HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing): a qualitative exploration of the acceptability of a complex oral health intervention

Abstract

Background To explore the acceptability of the oral health intervention, HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing) to parents with young children aged 9–12 months and health visitors. Methods Following the delivery of the universal oral health intervention called HABIT, qualitative semi-structured interviews with parents and focus groups with health visitors were undertaken. Interviews were audio-recorded and transcribed. Health visitors completed self-reported diaries after delivering the HABIT intervention with parents. The qualitative data was analysed using framework analysis (guided by a theoretical framework of acceptability). Results Seventeen parents were interviewed, and five health visitors and three nursery nurses participated in two focus groups. Parents reported health visitors to be ‘trusted’ and valued the reassurance provided during the HABIT visit. Health visitors found the HABIT training and resources useful and valued the consistency and increased confidence in undertaking oral health conversations. There were, however, challenges in changing behaviour where families faced competing demands on time and resources. Both health visitors and parents described the importance of the intervention's timing and suggested that multiple visits may be needed to support optimal oral health habits. Conclusion The HABIT intervention was acceptable to parents and health visitors. Health visitors would welcome a further refinement to enhance intervention delivery that specifically achieves a balance between using a guided script and retaining the flexibility to adapt the conversation to suit the needs of individual families. This, in turn, will maximise impact and enable parents of young children to adopt and maintain optimal home-based oral health behaviours for their child.

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

“…Detailed findings from the HABIT early-phase feasibility study are beyond the scope of this paper and are reported in separate publications [35][36][37]. In summary, the feasibility study identified that the HABIT intervention was acceptable to parents, feasible for health visitors to deliver and provided a strong signal of improved PSB behaviours at three months after the intervention.…”

“…We discuss how the findings were incorporated into the study design to ensure the intervention was feasible and deliverable within practice and the research setting. Other papers have focussed on individual aspects of the co-design process, for example the organisational barriers to oral health conversations [20], the feasibility study including the design [35] and mixed methods evaluation [36,37].…”

“…The HABIT intervention and resources were subjected to an early-phase evaluation to explore acceptability, feasibility, impact and mechanism of action [35]. A mixed methods evaluation was undertaken and is reported in detail in other publications [36,37].…”

“…2. Health visitor training -feedback from the dissemination day and the qualitative interviews with health visitors and parents identified inconsistencies in the delivery of the HABIT intervention [36,37]. Refinements to the HABIT training include preparation work for the delegates before they attended, such as watching the online SOAP resources, HABIT videos and videos showcasing examples of "effective" HABIT conversations.…”

HABIT: Health visitors delivering Advice in Britain on Infant Toothbrushing – an early-phase feasibility study of a complex oral health intervention

“…Intervention and study design was acceptable to participants and is reported in a separate paper exploring the qualitative findings. 23 In addition, key stakeholders were invited to a research dissemination event held in Bradford in which preliminary findings were presented and feedback sought. Participation included representatives from: Health Visiting and dental teams, Bradford District Care NHS Foundation Trust, Bradford Metropolitan District Council, the British Society of Paediatric Dentistry, Oral Health Strategy Group and Public Health England.…”