This application is in response to RFA-DE-15-006 Multidisciplinary and Collaborative Research Consortium to Reduce Oral Health Disparities in Children: A Multi-level Approach. The prevalence of Early Childhood Caries (ECC) is increasing, disproportionately affecting racial and ethnic minorities (Dye, 2007). Prevention efforts for high risk groups require multi-level strategies. We will target parents/legal guardians of children (<6 years) during pediatric well-child visits at urban community health centers (CHCs), and provide a text-message based ECC prevention intervention. We will also target the pediatric providers in the CHCs to adopt oral health guidelines from the American Academy of Pediatrics (AAP) and also improve documentation within their Electronic Health Records (EHRs). Thus, our multi-level intervention includes children, parents, providers and the CHC system. 85% of adults use text messaging, with no disparities by race/ethnicity, education or income. The benefits of text message interventions include the use anywhere/anytime, low cost, scalability to large populations, ability to tailor message content and intensity, and provision of strategies in real time. CHCs are an ideal venue for oral health promotion both at an individual level (they provide care to the groups at highest risk for ECC) and at a population level (there are 90 CHCs electronically linked locally and >1,100 CHCs nationally). In Phase 1 (UH2), we will conduct focus groups and interviews with parents and CHC providers to inform the development of the oral health text message intervention, as well as assess CHC work flow to identify sustainable strategies for oral health integration and eventual dissemination. This formative work is vital to ensure cultural and environmental compatibility, as we have done previously. The text messages will be consistent with AAP guidelines, our theoretical model (Social Cognitive Theory), and our previous work. We will use the Fisher-Owens Model (2007) as an intervention planning framework. In Phase 2 (UH3), 850 parents/legal guardians of children <6 years attending our target CHCs will be randomized to receive one of two dose-equivalent text message interventions: Oral Health Texts (OHT) or Child Wellness Texts (CWT). The primary outcome variable will be ECC incidence at 24 months. We will assess mediators and moderators of the intervention effect, perform a budget impact analysis to determine the financial consequences of adoption, diffusion, and sustainability of the OHT intervention at CHCs, assess CHC changes in oral health promotion (provider practices and EHR documentation), and assess changes in both pediatric and parent oral health behaviors. This research has strong potential to be an evidence based program that could easily be adopted at low cost and low provider burden in the 1,128 CHCs in the U.S. that treat almost 4.5 million high risk children <6 years old. Our text message intervention is innovative because involves system-generated real time support, tailoring, feedback, and interactivity. Our study has theoretical significance because it integrates a testable theory with an intervention planning model to elucidate mechanisms of change at multiple levels.
Despite the fact that early childhood caries (ECC) is preventable, it is the most common chronic childhood disease in the US, affecting 28% of those aged 2-5, and disproportionately affecting poor and minority groups. We propose an interactive text messaging intervention delivered to parents of children younger than 6 years old, which aims to foster healthy parent behaviors and reduce ECC in their children. This novel, low cost approach has the potential to expand the ability of community health center (CHC) pediatric clinics to efficiently integrate oral health promotion into their practice and could easily be disseminated to the 1200 CHCs in the United States that treat 4.5 million children younger than 6, most of whom are at high risk for ECC.
