Dental caries (tooth decay) in 2--11 year olds is increasing especially among poor and minority populations, and it is unlikely that Healthy People 2020 goals will be met. Dental screening of children in elementary schools has been mandated in 12 states and endorsed by US organizations and WHO. In spite of enthusiasm for the concept, screening and standard referral letters have been ineffective in getting parents/caregivers to take children to the dentist. Caregiver-level engagement or action is necessary to motivate follow-up on child- level interventions at schools. Thus, we propose an experimental intervention based upon the Common Sense Model of Self-Regulation (CSM) to address parent/caregiver illness perception (cognitive representation: identity, consequences, controllability, cause, timeline;and emotional representation) and navigation of resources to increase receipt of dental care for children with restorative dental needs.
The Specific Aims of the proposed multi-site double-blind Phase III randomized controlled clinical trial (RCT) study are: (1) Utilizing a three arm design, to evaluate the new CSM theory-driven referral letter alone or the new CSM referral letter + Dental Information Guide (DIG: facts about dental caries, hints for getting dental care, making appointments and Medicaid access, transportation and dentists availability resources) compared to a standard referral letter to increase receipt of dental care among inner-city urban African American, and rural Hispanic and White elementary school children;(2) To assess changes in parent/caregiver illness representation/perception and behavioral intention between the beginning and end of school year to understand the underlying mechanisms of the new vs. standard referral approach resulting in receipt of dental care. There will be 2 study sites: Ohio (East Cleveland City School District);Oregon (Jefferson County School District 509-J and Morrow County School District). All K-4th grade children and caregivers will be recruited through school district events. Children will be screened at beginning of the school year to determine caregiver eligibility for participation in the RCT. A total of 660 caregivers whose children have restorative dental needs will be randomized to the 3 study arms, and intervention letters will be sent home. Data collection includes: child baseline screening and follow-up dental exam at the study exit 7 mos later to determine if the child received care;caregiver illness perception questionnaire revised for dental (IPQ-RD) and a caregiver questionnaire at 3 time points (baseline, one-month after receipt of intervention letters exit). Data analysis for aim 1 includes a multivariate logistic regression model with adjustment for baseline characteristics;
and aim 2 includes a generalized causal mediation analysis to delineate the mechanism (or paths) through which interventions impact dental care receipt. This behavioral intervention has the potential to change the public health standard of practice for screening by utilizing a cost- effective, easily transportable, and sustainable approach. The RCT is a collaboration of Case Western Reserve University and University of Washington Northwest Center to Reduce Oral Health Disparities.
The proposed study will test an innovative behavioral approach to the referral process never attempted before. The new intervention letter and information guide are intended to change caregiver illness perception by addressing three issues - (1) knowing the 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 new referral approach also has the potential to change the public health standard of practice for school screening programs required by law in many states.