Facilitators and barriers to home-based toothbrushing practices by parents of young children to reduce tooth decay: a systematic review

Abstract

Objectives Parental supervised toothbrushing (PSB) is a collection of behaviours recommended by national guidance to improve oral health. This systematic review aimed to identify the barriers and facilitators to PSB. Materials and methods Studies investigating parental involvement in home-based toothbrushing in children under 8 years old and the impact on tooth decay were included. Electronic databases, references and unpublished literature databases were searched. The Theoretical Domains Framework (TDF) was used to code barriers/facilitators to PSB. Results Of the 10,176 articles retrieved, 68 articles were included. Barriers and facilitators were found across all 12 TDF domains. Barriers included an inadequate toothbrushing environment and resources, knowledge of what PSB entails and child behaviour management. Facilitators were increased oral health knowledge, the adaption of the social environment to facilitate PSB and positive attitudes towards oral health. When only high-quality articles were synthesized, knowledge was not a common barrier/facilitator. Conclusions There are a comprehensive range of barriers/facilitators to PSB acting across all domains and at multiple levels of influence. This review identifies the most popular domains, thus informing the focus for supporting resources to supplement oral health conversations. Clinical relevance PSB is a complex behaviour. Practitioners need to understand and be able to explore the wide range of potential barriers and have practical suggestions to enable PSB. This review provides pragmatic examples of different barriers and facilitators and emphasises the importance of listening to parents and exploring their story to identify the barriers and solutions that are relevant to each family.

Factors influencing oral health behaviours, access and delivery of dental care for autistic children and adolescents: A mixed‐methods systematic review

“…A range of different factors were found to impede the ability of autistic CYP to access dental care. In keeping with the findings from other reviews looking at vulnerable children's access to dental care, 81 , 82 finding a suitable provider, inadequate insurance cover, parents'/carers' lack of access to OH information, lack of professional knowledge and training and failure to fully accommodate the needs of the child were the most frequently cited barriers to care. Sensory sensitivities, the child's reaction to the dental environment and difficulties in managing the child's subsequent behaviour were also frequently cited as barriers.…”

“…The factors that affect the ability of autistic CYP to adopt beneficial OH behaviours that were most frequently cited in this review were sensory sensitivities, factors relating to cognitive and motor functions and competing parental priorities. Other barriers that a recent review report are also experienced by nonautistic CYP, and include lack of OH knowledge and child behaviour management 81 . Facilitators relevant to both autistic and nonautistic CYP include increased parental OH knowledge, the adaption of the social environment to facilitate parental supervised toothbrushing and positive attitudes towards OH 81 .…”

“…Other barriers that a recent review report are also experienced by nonautistic CYP, and include lack of OH knowledge and child behaviour management 81 . Facilitators relevant to both autistic and nonautistic CYP include increased parental OH knowledge, the adaption of the social environment to facilitate parental supervised toothbrushing and positive attitudes towards OH 81 . In addition, our review identified the modelling of good OH behaviours by the family and peers, incorporation of toothbrushing into the daily school routine and the use of behavioural techniques such as positive re‐enforcement as ways in which the adoption of beneficial OH behaviours can be enabled.…”

A qualitative study of the implementation of a pilot school-based, toothbrushing programme

“…This may also inspire further design accordingly [49]. Using this psychological framework could be the strength of this qualitative study because this may ensure the consistency of descriptions from participants and make them easier to be understood by a multidisciplinary eld [50]. The main theme of implementation of the program is "Habit."…”

Co-design of an oral health intervention (HABIT) delivered by health visitors for parents of children aged 9–12 months

“…The HABIT intervention was developed using an intervention mapping approach producing a theoretically informed and evidence-based intervention that included extensive community and stakeholder engagement, and a robust needs assessment [ 38 ]. This approach followed MRC complex intervention development guidance [ 39 ], and included undertaking systematic reviews [ 40 , 41 ] and qualitative interviews with local populations in Yorkshire to describe the barriers to PSB [ 42 ]. Each step of this process was underpinned by the Theoretical Domains Framework (TDF), a framework of the key determinants of behaviour developed from several behaviour change theories, [ 43 , 44 ] and behaviour change taxonomy [ 27 ].…”