Using a web-based resource to increase capacity for delivering eating disorder-specific secondary prevention among dental care providers

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Using a web-based resourceto increase capacity
for deliveringeating disorder-specificsecondary
prevention among dental care providers

• Rita DiGioacchino DeBate, Ph.D., MPH,
  CHESUniversity of South Florida
• Lisa Tedesco, Ph.D.
• Emory University

This study was funded by a grant (1 R15
DE013963-01A1) by the National Institutes of
Health, National Institute of Dental and
Craniofacial Research
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Background

• The American College of Physicians lists eating
  disorders as one of the nine most serious
  problems affecting adolescents and young adults,
  and Anorexia Nervosa as the 3rd most common
  chronic illness. 1
• Only 1 in 10 individuals with eating disorders
  receive treatment.2
• The number of individuals who are referred to
  care is influenced by the secondary-prevention
  efforts of various health practitioners who are
  skilled in detecting the physical and oral
  manifestations resulting from disordered eating
  behaviors

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Background

• Dentists and dental hygienists play a fundamental
  role in the secondary-prevention of eating
  disorders as they are often the first health
  professionals to observe overt health effects,
  enabling them to be first health practitioner in
  the process of secondary prevention.3-6
• The oral health care providers role also extends
  to tertiary-prevention (management of relapse) by
  way of case management.
• Despite this crucial role secondary-prevention of
  eating disorders, current research indicates few
  dentists and dental hygienists consistently
  participate in secondary prevention practices.

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Preliminary Studies

• The principal investigator was awarded a grant to
  explore the secondary prevention practices among
  dental practitioners.
• The specific aims of this study were to
• explore readiness among dental practitioners with
  regard to current eating disorder specific
  secondary prevention practices
• identify associated health beliefs influencing
  adoption secondary prevention behaviors
• develop and implement a continuing education
  program

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Preliminary Studies

• Increasing the behavioral capacity among dental
  professionals to engage in secondary prevention
  practices supporting the integration of oral and
  mental health services requires
• increasing personal perceptions among oral health
  practitioners with regard to perceived severity
  of eating disorders on the patients oral,
  physical, and mental health
• increasing knowledge of oro-dental cues of eating
  disorders
• skill development with regard to accurate
  assessment, providing appropriate home dental
  care, referring the patient for treatment, and
  communicating with the patients primary care
  provider.
• Increasing availability of resources (i.e.
  patient education, referral)

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Purpose of this study

• The specific aims
• Develop a Web-based Dental Practitioner Eating
  Disorder Toolkit
• Implement a pilot study of the web based
  toolkit
• Revise the toolkit as indicated by pilot study
  results.

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Intervention

• Based upon information from triangulation of data
  a web-based Eating Disorder Secondary Prevention
  Toolkit Developed
• Theory-based
• Interactive
• Oral and physical manifestations
• Types of Eating disorders and psychological
  characteristics
• Patient Approach
• Based upon brief motivational interviewing
• Includes videos, scripts, checklists
• Printer ready tools
• Home dental care
• Information regarding physical effects of eating
  disorders
• Referral lists

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Methods Theoretical Frameworks
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Methods Theoretical Frameworks
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Evaluation
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Preliminary Findings

• Preliminary process evaluation of the prototype
  resource kit was conducted with 16 dentists and
  hygienists to assess key determinates for
  likelihood of use.
• Data from pilot participants, who completed the
  posttest, responded with an indication of either
  strongly agree or agree to the following
• 83.4 This eating disorder toolkit provides more
  information about secondary prevention of eating
  disorders than is currently available to dental
  professionals
• 83.3 This eating disorder toolkit provides more
  resources about secondary prevention of eating
  disorders than is currently available to dental
  professionals
• 100 This eating disorder toolkit provides
  information regarding secondary prevention of
  eating disorders that is tailored specifically
  for dental professionals
• 100 This eating disorder toolkit is easy to
  navigate
• 100 This eating disorder toolkit is
  understandable
• 100 The information is easy to read
• 100 The toolkit can be easily accessible for
  future reference
• 100 If available, I would access this toolkit
  for information regarding secondary prevention of
  eating disorders.

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Discussion

• The web provides an excellent vehicle for easy
  access to reference materials.
• A web-based tool-kit may provide a user friendly
  resource for increasing eating-disorder specific
  secondary prevention among oral health care
  workers.

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Acknowledgements

• We would like to thank the following for their
  input, assistance, and support
• The Department of Computer Science, Old Dominion
  University. Especially Ajay Gupta and numerous
  very talented research assistants.
• The Department of Dental Hygiene, Old Dominion
  University. Especially Michelle Darby and Akira
  Jones.

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References

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   Position paper. Annals of Internal Medicine
   1989.
2. Cavanaugh CJ, Lemberg R. What we know about
   eating disorders Facts and statistics. In
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   Sourcebook. Phoenix Oryx Press 19997-12.
3. Altshuler BD, Deshow PC, Waller DA, et al. An
   Investigation of the Oral Pathologies Occurring
   in Bulimia Nervosa. International Journal of
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4. Harrison JL, George LA, Cheatham JL, et al.
   Dental effects and management of bulimia nervosa.
   General Dentistry. 1985January-February65-68.
5. Roberts MW, Li S. Oral Findings in Anorexia
   Nervosa and Bulimia Nervosa A Study of 47 Cases.
   Journal of the American Dental Association.
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6. Stege P, Visco-Dangler L, Rye L. Anorexia
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   Behavior and Health Education Theory, research,
   and practice. Josey-BassSan Francisco
   200299-120.
8. Janz NK, Champion VL, Strecher VJ. The Health
   Belief Model. In Glanz K, Rimer BK, Lewis FM,
   eds. Health Behavior and Health Education
   Theory, research, and practice. San
   FranciscoJoseey-Bass200245-66.

This study was funded by a grant (1 R15
DE013963-01A1) by the National Institutes of
Health, National Institute of Dental and
Craniofacial Research