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

牙病是儿童最常见的健康问题之一，也是他们住院的最常见原因。生活在社会最贫困条件下的儿童患牙病和在全身麻醉下拔牙的风险最高。为了预防未来的口腔健康问题，最近出版的国家健康和护理卓越研究所指导方针建议地方当局将口腔健康促进工作的重点放在儿童的早期，特别是在高度社会剥夺的地区。改善口腔健康的关键行为是已知的（刷牙，不使用瓶装含糖饮料，不带着瓶子上床睡觉，从瓶子到杯子的早期进展以及对口腔健康和牙科就诊的积极态度），但支持父母与幼儿一起进行这些行为的最佳方法是未知的，特别是在最贫困的社区。家庭护士伙伴关系是一项预防性方案，面向初次怀孕的脆弱年轻母亲，由受过专门培训的护士从怀孕初期到孩子两岁期间进行密集、有组织的家访。普利茅斯家庭护士成功地将方案参与者与性健康护士联系起来。父母解决婴儿口腔健康问题的动机已被证明是在第一个孩子的第一颗牙齿出现的时候，这发生在孩子大约六个月大的时候。该项目将制定一项干预措施，在婴儿接近6个月时，将牙科护士与参加家庭护理计划的年轻母亲联系起来。然后，将支持年轻父母制定关键行为，并建立他们这样做的信心。我们在与目前参与国家方案的人交谈时发现，这些是需要支助的主要领域。在第一阶段，我们将通过采访目前的FNP参与者来制定干预措施，了解什么有助于和不有助于他们进行这些行为，以及他们愿意接受什么帮助。我们将提出一个关于干预的理论和工具。在第二阶段，我们将尝试访问FNP参与者与婴儿约。6个月，为期6个月。我们将测试是否有可能到他们家中拜访并与他们谈论口腔健康（可行性），以及他们是否对我们这样做的方式感到满意（可接受性）。我们亦会访问家庭护士，了解他们的意见。在第三阶段，我们将修改干预理论和工具，并将其反馈给FNP参与者。他们会让我们知道他们的想法，以及他们认为可能影响其他FNP参与者参加试验的能力和意愿的任何事情。我们会让参与研究的每个人，以及其他可能感兴趣的人，通过当地的传播活动和学术期刊上的文章了解我们的发现。我们将利用我们所学到的来申请资金，以测试干预措施是否有效（有效性）。

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).