Leveraging technology to increase the disseminability of evidence-based treatment of dental fear: An uncontrolled pilot study

IF 1.8 4区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Journal of public health dentistry Pub Date : 2023-12-19 DOI:10.1111/jphd.12598
Richard E. Heyman PhD, Kelly A. Daly PhD, Amy M. Smith Slep PhD, Mark S. Wolff DDS, PhD
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Abstract

Objectives

U.S. and global estimates indicate that over 30% of adults fear receiving dental care, including over 20% who have visited a dentist in the last year, leading to avoidance and degraded oral and systemic health. Although evidence-based cognitive-behavioral treatments for dental fear (CBT-DF) exist, they have little impact on the millions who seek dental care annually because they are not disseminable (6 h of in-chair time, delivered only in person at a few sites). We developed a disseminable CBT-DF stepped-care treatment comprising (Step 1) a mobile-health application and, for those who remain fearful, (Step 2) a 1-h, one-on-one psychological treatment session that allows practice during exposure to the patient's most-feared stimuli. We hypothesized that the treatment would (a) be rated highly on usability and credibility and (b) result in clinically consequential (i.e., lowering fear into the 0–3 “no/low fear” zone) and statistically significant changes in global dental fear.

Method

Racially/ethnically diverse patients (N = 48) with moderate to severe dental fear were recruited; all completed Step 1, and n = 16 completed Step 2.

Results

As hypothesized, users found the stepped-care treatment highly usable, credible, and helpful. Critically, this stepped-care approach produced reductions in patients' dental fear that were both clinically consequential (with half no longer fearful) and statistically significant (d = 1.11).

Conclusions

This usable, credible, stepped-care approach to dental fear treatment holds promise for liberating evidence-based CBT-DF from specialty clinics, allowing broad dissemination.

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利用技术提高以证据为基础的牙科恐惧治疗的可传播性:一项非对照试点研究。
目标:据美国和全球估计,超过 30% 的成年人害怕接受牙科治疗,其中超过 20% 的人在过去一年中看过牙医,这导致了他们对牙科治疗的回避以及口腔和全身健康状况的下降。虽然已有针对牙科恐惧的循证认知行为疗法(CBT-DF),但它们对每年数百万寻求牙科治疗的人影响甚微,因为它们不具有可传播性(6 个小时的椅上时间,只能在少数几个地点亲自提供)。我们开发了一种可推广的CBT-DF阶梯式护理疗法,包括(第一步)移动医疗应用程序,以及(第二步)1小时的一对一心理治疗,让患者在接触最恐惧的刺激时进行练习。我们假设该治疗方法将(a)在可用性和可信度方面得到高度评价;(b)在临床上产生效果(即将恐惧感降至 0-3 级 "无/低恐惧 "区),并在统计学上显著改变总体牙科恐惧感:方法:招募了不同种族/族裔的中度至重度牙科恐惧患者(48 人);所有患者都完成了步骤 1,16 人完成了步骤 2:结果:正如假设的那样,使用者认为阶梯式护理疗法非常实用、可信且有帮助。重要的是,这种阶梯式护理方法减轻了患者的牙科恐惧,既有临床效果(半数患者不再恐惧),又有显著的统计学意义(d = 1.11):结论:这种可用、可信、阶梯式的牙科恐惧治疗方法有望将循证 CBT-DF 从专科门诊中解放出来,并得到广泛传播。
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来源期刊
Journal of public health dentistry
Journal of public health dentistry 医学-公共卫生、环境卫生与职业卫生
CiteScore
3.80
自引率
4.30%
发文量
69
审稿时长
6-12 weeks
期刊介绍: The Journal of Public Health Dentistry is devoted to the advancement of public health dentistry through the exploration of related research, practice, and policy developments. Three main types of articles are published: original research articles that provide a significant contribution to knowledge in the breadth of dental public health, including oral epidemiology, dental health services, the behavioral sciences, and the public health practice areas of assessment, policy development, and assurance; methods articles that report the development and testing of new approaches to research design, data collection and analysis, or the delivery of public health services; and review articles that synthesize previous research in the discipline and provide guidance to others conducting research as well as to policy makers, managers, and other dental public health practitioners.
期刊最新文献
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