Developing a Tailored, Web-delivered, Motivational Interviewing-based Intervention to Promote Oral Health

To address a persistent “silent epidemic” of oral diseases in the United States and reduce associated health disparities, a new paradigm for promoting oral health behavior change is urgently needed. Patient education and risk-reduction counseling have been identified as central components of an overall plan for preventing oral disease. However, the typical approach of dental professionals is to provide oral hygiene advice, demonstration, or instruction, which generally have little impact on behavior. Although motivational interviewing (MI) has received support as a method for promoting oral health behavior change, constraints in dental practice settings limit the practicality of such counseling. As a step toward developing novel, effective, high-impact approaches to promoting behaviors that reduce risks for oral disease, the present application proposes a mixed methods research project to develop a web-delivered adaptation of MI for increasing patients' health-promoting behavior (e.g., oral hygiene) and decreasing their health-risk behavior (e.g. tobacco and other substance use). This program would be the first technology-delivered adaptation of MI to be designed expressly for oral health promotion and the first web-delivered intervention to address all aspects of oral health-related behavior. This approach would represent a dramatic shift away from current practice in dental care settings and has the potential to yield substantial reductions in oral health disparities. The proposed project has three Specific Aims. Aim 1 will entail developing an initial prototype of the program. For this purpose, stakeholder recommendations will be gathered in focus group interviews with 32 dental patients and 32 dental professionals, content from a previously developed manual for face-to-face MI-based oral health promotion will be translated into elements suitable for inclusion in the program, feedback on design concepts will be obtained from 8 patients, and a full-featured prototype program will be developed. Aim 2 will entail a minimum of two iterations of usability and acceptability testing and subsequent program refinement, with 8 patients participating in each iteration. Aim 3 will entail administering the program to 24 dental patients in a public health dental clinic context and evaluating the extent to which they perceive the program as engaging, relevant, and possessing MI-consistent features expected to motivate change in oral health-related behavior. Achieving these aims will yield a theory-based intervention with demonstrated usability and acceptability and will support a subsequent application for an NIDCR R34 Behavioral Clinical Trial Planning Grant (PAR-14-342) to document feasibility and proposed procedures of a clinical trial. These activities would, in turn, support an application under NIDCR’s U01 Clinical Trial Cooperative Agreement (PAR-15-059) mechanism to test the program’s ability to yield improvements in oral health behavior and reductions in oral disease. Subsequent adaptation also would permit intervention with individuals not currently receiving services (e.g., via a public website) and to specific populations at heightened risk (e.g., due to diabetes, substance use, or HIV infection).