This cooperative project aims to develop a multi-site trial with fractional factorial design using community-based participatory research model.  The project specific aims are:

1. Detroit and Philadelphia.  The committees will work to develop logic maps for eliminating disparities in dental caries using pragmatic interventions in the community, homes, and Federally Qualified Health Centers (FQHCs).
2. To develop and pretest, with community groups, potential interventions to:
   1. screen for dental caries in the community using clinical, behavioral, social, and biological risk indicators;
   2. triage and navigate dental care with the FQHCs;
   3. reduce dental anxiety;
   4. provide social support;
   5. increase oral health and nutritional literacy; and
   6. provide tailored preventive and educational interventions in the homes of children and adults with high dental needs
3. To develop evidence-based clinical protocols for dental caries and evaluate a plan for implementations in the affiliated FQHC clinics.
4. To develop a proposal for a multi-site trial to evaluate the effectiveness of different combinations of the developed interventions on eliminating disparities in dental caries.

Research plan

The proposed planning project is based on the extensive findings and data collected by the NIH-funded Detroit Center for Research on Oral Health Disparities (U-54 DE 14261-01).  Dental disparities can only be eliminated using comprehensive models that reduce the impact of negative determinants of dental caries and increase the benefits of health promoting activities.  The Detroit Center has identified a number of key determinants of the disparities in dental caries such as social support, depression, dental fatalism, dietary and nutritional literacy, and community organizational factors that determine how families behave or have access to health promoting resources (e.g. fruits and vegetables, health care, transportation).

The research team will perform the project by:

1. Identifying with NIDCR geographic areas (i.e. Detroit, Philadelphia) to target in the development phase.
2. Locating and recruiting leaders of FQHCs to participate in the project.
3. Locating and recruiting community leaders representing an array of health and social service organizations to participate in the project.
4. Providing training to the community and FQHC representatives in the process of community-based participatory research.
5. Initiating discussions to develop a logic map to guide the development of the project.  The logic map will define the final outcomes desired by the communities, as well as the intermediate outcomes, activities, and resources available.
6. Guided by the logic map, initiating the development of modules for the interventions. Based upon previous research and if selected by the community advisory committees, we envision developing short interventions to screen for dental caries; triage and navigate dental care with the FQHCs; reduce dental anxiety; provide social support; increase oral health and nutritional literacy; and provide tailored preventive and educational interventions using the principles of motivational or persuasion behavioral change.
7. Reviewing local as well as national curricula to train community members (community navigators) to work as advocates and promoters for oral health in the community as well as to administer the interventions.  Training for the project (Manual of Operations) will be developed and tested in this phase.
8. Pretesting the interventions using the community navigators and volunteers from the communities.  Testing will focus on ease of use; reliability; and discriminative validity.
9. Finalizing the fractional factorial design and sample sizes for the intervention.
10. Finalizing the Manual of Operations for the proposed community trial.
11. Submitting a proposal to implement the plans using the cooperative funding mechanism.