Family Access to a Dentist Study (FADS): A multi-center randomized controlled trial.
BACKGROUND
Many low-income parent/caregivers do not understand the importance of cavity-free primary (baby) teeth and the chronic nature of dental caries (tooth decay). As a consequence, dental preventive and treatment utilization is low even when children are screened in schools and referred for care. This study aims to test a referral letter and Dental Information Guide (DIG) designed using the Common-Sense Model of Self-Regulation (CSM) framework to improve caregivers' illness perception of dental caries and increase utilization of care by children with restorative dental needs.


METHODS
A multi-site randomized controlled trial with caregivers of Kindergarten to 4th grade children in urban Ohio and rural Washington State will compare five arms: (1) CSM referral letter alone; (2) CSM referral letter+DIG; (3) reduced CSM referral letter alone; (4) reduced CSM referral letter+DIG; and (5) standard (control) referral. At baseline, children will be screened at school to determine restorative dental needs. If in need of treatment, caregivers will be randomized to study arms and an intervention packet will be sent home. The primary outcome will be dental care based on a change in oral health status by clinical examination 7 months post-screening (ICDAS sealant codes 1 and 2; restoration codes 3-8; extraction). Enrollment commenced summer 2015 with results in summer 2016.


CONCLUSIONS
This study uses the CSM framework to develop and test behavioral interventions to increase dental utilization among low-income caregivers. If effective this simple intervention has broad applicability in clinical and community-based settings.
Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, USA. Electronic address: sxn15@case.edu.
Suchitra
S
Nelson
Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA.
Christine
C
Riedy
Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, USA.
Jeffrey M
JM
Albert
Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, USA.
Wonik
W
Lee
Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, USA.
Mary Beth
MB
Slusar
Department of Community Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, USA.
Shelley
S
Curtan
Department of Pediatric Dentistry, School of Dental Medicine, Case Western Reserve University, Cleveland, USA.
Gerald
G
Ferretti
Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, USA.
Joana
J
Cunha-Cruz
Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, USA.
Peter
P
Milgrom
D017028:Caregivers / Q000193:education; D002648:Child; D003729:Dental Care / Q000523:psychology*; D003731:Dental Caries / Q000523:psychology*; D004311:Double-Blind Method; D005190:Family; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008960:Models, Psychological; D009909:Oral Health; D010465:Perception; D011203:Poverty; D012017:Referral and Consultation; D014505:Urban Population
Caregiver; Children; Dental care; Illness perception; Referral