Helping parents in a disadvantaged area of Dundee carry out nursery childrens tooth brushing at home

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Helping parents in a disadvantaged area of Dundee
carry out nursery childrens tooth brushing at
home.

• A Gilinsky1 V Swanson2
• K Power1 M Merrett1
• 1NHS Tayside 2University of Stirling

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Background

• Dental decay in young children is an avoidable
  disease
• Peak age for dental extractions (most under a
  General Aesthetic) is 5 years old (Downer, 2009).
• Scottish Government Dental Health Action Plan
  (2005)
• 60 of 5 year old children will have no signs of
  dental disease by 2010.

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of P1 children by DepCat with no obvious decay
experience
Source NDIP (2006)
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Background

• SIGN (2005) Community based tooth brushing
  programmes
• should be undertaken with parents to create a
  supportive environment for oral health behaviour.
• Dundee nursery schools in high deprivation areas
  link to P1 data
• Poor early years feeding and tooth brushing
  practices predict disease morbidity at age 6
  (Harris et al, 2004)

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Background

• Childrens teeth can be protected through simple
  behaviours (Levine, 1995)
• Children lt7 supervised to brush with a pea sized
  blob of fluoride toothpaste for two minutes twice
  a day
• Adoption and maintenance less simple for parents
  in disadvantaged areas?
• Lack of knowledge, no positive social norms, low
  levels of prior dental attendance, little
  reinforcement, low self-efficacy, less access,
  chaotic lifestyles?

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Aim Objectives

• Improve oral health outcomes of nursery children
• in disadvantaged areas of Dundee
• Objectives
• Pilot an intervention in a large nursery using a
  pre-post design.
• Evaluate the intervention (including feasibility
  and acceptability).

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Method

• Systematic Review (n4 papers)
• parents oral-health beliefs help predict tooth
  brushing frequency or adherence to twice daily
  brushing.
• Needs Assessment (n14 short focus groups)
• Parents valued nursery tooth brushing.
• Reinforced - rather than took away from their
  role at home.
• Child-led behaviour change as they learned from
  their peers.
• Parents still had difficulties changing behaviour
  at home - perceived external barriers, perceived
  low self-efficacy.

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Banduras Social Cognitive Theory
Adapted from Connor Norman (2005)
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Methods

• Tooth Brushing Olympics (3-week intervention)
• Aim Increased number of parents reporting their
  child
• engaged in twice-daily toothbrushing at home.

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Materials
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Results

• Child Outcomes
• N111 children registered at pilot nursery
• 74 registered with a dentist before the
  intervention
• 29 brushing less than twice-daily

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Results

• Parent Outcomes
• N80 parents interviewed prior to intervention
• N52 at T2 (66 response rate).
• Primary Quantitative Analysis
• Logistic Regression to predict group membership
  at T2
• (average 5 weeks post-intervention)
• Group 1 (N40) Child brushed twice-daily
• Group 2 (N12) Child brushed less than
  twice-daily

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Results
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Results
Plt0.05, Baseline scores controlled
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Results
Qualitative Analysis Making tooth brushing
easier - didnt have to nip her head Supervision
at brushing time - check if she was doing it
right Adopting a whole families approach - helped
his younger brothers Awareness of positive
practices - didnt know about not rinsing Time
spent brushing - couldnt believe how long the
timer went on
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Conclusions

• A short intervention engaged the majority of
  families from a disadvantaged area.
• Sustained involvement amongst some families is
  more difficult
• Targeting twice-daily tooth brushing using an
  intervention based on SCT led to parents finding
  brushing easier.
• Finding tooth brushing easier and brushing twice
  a day at baseline were associated with being more
  likely to brush twice a day after the
  intervention.

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References

• Bandura, A. (1986). Social Foundations of Thought
  and Actions A Cognitive Social Theory. Englewood
  Cliffs, NJ Prentice-Hall.
• Gilinsky A. (2009). Parental cognitions in
  explanatory models of young childrens oral
  health related behaviour and dental decay
  outcomes A systematic review. Health Psychology
  Update, 18 (1) 34 39.
• Harris, R., Nicoll, A. D., Adair, P. M., Pine,
  C. M. (2004). Risk factors for dental caries in
  young children a systematic review of the
  literature. Community Dental Health, 21
  (Supplement) 71 - 85.
• Scottish Executive (2005). An action plan for
  improving oral health and modernising NHS dental
  services in Scotland. Scottish Executive.
• Scottish Intercollegiate Guidelines Network
  (2005). Prevention and management of dental decay
  in the pre-school child. SIGN.