Evaluation of a Bright Futures Oral Health Intervention

Summary

Pediatricians serve an important role in promoting health in families. Bright Futures offers a child and family-centered approach to health promotion in incorporating partnership and communication skills of providers. Two areas of importance are in promotion of oral health and prevention of iron deficiency. We plan to study implementing educational curriculum to pediatric residents through a randomized controlled trial. Randomization will be done through assignment at the level of pediatric training program. Residents randomized to Group 1 will receive education about Bright Futures partnership and communication skills with oral health as the main health promotion topic. Group 2 will receive educational curriculum pertaining to the topic of iron deficiency prevention. While pediatricians are positioned perfectly to partner and effectively communicate with families on these two issues, there are gaps in pediatric education addressing these topics. The CORNET continuity practices of the Ambulatory Pediatric Association provide a venue through which multiple residency programs that educate pediatric residents and whose residents provide medical care to underserved children can participate. The research hypotheses include:

1. Residents in Group 1 will have greater confidence, knowledge and competence in partnership building and communication with families
2. Residents in Group 1 will have greater knowledge and competence in discussing oral health promotion
3. Residents in Group 2 will have greater knowledge and competence in discussing iron deficiency prevention
4. Parent-child dyads in Group 1 will be more likely to have established a dental home
5. Parent-child dyads in Group 1 will be more likely to be satisfied with their healthcare encounter.

Pediatric practices provide fertile ground for the provision of health promotion on oral health and iron deficiency prevention. However, evidence for the effectiveness of primary care clinician interventions of screening, referral and counseling to prevent dental caries is lacking \[14\]. The National Survey of America's Families \[15\] found 47% of children did not receive the recommended number of dental visits, with the youngest ones being least likely to receive any dental care.

Although 90% of pediatricians agreed they had important roles in identifying and counseling patients on prevention of caries, half stated they had received no previous training during medical school or residency and their knowledge of basic oral health topics was limited \[13\]. These studies highlight that pediatricians play important roles in oral health and are capable of being trained to complete oral screening exams, but more education and guidance is needed.

Iron deficiency is the most common childhood nutritional deficiency in the United States. Recent prevalence data have determined that 7-30% of children in the United States aged 1-2 years have iron deficiency and 3-10% have iron deficiency anemia \[17, 18\]. Specific goals in Health People 2010 include a reduction of iron deficiency to 5% in children less than 3 years of age.

Conditions

• Health Knowledge, Attitudes, Practice

Interventions

BEHAVIORAL

Group 1: Bright Futures Oral Health Curriculum

Residents who are randomized to Group 1 will receive a resident curriculum that exposes them to Bright Futures concepts of health promotion, including partnership building, communication and oral health. Group 1 residents will complete 7 modules, 3 on Bright Futures concepts (health, partnership building and communication), and 4 on oral health promotion. These modules have been developed in collaboration with the Pediatrics in Practice workgroup and the Open Wide modules endorsed by the American Academy of Pediatrics and the Maternal and Child Health Bureau. The oral health modules address dental caries development and prevention, importance of identifying maternal oral health status, duration of bottle-feeding or breastfeeding and discouraging both during sleep.

BEHAVIORAL

Group 2: Iron Deficiency Training Module

Our study team opted to include a single 1-hour educational module addressing the identification and prevention of iron deficiency created by the AAP on Pedialink® to the active control group. This educational module addresses screening for and assessing risk for iron deficiency.

Sponsors & Collaborators

• Continuity Research Network

  lead NETWORK

Principal Investigators

• Henry H Bernstein, DO · Dartmouth-Hitchcock Medical Center

Eligibility

Min Age

12 Months

Max Age

35 Months

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2005-09-30

Primary Completion

2010-12-31

Completion

2010-12-31

Countries

• United States

Study Locations