This exploratory grant proposal responds to NIDCR PAR-13-056: Dissemination and Implementation Research in Health (R03), and aims to explore the implementation of the prenatal oral health guidelines into clinical practice among prenatal and oral health providers. Consolidated guidelines, Oral Health Care during Pregnancy: A National Consensus Statement, sponsored by both the American College of Obstetricians and Gynecologists and the American Dental Association re-confer the importance of receiving oral health education, assessment and treatment during pregnancy given this critical period. However, previous research that examined prenatal and oral health providers' oral health knowledge, beliefs and practices identified substantial gaps between evidence and practice. Implementation strategies must respond to multi-level factors influencing providers' practice behaviors. However, factors influencing the implementation of the prenatal oral health guidelines and the mechanisms through which providers can deliver comprehensive and collaborative care remain a critical gap in oral-systemic research and practice. Our long-term goal is to increase oral-systemic prevention efforts during pregnancy, thus improving the health and well-being among women and children, and potentially decreasing risk for adverse health outcomes across the lifespan. The objective of this proposal, an initial step toward attainment of our long-term goal, is to identify and measure salient factors influencing the implementation of the prenatal oral health guidelines into clinical practice among prenatal and oral health providers in Florida. The objective will be achieved through the following specific aims: (1) Develop and validate a theory-based survey to assess factors influencing the implementation of the prenatal oral health guidelines among prenatal and oral health providers; (2) Assess the multi-level contextual factors that impact prenatal and oral health providers' practice behaviors regarding the prenatal oral health guidelines. Methods in Aim 1 include development of survey items with Scientific and Practice Advisory Boards, and pilot testing via cognitive interviews among prenatal and oral health providers (n=8). Methods used in Aim 2 include an online quantitative surveys administered to a random sample of licensed prenatal providers (MD, DO, CNM) and dental providers (DMD) in Florida (n=1,500). Achievement of these aims will be guided by the Consolidated Framework for Implementation Research.This study is significant as the Institute of Medicine has recognized the importance of guideline implementation as a strategy to improve health services in the U.S. Moreover, maternal and child oral health is identified as a national priority area by the NIH Office of Women's Health, the Maternal and Child Health Bureau, and Healthy People 2020. Findings have the potential to significantly improve maternal and child oral- systemic health across the lifecourse and could be applied to other health issues that necessitate effective dissemination and implementation strategies.
Poor oral health during pregnancy is a significant public health issue because of its prevalence, impact on 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 promoting oral health education, assessment, and treatment efforts during pregnancy; however, barriers and facilitators to implementing these guidelines into practice remain unknown. The proposed project aims to address this gap by exploring multi- level system factors that influence guideline implementation among prenatal and oral health providers, ultimately improving oral-systemic health among women and their offspring.
