevention efforts for high risk groups require multi-level strategies. We will target parents/legal guardians of children (<6 years) during pediatric well-child visits at urban community health centers (CHCs), and provide a text-message based ECC prevention intervention. We will also target the pediatric providers in the CHCs to adopt oral health guidelines from the American Academy of Pediatrics (AAP) and also improve documentation within their Electronic Health Records (EHRs). Thus, our multi-level intervention includes children, parents, providers and the CHC system. 85% of adults use text messaging, with no disparities by race/ethnicity, education or income. The benefits of text message interventions include the use anywhere/anytime, low cost, scalability to large populations, ability to tailor message content and intensity, and provision of strategies in real time. CHCs are an ideal venue for oral health promotion both at an individual level (they provide care to the groups at highest risk for ECC) and at a population level (there are 90 CHCs electronically linked locally and >1,100 CHCs nationally). In Phase 1 (UH2), we will conduct focus groups and interviews with parents and CHC providers to inform the development of the oral health text message intervention, as well as assess CHC work flow to identify sustainable strategies for oral health integration and eventual dissemination. This formative work is vital to ensure cultural and environmental compatibility, as we have done previously. The text messages will be consistent with AAP guidelines, our theoretical model (Social Cognitive Theory), and our previous work. We will use the Fisher-Owens Model (2007) as an intervention planning framework. In Phase 2 (UH3), 850 parents/legal guardians of children <6 years attending our target CHCs will be randomized to receive one of two dose-equivalent text message interventions: Oral Health Texts (OHT) or Child Wellness Texts (CWT). The primary outcome variable will be ECC incidence at 24 months. We will assess mediators and moderators of the intervention effect, perform a budget impact analysis to determine the financial consequences of adoption, diffusion, and sustainability of the OHT intervention at CHCs, assess CHC changes in oral health promotion (provider practices and EHR documentation), and assess changes in both pediatric and parent oral health behaviors. This research has strong potential to be an evidence based program that could easily be adopted at low cost and low provider burden in the 1,128 CHCs in the U.S. that treat almost 4.5 million high risk children <6 years old. Our text message intervention is innovative because involves system-generated real time support, tailoring, feedback, and interactivity. Our study has theoretical significance because it integrates a testable theory with an intervention planning model to elucidate mechanisms of change at multiple levels.

抽象的本申请是为了响应 RFA-DE-15-006“减少儿童口腔健康差异的多学科协作研究联盟：多层次方法”。儿童早期龋齿 (ECC) 的患病率正在增加，对少数种族和族裔的影响尤为严重（Dye，2007 年）。高危人群的预防工作需要多层次的策略。我们将在城市社区卫生服务中心 (CHC) 儿童健康儿童就诊期间针对儿童（<6 岁）的父母/法定监护人，并提供基于短信的 ECC 预防干预。我们还将针对 CHC 中的儿科服务提供者采用美国儿科学会 (AAP) 的口腔健康指南，并改进其电子健康记录 (EHR) 中的记录。因此，我们的多层次干预包括儿童、家长、提供者和 CHC 系统。 85% 的成年人使用短信，种族/民族、教育程度或收入没有差异。短信干预的好处包括随时随地使用、低成本、可扩展到大量人群、定制消息内容和强度的能力以及实时提供策略。 CHC 是促进口腔健康的理想场所，无论是在个人层面（它们为 ECC 风险最高的群体提供护理）还是在人口层面（当地有 90 个通过电子方式连接的 CHC，全国有超过 1,100 个 CHC）。在第一阶段 (UH2)，我们将开展焦点小组活动并对家长和 CHC 提供者进行访谈，以告知口腔健康短信干预的发展，并评估 CHC 工作流程，以确定口腔健康整合和最终传播的可持续策略。正如我们之前所做的那样，这项形成性工作对于确保文化和环境的兼容性至关重要。短信将与 AAP 指南、我们的理论模型（社会认知理论）和我们之前的工作保持一致。我们将使用 Fisher-Owens 模型（2007）作为干预计划框架。在第 2 阶段 (UH3)，850 名参加我们目标 CHC 的 6 岁以下儿童的父母/法定监护人将被随机接受两种剂量当量短信干预措施之一：口腔健康短信 (OHT) 或儿童健康短信 (CWT)。主要结果变量是 24 个月时的 ECC 发生率。我们将评估干预效果的中介者和调节者，进行预算影响分析，以确定 OHT 干预措施在 CHC 中的采用、推广和可持续性的财务后果，评估 CHC 在口腔健康促进方面的变化（提供者实践和 EHR 文件），并评估儿科和家长口腔健康行为的变化。这项研究具有成为一项基于证据的计划的巨大潜力，可以在美国 1,128 个 CHC 中以低成本和低提供者负担轻松采用，这些 CHC 治疗了近 450 万 6 岁以下的高危儿童。我们的短信干预是创新的，因为涉及系统生成的实时支持、定制、反馈和交互性。我们的研究具有理论意义，因为它将可检验的理论与干预计划模型相结合，以阐明多个层面的变化机制。