Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits
<b>Background</b>: Dental caries in pediatric patients are noted to have broad impacts on systemic health and well-being. Thus, utilizing an effectiveness-implementation hybrid I design, the Pediatric Providers Against Cavities in Children’s Teeth (PACT) trial is investigating multi-leve...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-09-01
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| Series: | Dentistry Journal |
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| Online Access: | https://www.mdpi.com/2304-6767/8/3/101 |
| _version_ | 1827707107262070784 |
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| author | Suchitra Nelson Mary Beth Slusar Shelley Curtan David Selvaraj Andrew Hertz |
| author_facet | Suchitra Nelson Mary Beth Slusar Shelley Curtan David Selvaraj Andrew Hertz |
| author_sort | Suchitra Nelson |
| collection | DOAJ |
| description | <b>Background</b>: Dental caries in pediatric patients are noted to have broad impacts on systemic health and well-being. Thus, utilizing an effectiveness-implementation hybrid I design, the Pediatric Providers Against Cavities in Children’s Teeth (PACT) trial is investigating multi-level interventions at the practice (incorporation of oral health in electronic medical record [EMR]) and provider levels (theory-based didactic and skills training to communicate oral health facts to parent/caregiver, give a prescription to see a dentist and a list of area dentists) to increase dental utilization among 3 to 6 year old Medicaid-enrolled children attending well-child visits (WCV). The formative and pilot work for the larger main trial are presented. <b>Methods</b>: Formative work—Focus groups with 26 participants (Community leaders, providers, parent/caregivers); and key informant interviews with practice leadership (n = 4). Topics discussed were: core oral health (OH) information to communicate at WCVs and study logistics. Transcripts were coded and analyzed using Atlas.ti; <i>Pilot study</i> was refined using the formative findings and was conducted at two pediatric practices to test the implementation of: the provider didactic and skills training curriculum; EMR incorporation of four OH questions; logistics of incorporating OH activities at a WCV; and parent/caregiver recruitment. <b>Results</b>: Formative work showed that providers and parent/caregivers required knowledge of dental caries, and a list of area Medicaid-accepting dentists. Providers and practice leadership advised on the logistics of incorporating oral health into WCVs. All groups suggested asking parent/caregivers their preferred method of contact and emphasizing importance of OH to motivate participation. Utilizing these findings, the curriculum and protocol was revised. The <i>pilot study</i> in two practices successfully implemented the protocol as follows: all seven providers were trained in two 45 min didactic education and skills session; incorporation of OH questions into practices EMR; recruited 86 child-parent dyads (95% participation) at the WCV; providers delivered the OH intervention to parent/caregivers in <2 min and 90% completed EMR documentation of OH questions. These findings were instrumental in finalizing the main PACT trial in 18 practices. The RE-AIM framework is used in the main trial to collect effectiveness and implementation measures at baseline and follow-up visits. <b>Conclusions</b>: The formative and pilot findings were instrumental in refining the OH intervention and protocol which has resulted in successful implementation of the main trial. <b>Trial Registration</b>: Clinical trials.gov, Registered 9 November 2017, NCT03385629. |
| first_indexed | 2024-03-10T16:38:53Z |
| format | Article |
| id | doaj.art-8de4aad956c445318ab16f57d8a71adb |
| institution | Directory Open Access Journal |
| issn | 2304-6767 |
| language | English |
| last_indexed | 2024-03-10T16:38:53Z |
| publishDate | 2020-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Dentistry Journal |
| spelling | doaj.art-8de4aad956c445318ab16f57d8a71adb2023-11-20T12:11:35ZengMDPI AGDentistry Journal2304-67672020-09-018310110.3390/dj8030101Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child VisitsSuchitra Nelson0Mary Beth Slusar1Shelley Curtan2David Selvaraj3Andrew Hertz4Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, OH 44106-4905, USADepartment of Sociology, California State University Northridge, Northridge, CA 91330, USADepartment of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, OH 44106-4905, USADepartment of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, OH 44106-4905, USAUniversity Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA<b>Background</b>: Dental caries in pediatric patients are noted to have broad impacts on systemic health and well-being. Thus, utilizing an effectiveness-implementation hybrid I design, the Pediatric Providers Against Cavities in Children’s Teeth (PACT) trial is investigating multi-level interventions at the practice (incorporation of oral health in electronic medical record [EMR]) and provider levels (theory-based didactic and skills training to communicate oral health facts to parent/caregiver, give a prescription to see a dentist and a list of area dentists) to increase dental utilization among 3 to 6 year old Medicaid-enrolled children attending well-child visits (WCV). The formative and pilot work for the larger main trial are presented. <b>Methods</b>: Formative work—Focus groups with 26 participants (Community leaders, providers, parent/caregivers); and key informant interviews with practice leadership (n = 4). Topics discussed were: core oral health (OH) information to communicate at WCVs and study logistics. Transcripts were coded and analyzed using Atlas.ti; <i>Pilot study</i> was refined using the formative findings and was conducted at two pediatric practices to test the implementation of: the provider didactic and skills training curriculum; EMR incorporation of four OH questions; logistics of incorporating OH activities at a WCV; and parent/caregiver recruitment. <b>Results</b>: Formative work showed that providers and parent/caregivers required knowledge of dental caries, and a list of area Medicaid-accepting dentists. Providers and practice leadership advised on the logistics of incorporating oral health into WCVs. All groups suggested asking parent/caregivers their preferred method of contact and emphasizing importance of OH to motivate participation. Utilizing these findings, the curriculum and protocol was revised. The <i>pilot study</i> in two practices successfully implemented the protocol as follows: all seven providers were trained in two 45 min didactic education and skills session; incorporation of OH questions into practices EMR; recruited 86 child-parent dyads (95% participation) at the WCV; providers delivered the OH intervention to parent/caregivers in <2 min and 90% completed EMR documentation of OH questions. These findings were instrumental in finalizing the main PACT trial in 18 practices. The RE-AIM framework is used in the main trial to collect effectiveness and implementation measures at baseline and follow-up visits. <b>Conclusions</b>: The formative and pilot findings were instrumental in refining the OH intervention and protocol which has resulted in successful implementation of the main trial. <b>Trial Registration</b>: Clinical trials.gov, Registered 9 November 2017, NCT03385629.https://www.mdpi.com/2304-6767/8/3/101oral healthpediatricqualitative researchpilot studyimplementation |
| spellingShingle | Suchitra Nelson Mary Beth Slusar Shelley Curtan David Selvaraj Andrew Hertz Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits Dentistry Journal oral health pediatric qualitative research pilot study implementation |
| title | Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits |
| title_full | Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits |
| title_fullStr | Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits |
| title_full_unstemmed | Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits |
| title_short | Formative and Pilot Study for an Effectiveness-Implementation Hybrid Cluster Randomized Trial to Incorporate Oral Health Activities into Pediatric Well-Child Visits |
| title_sort | formative and pilot study for an effectiveness implementation hybrid cluster randomized trial to incorporate oral health activities into pediatric well child visits |
| topic | oral health pediatric qualitative research pilot study implementation |
| url | https://www.mdpi.com/2304-6767/8/3/101 |
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