Background
Although the poor oral health of adults with intellectual and
developmental disabilities (IDD) constitutes a significant health disparity
in the United States, few interventions to date have produced lasting
results. Moreover, there is minimal application of planning models to inform
and design a theory-based strategy that has the potential to be effective
and sustainable in this population.

Methods
The PRECEDE-PROCEED planning model is being used to design and
evaluate an oral health strategy for adults with IDD. The PRECEDE component
involves assessing social, epidemiological, behavioral, environmental,
educational, and ecological factors that informed the development of an
intervention with underlying social cognitive theory assumptions. The
PROCEED component consists of pilot-testing and evaluating the
implementation of the strategy, its impact on mediators and outcomes of the
population under study.

Results
A The PRECEDE assessment and strategy design results are presented
including a conceptual framework and oral health strategy that are linked to
social cognitive theory and Health Action Process Approach. We have
developed a strategy consisting of a planned actions, capacity building,
environmental adaptations, and caregiver reinforcement within group homes.
The strategy is designed to increase caregiver self-efficacy, outcome
expectancies, and behavioral capability, and also to create environmental
influences that will lead to improved self-care behavior of the adult with
IDD. It is anticipated that this strategy will improve the oral health and
quality of life, including respiratory health, of individuals with IDD. The
planned PROCEED component of the planning model includes a description of an
in-process pilot study to refine the oral health strategy, along with a
future randomized controlled clinical trial to demonstrate its
effectiveness.

Conclusions
The application of the PRECEDE-PROCEED planning model presented here
demonstrates the feasibility of this planning model for developing and
evaluating interventions for adults within the IDD population.