Tooth decay is the most common chronic childhood disease and a recent report from the National Center for Health Statistics indicates that the problem is worsening among preschool children. Furthermore, the burden of this condition falls disproportionately upon children from minority and low socioeconomic status groups. Good dietary and oral hygiene practices and use of appropriate dental services and treatments for both the parent and their child are essential to good oral health. To reduce the prevalence of tooth decay and other oral health conditions among preschoolers, it is critical that more parents become knowledgeable about the causes and consequences of major child oral health diseases and actions they can take to prevent them. Anticipatory guidance from pediatric providers remains an important source of information for parents. However, time constraints during clinical encounters and the unique information needs different parents have indicate that new strategies are needed to enhance the efficiency and the patient-centeredness of the anticipatory guidance process. Specifically, if short, precise measures are available to assess parents'knowledge across relevant content areas before an upcoming visit, parent-specific knowledge profiles can be generated to help clinicians tailor their guidance to parents'specific needs. Computerized adaptive testing (CAT), a measurement approach based on item response theory (IRT) in which items selected for presentation is adapted to the subject's ability level, could provide the basis for these short, accurate assessments. This project will develop a prototype for this knowledge assessment CAT system. Given the impact of tooth decay and worsening trend among young children, we will focus on developing an oral health module in this project. Other modules (e.g., in injury prevention and child development) will be developed in future projects. The proposed project will: 1) develop knowledge questions on child oral health;2) evaluate questions for inclusion based on readability, understandability, clinical relevance and psychometric performance;and 3) develop an experimental CAT prototype and pilot test CAT score validity. Dental, pediatric and measurement experts will develop knowledge questions based on evidenced-based sources. Readability is assessed by evaluating reading level. Cognitive interviews with a socio-demographically diverse group of parents (N=48) will assess understandability. Clinical experts (dental and pediatric) will review items for clinical relevance, clarity and evidence base. Factor and IRT analyses will be used to examine psychometric performance. Preliminary validity of CAT scores will be assessed through simulation studies and known group tests (across parental health literacy and education groups). Data for analyses will be drawn from self-administered surveys of 350 primary caregivers of children recruited from two Washington D.C. pediatric primary care practices serving diverse racial/ethnic and socio-economic populations.
The high prevalence and worsening trend in dental caries and disparities in overall oral health observed for preschoolers highlight the importance of oral health as a major public health problem in children. Evidence of deficits and disparities in parental oral health knowledge indicate that educating parents about the causes, consequences and the preventive actions they can take could be an important first step to addressing this problem. The long-term goal of this project is to develop a series of adaptive parental knowledge assessment tests that can support providers in individualizing anticipatory guidance to the needs of parents and their children, which we hope will improve quality of care and outcomes for children.