The study addresses an innovative behavioral approach to the referral process never attempted before to address three caregiver issues – (1) importance of caries-free baby teeth for protection of permanent teeth (2) viewing dental caries as a chronic disease rather than acute or episodic; and (3) navigation of resources for dental care access. This behavioral approach also has the potential to change the public health standard of practice for school screening programs required by law in many states.
Tooth decay in 2- to 11-year-olds is increasing nationally, especially among poor and minority populations, and it is unlikely that Healthy People 2020 goals will be met. Dental screening of children in public elementary schools has been mandated in 12 states and endorsed by U.S. and international organizations. Nevertheless, in spite of enthusiasm for the concept, screening and referral has been ineffective as a tool to get parents and caregivers to take children to the dentist.
This project is to support planning of a Phase II randomized clinical trial to assess the effectiveness of a referral approach to increase dental attendance (for receipt of care) among inner-city urban elementary school children with urgent/restorative needs. The intervention to be tested relies on two theoretical frameworks – Common Sense Model of Self-Regulation (CSM), and the theory of Planned Behavior (TPB) that could be used in conjunction with child-level interventions in a school-based program.
The objectives of the study will occur in two phases: (1) pilot phase to validate the modified illness perception questionnaire –Revised (IPQ-RD) for dental caries, acceptability and delivery of the intervention, mediators and moderators for accessing care; focus groups of community organizations and providers to identify enabling resources to be included in the experimental intervention; and testing the experimental intervention regarding appropriateness/accuracy of educational materials; (2) planning phase primarily devoted to the major planning activities required for a U01 submission including development of the study protocol, manual of operations, and Institutional Review Board application and its associated materials. The sample size for the R34 includes 120 caregivers of KG, first, and second grade school children recruited from among 5 elementary schools in an urban inner-city school district in Cleveland, OH, and 10 to 20 key informants from several community agencies or providers. Data collection involves semi-structured one-to-one interviews and questionnaire responses for caregivers and focus groups for community/provider informants. Data analysis will utilize a mixed method design (grounded theory and theory driven) for qualitative data, and descriptive/analytical statistics for quantitative data.
This behavioral approach has the potential to change the public health standard of practice for screening programs by utilizing a cost-effective, easily transportable, and sustainable referral approach. The trans-discipilinary research team includes faculty from Department of Community Dentistry at Case Western Reserve and the Northwest Center to Reduce Oral Health Disparities at the University of Washington.
Suchitra Nelson, PhD – Department of Community Dentistry
Gerald Ferretti, DDS, MS, MPH - Department of Pediatric Dentistry
Peter Milgrom, DDS - Department of Community Dentistry
Jeffrey Albert, PhD - Department of Epidemiology and Biostatistics, School of Medicine