Evaluation of a Multicomponent Oral Health Education Intervention in a Vulnerable Infant Population: A Mixed Methods Study

Abstract

Policy makers and researchers have recommended that oral health initiatives should target primary caregivers in the first year of life to reduce the risk of early childhood caries. Approaches using mobile technologies for oral health are now being endorsed by the World Health Organisation.

This mixed methods exploratory study examined the feasibility, acceptability and effectiveness of engaging and delivering a multicomponent oral health education intervention to vulnerable caregivers in the first year of their infant’s life. The study explored three engagement approaches: in-person (IP), a social messaging platform (two-way text messaging and/or a social messaging group) (SMP), or both (IP-SMP). The intervention supported a caregiver’s self-efficacy in the uptake and maintenance of key oral health behaviours. A survey and analytical framework were used for data collection and analysis of acceptability. The validated general self-efficacy scale was used to measure self-efficacy. In addition, a methodological study explored the feasibility of using full arch digital images as a dental caries examination method for its potential use at the end of the study intervention.

Forty-four mothers were recruited and randomised into the three engagement approaches and a control group. The IP-SMP intervention delivery method was shown to be the most acceptable (P=0.03) with the optimal start of delivery being when infants are four months old. Peer-to-peer support, flexibility in how to access expertise and trust in expertise impacted acceptability. How mothers coped with infant temperament and teething impacted the uptake and maintenance of oral health practices. Reassurance and guidance on how to facilitate toothbrushing, especially during periods of teething, was highly valued by the mothers. Trust was lost in early years services when compassion for the challenges associated with infant temperament and teething wasn’t shown. Educating early years and family support services on the impact of infant temperament and teething on oral health behaviours may have value in encouraging caregivers with their infant’s oral health. Two-way text messaging could be a flexible and low-resource way of early years services supporting caregivers in this way and should be investigated. In addition, early years services themselves may benefit from text message support to aid the delivery of oral health education which could be a further valuable avenue of study.