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

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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).