Using a web-based resource

to increase capacity for delivering

eating 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

BackgroundThe 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

BackgroundDentists 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.

Preliminary StudiesThe principal investigator was awarded a grant to explore the secondary prevention practices among dental practitioners. The specific aims of this study were to:

1) explore readiness among dental practitioners with regard to current eating disorder specific secondary prevention practices

2) identify associated health beliefs influencing adoption secondary prevention behaviors

3) develop and implement a continuing education program

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 patient’s 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 patient’s primary care provider. Increasing availability of resources (i.e. patient education, referral)

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.

InterventionBased upon information from triangulation of data a web-based Eating Disorder Secondary Prevention Toolkit Developed

Theory-basedInteractive

Oral and physical manifestationsTypes of Eating disorders and psychological characteristicsPatient 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

Methods: Theoretical Frameworks

Methods: Theoretical Frameworks

24

Evaluation

25

Preliminary FindingsPreliminary 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.”

DiscussionThe 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.

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.

References1. Snyder L. Health care needs of the adolescent: Position paper. Annals of Internal Medicine; 1989. 2. Cavanaugh CJ, Lemberg R. What we know about eating disorders: Facts and statistics. In Lemberg, R.,

ed. Eating Disorders: A Reference Sourcebook. Phoenix: Oryx Press; 1999:7-12. 3. Altshuler BD, Deshow PC, Waller DA, et al. An Investigation of the Oral Pathologies Occurring in Bulimia

Nervosa. International Journal of Eating Disorders. 1990;9(2):191-199.4. Harrison JL, George LA, Cheatham JL, et al. Dental effects and management of bulimia nervosa. General

Dentistry. 1985;January-February:65-68.5. Roberts MW, Li S. Oral Findings in Anorexia Nervosa and Bulimia Nervosa: A Study of 47 Cases. Journal

of the American Dental Association. 1987;15:407-409.6. Stege P, Visco-Dangler L, Rye L. Anorexia nervosa: review including oral and dental manifestations.

Journal of the American Dental Association. 1982;104:1982. 7. Prochaska JO, Redding CA, Evers KE. The Transtheoretical Model and stages of change. In Glanz K,

Rimer BK, Lewis FM, eds. Health Behavior and Health Education: Theory, research, and practice. Josey-Bass:San Francisco; 2002:99-120.

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 Francisco:Joseey-Bass;2002:45-66.

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