Investigating opportunities to provide behaviour change conversations to promote child oral health in non-dental settings

Abstract

Background: In 2022, almost a quarter of 5-year-old children in England had at least three untreated teeth with deep tooth decay. This is partly due to limited access to dentists, suggesting a need for additional ways to support children's oral health. Therefore, this PhD project sought to investigate opportunities to provide behaviour change conversations (BCC) to reduce children's oral health problems in early years settings (EYS). Method: The thesis aim was addressed through three stages using a mixed-method approach. In the first stage, a secondary analysis was conducted of electronic records of children referred to general dental anaesthesia in northwest England for tooth extraction. In the second phase,14 parents and 11 EYS staff were interviewed to explore their views regarding delivering and receiving messages to promote children's oral health. Sampling of participants sought to include those from varied backgrounds and 8 (57%) of parent interviews were conducted in Arabic. A systematic approach was developed to ensure accurate translation of non-English data, which preserved cultural and linguistic nuances during analysis. In the final stage, the behaviour change wheel approach was used to design an intervention to address the barriers and challenges identified in the previous stages. Results: Stage one revealed that despite an increased need, there were 90% fewer referrals to general anaesthesia during lockdown than in the corresponding period in the previous year. These findings indicate the need to explore the potential for non-clinical settings to address children’s oral healthcare. Stage two revealed that parents have limited awareness of oral health activities in EYS. They acknowledged that EYS staff could influence children's oral health behaviours, but identified several limitations, such as staff credibility. EYS staff recognised the need to address child oral health yet viewed the inclusion of oral health activities as overwhelming and reported how they avoid difficult conversations about oral health with parents. In response to the challenges of translating non-English data, a framework consisting of six stages was developed to ensure accurate translation and to guide researchers through the translation process. In stage three, the ToothTalk toolkit intervention was developed to facilitate communication between EYS staff and parents regarding children's oral health. This comprised a booklet for staff with information and behaviour change techniques to support their conversations, and an accompanying parents’ interactive workbook. Conclusion: The thesis provides timely and important evidence to support the existing rollout and proposals for expanding oral health practice at EYS in England, which may have potential also for other geographical localities. It found that oral health is considered a delicate conversation where staff need training to develop the necessary communication skills and confidence to initiate and hold tooth-kind conversations. Parents need support to trust and engage more in these conversations. The ToothTalk intervention was developed to address the identified barriers, which aim to increase the frequency and quality of oral health-related discussions initiated by EYS staff with parents. Further research is necessary to evaluate its effectiveness and acceptability in the EYS context. As well as its potential to be tailored to other contexts both within the four nations of the UK, and beyond.