Graduate Program in Assessment Technology for the National Health System (SUS), Grupo Hospitalar Conceição (GHC), Porto Alegre, Brazil.
Graduate Program in Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Community Dent Oral Epidemiol. 2019 Dec;47(6):477-484. doi: 10.1111/cdoe.12488. Epub 2019 Aug 6.
This study aimed to investigate the differential preventive effect of motivational interviewing (MI) on early childhood caries (ECC) according to socioeconomic variables, using a community-based trial in a public healthcare setting.
A cluster-randomized, double-blind study with two parallel groups in healthcare clinical settings (HCCs) comparing conventional oral health education (CE) and MI aimed at mothers of children born in 2013 and 2014. The oral health team of 6 of the 12 HCCs were trained in MI. This training was intensive for active learning of the basic MI principles, conducted by a psychologist who is a PhD in psychiatry and has extensive experience in conducting MI training workshops. It was held in an experiential format divided into two 4-hour shifts, with a 1-week interval. Children who attended at least one dental visit in the first year of life at their HCC were clinically evaluated by trained examiners and parents responded to a questionnaire. The effect of MI on the caries outcome compared with CE was evaluated in different subgroups: family income, mother's education and skin colour.
One hundred and eighty-six were included in the CE group and 228 in the MI group. The caries rate per 100 surface-year was 1.29 (95%CI: 0.92-1.80) in the CE group and 0.46 (95%CI: 0.29-0.73) in the MI group. The effect of MI was statistically significant in the lower-income category (P = .03); MI prevented 57% of carious lesions (IRR = 0.43, 95% CI 0.22-0.83) and reduced the occurrence of the disease on more than one surface per 100 followed surface-year in this same category in the equivalent income subgroup (IRD = -1.37, P = .04).
Motivational interviewing had a greater preventive effect against caries in children whose families are of lower income.
本研究旨在通过社区为基础的公共卫生保健环境中的临床试验，探究动机性访谈（MI）对幼儿龋病（ECC）的预防效果是否因社会经济变量而存在差异。
这是一项在医疗保健临床环境（HCC）中进行的集群随机、双盲对照研究，有两个平行组，比较了针对 2013 年和 2014 年出生的儿童的母亲的常规口腔健康教育（CE）和 MI。HCC 中 6 个口腔保健团队接受了 MI 培训。该培训是通过一位精神病学博士、具有丰富 MI 培训经验的心理学家进行的，以积极学习 MI 的基本原则，培训以体验式格式进行，分为两个 4 小时的班次，间隔一周。在 HCC 至少接受一次第一年牙科就诊的儿童由经过培训的检查者进行临床评估，家长则回答一份调查问卷。在不同亚组中，与 CE 相比，MI 对龋病结果的影响进行了评估：家庭收入、母亲的教育程度和皮肤颜色。
CE 组纳入 186 名儿童，MI 组纳入 228 名儿童。CE 组每 100 个表面年的龋病率为 1.29（95%CI：0.92-1.80），MI 组为 0.46（95%CI：0.29-0.73）。MI 在低收入类别中具有统计学意义（P=.03）；MI 可预防 57%的龋病病变（IRR=0.43，95%CI 0.22-0.83），并在相同收入亚组中减少每 100 个随访表面超过一个表面的疾病发生（IRD=-1.37，P=.04）。
动机性访谈对收入较低家庭的儿童龋病具有更强的预防作用。
