College of Public Health, University of South Florida, Tampa, FL, USA.
Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA.
Transl Behav Med. 2019 Nov 25;9(6):1100-1111. doi: 10.1093/tbm/ibz047.
Poor maternal oral health during pregnancy is associated with adverse maternal and child outcomes, including preterm birth and early childhood caries. Subsequently, professional associations have developed prenatal oral health guidelines, but significant gaps exist in implementing guidelines into clinical practice. The purpose of this study was to develop and test the usability of an innovative, theory-driven, eHealth application ("app") to facilitate prenatal providers' (nurse practitioners and midwives) implementation of oral health promotion during prenatal care visits. App development was guided by previous research, an integrated conceptual framework, Scientific Advisory Board input, and consumer-engaged iterative processes utilizing mixed-methods (observations, surveys, in-depth interviews) among providers (n = 4) during 10 unique prenatal care visits at a federally qualified health care center. Triangulation of quantitative and qualitative data analysis produced descriptive frequencies and salient themes. Concepts and principles from the following theoretical frameworks informed intervention development and testing: Consolidated Framework for Implementation Research; Information-Motivation-Behavioral Skills Model; Health Literacy; and Brief Motivational Interviewing. Overall, providers reported the app was effective at providing the information, motivation, and behavioral skills needed to integrate oral health promotion (e.g., easy to use; provided cues to action via scripts and tailored education; and documented findings into the patient's record). Although providers reported high usability, time constraints and detailed patient counseling scripts were identified areas for improvement. Findings suggest that the eHealth app could serve as an innovative mechanism to assist providers in implementing the prenatal oral health guidelines into practice. Future research is needed to continue app development efforts and to determine efficacy and effectiveness in practice settings.
孕妇口腔健康状况不佳与母婴不良结局有关，包括早产和幼儿龋齿。因此，专业协会已经制定了产前口腔健康指南，但在将指南付诸临床实践方面仍存在很大差距。本研究旨在开发和测试一种创新的、基于理论的电子健康应用程序（“应用程序”）的可用性，以促进产前护理期间促进口腔健康。应用程序的开发以先前的研究、综合概念框架、科学咨询委员会的意见以及利用混合方法（在联邦合格医疗中心的 10 次独特产前护理访问中进行观察、调查、深入访谈）在提供者（护士从业者和助产士）中进行的消费者参与式迭代过程为指导。定量和定性数据分析的三角分析产生了描述性频率和突出主题。以下理论框架的概念和原则为干预措施的开发和测试提供了信息：实施研究综合框架；信息-动机-行为技能模型；健康素养；简短动机访谈。总的来说，提供者报告说，该应用程序有效地提供了整合口腔健康促进所需的信息、动机和行为技能（例如，易于使用；通过脚本和量身定制的教育提供行动提示；并将发现记录在患者的记录中）。尽管提供者报告说可用性很高，但发现时间限制和详细的患者咨询脚本是需要改进的领域。研究结果表明，电子健康应用程序可以作为一种创新机制，帮助提供者将产前口腔健康指南付诸实践。需要进一步研究来继续应用程序的开发工作，并确定在实践环境中的效果和有效性。
