{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:29:42Z","timestamp":1780392582307,"version":"3.54.1"},"reference-count":40,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,3]],"date-time":"2025-08-03T00:00:00Z","timestamp":1754179200000},"content-version":"unspecified","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72374146"],"award-info":[{"award-number":["72374146"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,7,16]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Caries risk assessment and management (CRAM) conducted by primary care providers is critical for preventing early childhood caries. Yet, the implementation of these preventive strategies remains understudied in low- and middle-income countries. This study aims to evaluate the implementation and effectiveness of a CRAM intervention in Chinese primary care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>We will conduct a hybrid type II stepped-wedge cluster randomised controlled trial across nine primary healthcare institutions in Luzhou City, China. Institutions will be randomly allocated into three intervention waves. Primary care providers will be trained to deliver CRAM. The two primary outcomes are (1) the proportion of primary care providers completing all CRAM procedures and (2) improvements in parents\u2019 home-based oral care practices for children under age 3. Secondary outcomes include children\u2019s oral health-related quality of life, time to first caries incidence, and the cost-effectiveness of the intervention. Qualitative interviews will explore barriers and facilitators to implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study protocol has received approval from the Ethics Committee of West China Hospital, Sichuan University. Study findings will be disseminated through peer-reviewed journal publications and presentations at academic conferences. Research summaries and policy briefs will be developed for key stakeholders and decision-makers at the local, provincial and national levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>ChiCTR2400090741.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-102143","type":"journal-article","created":{"date-parts":[[2025,8,3]],"date-time":"2025-08-03T14:05:25Z","timestamp":1754229925000},"page":"e102143","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluating an early childhood caries prevention strategy: a study protocol for a stepped-wedge cluster randomised controlled trial"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3962-9095","authenticated-orcid":false,"given":"Peiya","family":"Cao","sequence":"first","affiliation":[{"name":"Research Center for Healthcare Service Management and Policy, Institute of Hospital Management, Sichuan University West China Hospital, Chengdu, Sichuan, China"},{"name":"School of Kinesiology and Health Science, York University - Keele Campus, Toronto, Ontario, Canada"},{"name":"HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3166-7556","authenticated-orcid":false,"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4846-937X","authenticated-orcid":false,"given":"Shannon H.","family":"Houser","sequence":"additional","affiliation":[{"name":"Department of Health Services Administration, The University of Alabama at Birmingham, Birmingham, Alabama, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0974-3267","authenticated-orcid":false,"given":"Jinming","family":"Yang","sequence":"additional","affiliation":[{"name":"West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China"},{"name":"Med-X Center for Informatics, Sichuan University, Chengdu, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5926-2545","authenticated-orcid":false,"given":"Wenjuan","family":"Tao","sequence":"additional","affiliation":[{"name":"Research Center for Healthcare Service Management and Policy, Institute of Hospital Management, Sichuan University West China Hospital, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1269-0462","authenticated-orcid":false,"given":"Fan","family":"Zhang","sequence":"additional","affiliation":[{"name":"Physical Examination Center, Sichuan University West China Hospital, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1866-4900","authenticated-orcid":false,"given":"Wei","family":"Yin","sequence":"additional","affiliation":[{"name":"Department of Preventive Dentistry, Sichuan University West China Hospital of Stomatology, Chengdu, Sichuan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6395-0084","authenticated-orcid":false,"given":"Xuedan","family":"Shi","sequence":"additional","affiliation":[{"name":"Outpatient department, West China Hospital, Sichuan University, Chengdu, Sichuan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7696-7192","authenticated-orcid":false,"given":"Xing","family":"Qu","sequence":"additional","affiliation":[{"name":"Research Center for Healthcare Service Management and Policy, Institute of Hospital Management, Sichuan University West China Hospital, Chengdu, Sichuan, China"},{"name":"HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,3]]},"reference":[{"key":"2025123106450631000_15.8.e102143.1","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1111\/ipd.12783","article-title":"The global prevalence of early childhood caries: A systematic review with meta-analysis using the WHO diagnostic criteria","volume":"31","author":"Uribe","year":"2021","journal-title":"Int J Paediatr Dent"},{"key":"2025123106450631000_15.8.e102143.2","first-page":"495","article-title":"Expert consensus on clinical management for early childhood caries","volume":"40","author":"Zhang","year":"2022","journal-title":"Hua Xi Kou Qiang Yi Xue Za Zhi"},{"key":"2025123106450631000_15.8.e102143.3","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2017.00157","article-title":"Early Childhood Caries: Prevalence, Risk Factors, and Prevention","volume":"5","author":"Anil","year":"2017","journal-title":"Front Pediatr"},{"key":"2025123106450631000_15.8.e102143.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12903-021-01500-8","article-title":"An ecological study on the association between universal health service coverage index, health expenditures, and early childhood caries","volume":"21","author":"Folayan","year":"2021","journal-title":"BMC Oral Health"},{"key":"2025123106450631000_15.8.e102143.5","first-page":"672","article-title":"The Common Risk Factor Approach - 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Global strategy and action plan on oral health 2023-2030. 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