Reducing persistent oral health disparities among vulnerable low income older adults and adults with disabilities is a central objective in Healthy People 2020 and is a priority of state health departments and area agencies on aging. Limited knowledge of oral health and prevention and treatment alternatives, cultural differences in language and perception of oral health problems, and structural barriers combine to increase oral health disparities in vulnerable populations. This proposal, entitled "Changing Oral Health Norms and Hygiene Practices among Vulnerable Older Adults" aims to address these issues by developing and pilot testing a bi-level (building and individual) cognitive/behavioral intervention (Pro-GOH: Pro-Good Oral Health) to reduce significant and persistent disparities in oral health among vulnerable older low income, minority and disabled adults residing in publicly funded senior housing in Central Connecticut. The proposed intervention model is based on Fishbein's modified theory of reasoned action called Integrated Model (IM) of Behavioral Prediction operationalized through Adapted Motivational Interviewing and Practice-to-Mastery (AMI-PM). A substantial percentage of community-residing low income, disabled and minority adults aged 62 and over live in low income senior housing. They are known to be among those most vulnerable to depression, chronic diseases, inadequate primary care, and oral and other health disparities. A successful pilot intervention will provide the basis for a larger efficacy trial based on the RE-AIM approach in other buildings housing vulnerable older adults and adults with disabilities in the Central Connecticut area.
The aims of the proposed pilot study are to: 1) Conduct formative research, 2) Conduct a pilot of the intervention at the individual and building level in a typical low income senior residence, 3) Evaluate the pilot individual-level and building-level intervention processes for feasibility, acceptability and fidelity, 4) Conduct an individual level outcome evaluation comparing participants in the treatment building with a matched control building, using a pre and two post intervention assessments, and 5) Prepare Standard Operating Procedures (SOP), evaluation measures and intervention manuals for use in a broad clinical trial in Connecticut.
The proposed study's primary significance lies in the potential of this experimental intervention to address significant disparities in oral health and consequent morbidity or reduced quality of life among vulnerable, low- income and primarily minority older adults and those with disabilities through prevention in the locations where they reside. The intervention could provide a model for programs to reduce oral health disparities across Connecticut and nationally.