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

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 Electronic databases, references and unpublished literature databases were searched.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.

Home-based toothbrushing interventions for parents of young children to reduce dental caries: A systematic review.

BACKGROUND: Dental caries is the most prevalent preventable condition in children. A key preventive home-based oral health behaviour is the adoption and maintenance of parental supervised toothbrushing until 8 years of age. AIM: To examine interventions promoting parental supervised toothbrushing practices to reduce dental caries in young children (<8 years old). DESIGN: Interventions promoting parental involvement in home-based toothbrushing in children under 8 years old and their impact on caries were subjected to review. Electronic databases (MEDLINE, EMBASE, PubMed, Web of Science, PsycINFO, Scopus, and the Cochrane Library), references, and unpublished literature databases were searched for relevant literature. RESULTS: Of the 10 176 articles retrieved, forty-two articles were included. The Theoretical Domains Framework was used to code intervention content, with the main domains addressed being knowledge (41/42), skills (35/42), and environmental context and resources (22/42). Sufficient descriptions of the intervention development, delivery, and evaluation were lacking, with only 18 studies being underpinned by theory. Twenty-nine studies explored the impact on caries yielding mixed results. CONCLUSIONS: There are few interventions targeting home-based oral health behaviours underpinned by theory and methodological rigour in their development and evaluation. This demonstrates a clear need for future interventions to be guided by complex intervention methodology.

It's not just the joints, it's the whole thing: qualitative analysis of patients' experience of flare in psoriatic arthritis.

OBJECTIVE: Flare is a commonly used term in arthritis, including PsA, but remains undefined. This study seeks to explore patients' experience of flare. METHODS: Eighteen semi-structured interviews were undertaken with patients with PsA in an informal clinical setting. Patients were purposively sampled from specialist clinic lists to reflect the major elements of the psoriatic disease spectrum. Approximately one-third of patients reported themselves to be in a flare state at the time of the interview. Transcripts underwent thematic analysis according to the recommendations of Braun and Clarke (Using thematic analysis in psychology. Qual Res Psychol 2006;3:77-101). NVivo software was utilized, with initial coding reflecting the source data, such as pain, feeling miserable and feeling slowed down. Codes were then grouped into associated clusters. These clusters and the interrelationships were then summarized into emergent themes. RESULTS: The mean age of the patients was 44 years, and patients' average disease duration was 4.5 years. Nine main overarching themes pertaining to flare were identified: physical symptoms, social withdrawal, psychological symptoms, fatigue, loss of normal function, triggers, management of pre-flare, management of flare and timing. These show some degree of overlap and are interlinked, with some degree of temporality emerging as related to patients' experience of flare. CONCLUSION: This study has identified a number of components of flare in PsA from the patient perspective. Although the emergent themes are of an overlapping and interactive nature, it is clear that flare in PsA is more than a swollen or tender joint count as measured in clinical practice.

Experiences of newly qualified dentists in delivering oral health advice to parents/caregivers of young children-challenges and solutions.

Introduction: A key skill for dental professionals to master is their ability to have effective preventive oral health conversations. On qualifying, UK dentists undertake a one-year foundation training programme in general practice. This study explored with Foundation Dentists, the barriers and facilitators to undertaking oral health conversations with parents/caregivers and their children, aged 0-11 years old. Materials and methods: Approximately 100 Foundation Dentists from the Yorkshire and Humber region attended a series of focus groups. They discussed how they and their wider dental team undertake oral health conversations with parents/caregivers of young children, aged 0-11 years old. The data was analysed using thematic analysis. Results: Five themes were identified as barriers and facilitators to providing oral health advice: (1) Lack of knowledge around parenting skills and child development; (2) Parental receptivity; (3) Motivation for changing behaviours; (4) Information content and inconsistency; and (5) Current National Health Service (NHS) structures of general dental practice. Discussion: A multi-faceted approach is needed to develop the training of Foundation Dentists to undertake preventive oral health conversations with parents/caregivers and children. Such an approach has the potential to improve the patient-practitioner relationship and increase effective behaviour change conversations taking place in general dental care, thus improving children's oral health.

Interpreting outcome following foot surgery in people with rheumatoid arthritis.

BACKGROUND: Foot surgery is common in RA but the current lack of understanding of how patients interpret outcomes inhibits evaluation of procedures in clinical and research settings. This study aimed to explore which factors are important to people with RA when they evaluate the outcome of foot and ankle surgery. METHODS AND RESULTS: Semi structured interviews with 11 RA participants who had mixed experiences of foot surgery were conducted and analysed using thematic analysis. Responses showed that while participants interpreted surgical outcome in respect to a multitude of factors, five major themes emerged: functional ability, participation, appearance of feet and footwear, surgeons' opinion, and pain. Participants interpreted levels of physical function in light of other aspects of their disease, reflecting on relative change from their preoperative state more than absolute levels of ability. Appearance was important to almost all participants: physical appearance, foot shape, and footwear were closely interlinked, yet participants saw these as distinct concepts and frequently entered into a defensive repertoire, feeling the need to justify that their perception of outcome was not about cosmesis. Surgeons' post-operative evaluation of the procedure was highly influential and made a lasting impression, irrespective of how the outcome compared to the participants' initial goals. Whilst pain was important to almost all participants, it had the greatest impact upon them when it interfered with their ability to undertake valued activities. CONCLUSIONS: People with RA interpret the outcome of foot surgery using multiple interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than anticipated. These factors can help clinicians in discussing surgical options in patients.