Behavioral and Social Sciences Research Branch
Center for Integrative Biology and Infectious Diseases
OBJECTIVE
The purpose of this funding opportunity announcement is to encourage research that identifies new ways to conceptualize the numerous behavioral and social contributors to oral health, and to provide a foundation for future successful oral health interventions.
BACKGROUND
Traditional models typically explain health behavior in terms of a rational, linear, uni-directional set of causes and effects. While these models have facilitated a number of important advances, they do not adequately capture the complexity of oral health behavior, which has multiple interacting determinants, across multiple levels, many of which change over time. New models are needed that account for the complexity of oral health behavior, and identify targets for intervention to improve oral health behavior.
Descriptive, clinical, and health services research makes clear that health behavior in general, and oral health behavior in particular are complex phenomena. Behavioral factors such as knowledge, attitudes, risk perception, coping, emotion/affect, sense of purpose, self-efficacy, values, and many others shape the types and frequencies of health behaviors in which people engage. Similarly, social factors such as family, peer, community and cultural norms, the experience of stigma or discrimination, degree of connection to a larger community, availability of quality oral health and ancillary services, access to services, ability to navigate the service system, and others also play a key role in health behaviors. Current models of health behavior have difficulty accounting for the multitude of oral health determinants and needs of individuals, families, groups, and communities.
The traditional models of health behavior that guide most current research posit that health behaviors result from a rational weighing of risks and benefits, or needs and resources. Examples of such models that guide most current health behavior research are the Health Belief Model, the Theory of Reasoned Action, and the Transtheoretical Model/Stages of Change. While each of these models has identified aspects of health behavior that are relevant to health behavior, none of these models provides an adequate causal explanation. For instance, all three models emphasize the importance of knowledge and attitudes, and yet research findings across many fields consistently show that knowledge and attitudes do not necessarily explain behavior. Many have argued that these and other traditional models aren’t able to capture the complexity of health behavior, and that new models are needed.
Researchers, providers of funding, and policy makers in the oral health field, as well as those in other health fields, have called for new approaches to modeling complex systems. A recent review by Hollister and Anema (2004) highlighted the varying utility traditional models of health behavior have had for oral health, and echoed the Surgeon General’s call in 2000 for more complex models of oral health behavior. Among the four “core priorities” identified in the NIH Office of Behavioral and Social Sciences 2007 Strategic Plan is development of systems approaches to health. A trans-NIH initiative administered via the NIH Roadmap set the stage for research involving complex systems, funding a grant program aimed at developing methods and technologies that support complex systems research involving interdisciplinary collaborations. An NIDCR implementation plan working group convened in December, 2006 recommended, as a direction for future research, several areas that require a systems perspective of oral health, including developing systems approaches for interventions, attending to developmental trajectories in oral health behavior, understanding oral-systemic connections in health and disease, and others.
The funding opportunity proposed here aims to build on the richness of data gathered from traditional models of health and oral health behavior, and to better capture the complexity of health behavior by developing new models and theories. Of particular interest are models accounting for health behaviors related to maintaining dental and oral health (e.g., tooth brushing and flossing), engaging in health behaviors strongly associated with oral health or disease (e.g., tobacco or other drug use, attention to nutrition, diabetes management, eating disorders, etc.), and/or seeking preventive care or treatment. The longer-term goal of developing complex models of health behavior is to identify potential targets for oral health interventions.