Developing and exploring the acceptability and feasibility of an intervention to prevent oral disease in high risk child populations

Dental disease is one of the commonest health problems for children and the commonest reason for them being admitted to hospital. Children living in the most socially deprived conditions are at the highest risk of dental disease and tooth extraction under general anaesthetic. To prevent future oral health problems the recently published National Institute for Health and Care Excellence guidelines recommend that local authorities focus their oral health promotion efforts on children's early years, particularly in areas of high social deprivation. The key behaviours that will deliver improved oral health are known (tooth brushing, not using sugared drinks in bottle, not putting to bed with a bottle, early progression from bottle to cup and positive attitudes to oral health and dental visiting) but the best ways to support parents to carry out these behaviours with their young children are unknown, particularly in the most deprived communities.
The Family Nurse Partnership (FNP) is a preventative programme, for vulnerable first time young mothers, offering intensive, structured home visiting by specially trained nurses, from early pregnancy until the child is two. The Plymouth Family Nurses successfully link the programme participants with a sexual health nurse. Parents' motivation to address infant oral health has been shown to be at around the time of the appearance of the first tooth of the first child, which happens when the child is approximately six months old. This project will develop an intervention that would link a dental nurse to the young mothers taking part in the FNP, when the infant is approaching six months of age. The young parents would then be supported to enact the key behaviours and build their confidence in doing so. Our work in talking to current participants in the FNP has identified that these are the main areas requiring support.
In phase one we will develop the intervention by interviewing current FNP participants about what does and doesn't help them in carrying out these behaviours and what they would be willing to accept help with. We will produce a theory about, and tools to deliver, the intervention. In phase two we will try to visit FNP participants with infants of approx. 6 months, for a period of 6 months. We will test whether it is possible to visit them at home and talk to them about oral health (feasibility) and if they are comfortable with the ways in which we are doing that (acceptability). We will also interview the Family Nurses about their views. In phase three we will revise the intervention theory and tools and feed it back to groups of FNP participants. They will let us know what they think and anything that they think might affect other FNP participants' ability and willingness to take part in a trial.
We will let everyone who has been involved in the research, and others who may be interested, know what we found out through local dissemination events and an article in an academic journal. We will use what we have learnt to apply for funding to test whether the intervention works (effectiveness).

An investigation into the feasibility and acceptability of an intervention to reduce oral disease in at-risk infants. The objective of the intervention is to support the development of the behaviours as recommended in the DOH document "Delivering Better Oral Health". The target group will be clients of the Family Nurse Partnership; an evidence based intervention designed to support the health and wellbeing of the most vulnerable families in the UK. The investigation will consist of an exploratory phase which will be used to develop both a logic model underpinning orally healthy behaviours, and the details and tools of the intervention. This will be followed by an embedded process evaluation of delivery of the intervention to test its feasibility and acceptability. The study forms the initial phases of the development of a complex intervention - the effectiveness of which will ultimately be tested in a national cluster RCT.
The intervention development will be informed by Protection Motivation Theory. Although across a range of behaviours the evidence for intervention effectiveness when seeking to elicit fear is weak (Ruiter et al. Sixty years of fear appeal, Int J Psychol. 2014) one study has shown that raising risk perception of oral health (periodontal disease risk) can lead to more favourable outcomes (Asimakopoulou et al. Providing periodontal disease risk info, J Clin Periodont. 2015). Generally, fear messages in health promotion are only effective when adding intervention components to develop coping resources (e.g. self-efficacy). Drawing on Social Cognitive Theory (Bandura. Social Learning Theory, 1977), self-efficacy can be enhanced by supporting individuals to focus on past performance accomplishments, vicarious experiences, verbal persuasion, and emotional arousal. The proposed intervention will involve helping parents to recognise the possible risk to their child while also providing support to build self-efficacy to perform these protective behaviours.