Oral disease is a "silent epidemic" because of its prevalence and missed prevention opportunities. Evidence has established connections between oral-systemic etiologies, including the effects of periodontal disease (PD), and a range of health outcomes and co-morbidities across the lifecourse (e.g., adverse pregnancy and birth outcomes;early childhood carries;chronic conditions throughout adulthood). Pregnancy represents a sensitive period in the lifecourse increasing risk for poor oral health among mothers and their offspring. Although research indicates approximately 40% of pregnant women experience PD, only 23-35% of pregnant women report visiting a dentist during pregnancy. Subsequently, provider guidelines, endorsed by the American College of Obstetricians and Gynecologists (ACOG) and the American Dental Association (ADA), confer the importance of receiving oral health education, assessment, and treatment during pregnancy. However, barriers to positive oral healthcare practices during pregnancy include: a) misconceptions among pregnant women about risks/benefits of oral healthcare during pregnancy;b) prenatal providers not assessing, advising or referring patients on oral health issues during prenatal care visits;and c) lack of communication and patient case management between prenatal and oral health providers. Lack of familiarity with guidelines, low self-efficacy and environmental constraints (e.g., lack of time;other resources) has also been documented. Thus, it is imperative to address this gap in translating evidence-based research into prenatal care practice. Our long-term goal is to increase oral-systemic prevention efforts during pregnancy, thus potentially decreasing risk for poor health across the lifecourse. The objective of this project is to develop and determine the usability and feasibility of a consumer-driven eHealth application that will facilitate the translation of the oral healthcare guidelines into practice duing prenatal visits. This will be achieved through the following aims: (1) assess clinical system for interoperability with the eHealth application and identify key characteristics and features among stakeholders (prenatal providers;oral health providers;clinic personnel) through consumer-based research based on dimensions of the Consolidated Framework for Implementation Research and Diffusion of Innovations;(2) develop and pretest an interactive prototype based on information derived from Aim 1, advisory board input, and Information-Motivation-Behavioral Skills (IMB) and Brief Motivational Interviewing constructs/mechanisms;and (3) conduct usability and feasibility to evaluate the acceptability and preliminary impacts on changes in providers'IMB constructs, including practice behaviors per the guidelines. This innovative, timely and theory-driven project has the potential to translate pregnancy-related oral-systemic evidence into practice and facilitate inter-professional collaborations, thus decreasing gaps in the healthcare system. The multi-disciplinary team has the skills and expertise to ensure aims are successfully achieved and that this novel intervention leads to a marketable product that shifts the current practice paradigm.
Poor oral health during pregnancy is a significant public health issue because of its prevalence, impact on pregnant women's oral health and their future children's oral health, and emerging evidence suggesting oral- systemic links with adverse pregnancy and birth outcomes and other chronic health conditions across the lifecourse. Both medical and dental professional organizations have endorsed guidelines supporting oral health education, assessment, treatment and collaborative efforts during pregnancy;however, barriers to translating these guidelines into practice remain. The proposed project aims to address this gap by developing and determining the feasibility of an innovative consumer and theory-driven eHealth application in facilitating the translation of the guidelines into clinical practice during prenatal visits.