The study illustrates that a multi-component, theory-based intervention at community level had only a limited and temporary effect on oral health-related behaviours in the community under study. Further research is needed to determine how oral health in young children can be improved in the long term.

Abstract.This study aims to investigate the social gradient in the reported oral health-related behaviour and oral health status of preschool children. Participants were 1,057 children born between October 2003 and July 2004 in Flanders, Belgium. Oral health examinations were performed by trained dentists when the children were three and five years old (respectively in 2007 and 2009); data on dietary habits, oral hygiene habits and dental attendance of the children were obtained through structured questionnaires completed by the parents. Maternal educational level, measured in four categories, was used as a proxy of socio-economic status. Logistic and ordinal regressions showed a social gradient for the oral health-related behaviours: a lower educational level of the mother was related to a higher consumption of sugared drinks between meals and to a lower brushing frequency and dental attendance of the child. Children from low-educated mothers also had seven times more chance to present with caries experience than children from mothers with a bachelor degree. Contrary to the expectations, there was a deviation from the gradient in three-year-olds from the highest educational group showing an increased risk for caries experience (OR=3.84, 95% CI=1.08-13.65). Conclusion. Already in very young children, a graded relationship is observed between socio-economic position, oral health and related behaviours. The results suggest that different approaches are required to promote oral health during early childhood depending on the mother's educational background. As children from the highest social group also have an increased caries risk, specific techniques may be needed.2

This study evaluates the process of implementation of a longitudinal intervention program to promote oral health in preschool children in Flanders, Belgium. As the program was implemented in an existing preventive health care organization, the study also evaluates this setting as the context for implementation. Qualitative and quantitative methods were used to evaluate implementation fidelity, based on Carroll's theoretical framework of implementation fidelity (Carroll et al., Implementation Science 2:40, 2007). Questionnaire data from participants and health workers were analyzed, and document analyses were performed to compare registrations of the actions with the planning manual. Results were mixed. Whereas more than 88 % of all parents attended all home visits, only 57 % received at least 9 of the 11 planned consultations. Fifty-two percent of the families received all supporting materials, and on average, 73 % of all attending families received all information at a contact as described in the manual. Moderating factors such as the adequate use of facilitators and high participant responsiveness had a positive impact on implementation fidelity, whereas the quality of delivery differed to a great extent between the nurses who were involved during the entire intervention period and those who gave only a few sessions. Implementing an intervention in an existing well-baby program has many advantages, although lack of time presents a challenge to implementation fidelity. The results of this process evaluation allow a better understanding of the contribution of implementation fidelity to the effectiveness of health promotion programs.

Objective: This study aimed to test the predictive validity of the Theory of Planned Behaviour (TPB) when applied to the oral health-related behaviours of parents towards their preschool children in a cross-sectional and prospective design over a 5-year interval. Methods: Data for this study were obtained from parents of 1,057 children born between October 2003 and July 2004 in two regions in Flanders, Belgium. Three behaviours related to oral health (dietary habits, oral hygiene habits, dental attendance) as well as their psychological determinants based on the TPB (attitude, subjective norms, perceived behavioural control (PBC), intention) were measured using validated self-report questionnaires when the children were 0 (2003–2004), 3 (February–June 2007) and 5 years old (March–June 2009). Results: Multiple linear regression analyses indicated cross-sectionally that the contribution of attitudes, subjective norms and PBC towards intention, and of intention and PBC towards the frequency of consumption of sugared snacks and drinks, tooth brushing and dental attendance was significant ( p < .001). The combined determinants explained 27%–37% of the variance in intentions and 7%–39% of the variance in the behaviours. Across time, only parental PBC as measured at birth could significantly predict dietary and oral hygiene behaviours at children’s ages 3 and 5 years. Conclusion: This study supports the validity of the TPB to predict intentions and oral health-related behaviours of parents of preschool children. Interventions should aim to improve parental attitudes towards diet and dental attendance, and their PBC towards tooth brushing.

The oral health-related beliefs of parents have an important impact on the oral health status of their children; however, they are not stable over time. This study aimed to assess the changes, over time, in the determinants of parental oral health-related behaviour based on the Theory of Planned Behaviour and to investigate socio-economic inequalities. The cohort consisted of the parents - mainly the mothers - of 1,057 children born in 2003 and 2004 in Flanders (Belgium). According to the Theory of Planned Behaviour, validated questionnaires, completed at children's birth and at age 3 and 5 yr, assessed parental attitudes, social norms, perceived behavioural control, and intention towards three behaviours: dietary habits, oral hygiene habits, and dental attendance. Linear mixed-model analyses were applied. Positive parental attitudes towards oral health-related behaviours increased between birth and 3 yr of age, whereas the scores for subjective norms and intentions decreased. Scores remained stable for children between three and 5 yr of age. Highly educated mothers had significantly higher scores for attitudes, perceived behavioural control, and intentions than less-educated mothers. Health promotion campaigns should take these natural changes and inequalities of dental beliefs into account when developing and evaluating interventions.