To improve oral health in children, the key behaviours (tooth brushing and sugar control) responsible for development of dental caries need to be better understood, as well as how to promote these behaviours effectively so they become habitual; and, the specific, optimal techniques to use in interventions. The aim of this paper is to describe and analyse the behaviour change techniques that have been used in primary school-based interventions to prevent dental caries (utilizing a Cochrane systematic review that we have undertaken) and to identify opportunities for improving future interventions by incorporating a comprehensive range of behaviour change techniques. Papers of five interventions were reviewed and data were independently extracted. Results indicate that behaviour change techniques were limited to information-behaviour links, information on consequences, instruction and demonstration of behaviours. None of the interventions were based on behaviour change theory. We conclude that behaviour change techniques used in school interventions to reduce dental caries were limited and focused around providing information about how behaviour impacts on health and the consequences of not developing the correct health behaviours as well as providing oral hygiene instruction. Establishing which techniques are effective is difficult due to poor reporting of interventions in studies. Future design of oral health promotion interventions using behaviour change theory for development and evaluation (and reporting results in academic journals) could strengthen the potential for efficacy and provide a framework to use a much wider range of behaviour change techniques. Future studies should include development and publication of intervention manuals which is becoming standard practice in other health promoting programmes.

Keywords:
Behaviour change, Children, Dental caries, Oral health promotion, Primary school
1.
Abraham C: WIDER recommendations to improve reporting of the content of behaviour change interventions. http://interventiondesign.co.uk/?page_id=84 (accessed 2012).
2.
Abraham C, Michie S: A taxonomy of behavior change techniques used in interventions. Health Psychol 2008;27:379-387.
3.
Adair PM, Pine CM, Burnside G, Nicoll AD, Gillett A, Anwar S, Broukal Z, Chestnutt IG, Declerck D, Ping FX, Ferro R, Freeman R, Grant-Mills D, Gugushe T, Hunsrisakhun J, Irigoyen-Camacho M, Lo EC, Moola MH, Naidoo S, Nyandindi U, Poulsen VJ, Ramos-Gomez F, Razanamihaja N, Shahid S, Skeie MS, Skur OP, Splieth C, Soo TC, Whelton H, Young DW: Familial and cultural perceptions and beliefs of oral hygiene and dietary practices among ethnically and socio-economically diverse groups. Community Dent Health 2004;21:102-111.
4.
Bartholomew LK, Mullen PD: Five roles for using theory and evidence in the design and testing of behavior change interventions J Public Health Dent 2011;71(suppl 1):S20-S33.
5.
Bartholomew LK, Parcel GS, Kok G, Gottlieb NH, Fernandez ME: Planning Health Promotion Programs: An Intervention Mapping Approach, ed 3. San Francisco, Jossey-Bass, 2011.
6.
Beighton D: The complex oral microflora of high-risk individuals and groups and its role in the caries process. Community Dent Oral Epidemiol 2005;33:248-255.
7.
Brug J, Oenema A, Ferreira I: Theory, evidence and Intervention Mapping to improve behavior nutrition and physical activity interventions. Int J Behav Nutr Phys Act 2005;2:2.
8.
Camacho-Miñano MJ, LaVoi NM, Barr-Anderson DJ: Interventions to promote physical activity among young and adolescent girls: a systematic review. Health Educ Res 2011;26:1025-1049.
9.
Cooper AM, O'Malley LA, Elison SN, Armstrong R, Featherstone VA, Burnside G, Adair P, Dugdill L, Pine C: Primary school-based behavioural interventions for preventing caries. Cochrane Database Syst Rev 2013;5:CD009378.
10.
Crosby R, Noar SM: Theory development in health promotion: are we there yet? J Behav Med 2010;33:259-263.
11.
Davis DM, Fiske J, Scott B, Radford DR: The emotional effects of tooth loss in a group of partially dentate people: a quantitative study. Eur J Prosthodont Restor Dent 2001;9:53-57.
12.
DH/British Association for the Study of Community Dentistry: Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention, ed 2. London, Department of Health, 2009.
13.
Friel S, Hope A, Kelleher C, Comer S, Sadler D: Impact evaluation of an oral health intervention amongst primary school children in Ireland. Health Promot Int 2002;17:119-126.
14.
Gill P, Chestnutt I, Channing D: Opportunities and challenges to promoting oral health in primary schools. Community Dent Health 2009;26:188-192.
15.
Glanz K, Bishop DB: The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health 2010;31:399-418.
16.
Green LW, Glanz K, Hochbaum GM, Kok G, Kreuter MW, Lewis FM, et al: Can we build on, or must we replace, the theories and models in health education? Health Educ Res 1994;9:397-404.
17.
Green LW, Kreuter MW: Health Program Planning: An Educational and Ecological Approach, ed 4. New York, McGraw Hill Professional, 2005.
18.
Harris R, Nicoll AD, Adair PM, Pine CM: Risk factors for dental caries in young children: a systematic review of the literature. Community Dent Health 2004;21:71-85.
19.
Hosey MT, Macpherson LM, Adair PM, Tochel C, Burnside G, Pine C: Dental anxiety, distress at induction and postoperative morbidity in children undergoing tooth extraction using general anaesthesia. Br Dent J 2006;200:39-43.
20.
Ismail A, Ondersma S, Jedele J, Little R, Lepkowski J: Evaluation of a brief tailored motivational intervention to prevent early childhood caries. Community Dent Oral Epidemiol 2011;39:433-448.
21.
Kay E, Locker D: A systematic review of the effectiveness of health promotion aimed at improving oral health. Community Dent Health 1998;15:132-144.
22.
Kwan S, Petersen PE: Oral health promotion: an essential element of a health promoting school. http://www.who.int/oral_health/publications/doc11/en/ (accessed 2012).
23.
Lepore L, Yoon R, Chinn C, Chussid S: Evaluation of behavior change goal-setting action plan on oral health activity and status. NY State Dent J 2011;77:43-47.
24.
Locker D, Thomson WM, Poulton R: Psychological disorder, conditioning experiences, and the onset of dental anxiety in early adulthood. J Dent Res 2001;80:1588-1592.
25.
Marsh PD: Dental plaque as a biofilm and a microbial community - implications for health and disease. BMC Oral Health 2006;6(suppl 1):S14.
26.
Michie S, Abraham C, Eccles MP, Francis JJ, Hardeman W, Johnston M: Strengthening evaluation and implementation by specifying components of behaviour change interventions: a study protocol. Implement Sci 2011a;6:10.
27.
Michie S, Ashford S, Sniehotta FF, Dombrowski SU, Bishop A, French DP: A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health 2011b;26:1479-1498.
28.
Michie S, Jochelson K, Markham WA, Bridle C: Low-income groups and behaviour change interventions: a review of intervention content, effectiveness and theoretical frameworks. J Epidemiol Community Health 2009;63:610-622.
29.
Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A: Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality Saf Health Care 2005;14:26-33.
30.
Passalacqua A, Reeves A, Newton T, Hughes R, Dunne S, Donaldson N, Wilson N: An assessment of oral health promotion programmes in the United Kingdom. Eur J Dent Educ 2011;16:e19-e26.
31.
Peng B, Petersen PE, Bian Z, Tai B, Jiang H: Can school-based oral health education and a sugar-free chewing gum program improve oral health? Results from a two-year study in PR China. Acta Odontol Scand 2004;62:328-332.
32.
Petersen PE, Peng B, Tai B, Bian Z, Fan M: Effect of a school-based oral health education programme in Wuhan City, Peoples Republic of China. Int Dent J 2004;54:33-41.
33.
Petrecca S, D'Arcangelo C, Esposito P, Di Marco N: Valutazione a due anni di vari metodi di profilassi della carie dentaria su un campione di popolazione in età scolare (A two-year evaluation of various prophylactic methods against dental caries in a school-age population sample). Minerva Stomatol 1994;43:23-28.
34.
Pine CM, Adair PM, Nicoll AD, Burnside G, Petersen PE, Beighton D, Gillett A, Anderson R, Anwar S, Brailsford S, Broukal Z, Chestnutt IG, Declerck D, Ping FX, Ferro R, Freeman R, Gugushe T, Harris R, Lin B, Lo EC, Maupome G, Moola MH, Naidoo S, Ramos-Gomez F, Samaranayake LP, Shahid S, Skeie MS, Splieth C, Sutton BK, Soo TC, Whelton H: International comparisons of health inequalities in childhood dental caries. Community Dent Health 2004a;21:121-130.
35.
Pine CM, Adair PM, Petersen PE, Douglass C, Burnside G, Nicoll AD, Gillett A, Anderson R, Beighton D, Jin-You B, Broukal Z, Brown JP, Chestnutt IG, Declerck D, Devine D, Espelid I, Falcolini G, Ping FX, Freeman R, Gibbons D, Gugushe T, Harris R, Kirkham J, Lo EC, Marsh P, Maupome G, Naidoo S, Ramos-Gomez F, Sutton BK, Williams S: Developing explanatory models of health inequalities in childhood dental caries. Community Dent Health 2004b;21:86-95.
36.
Saied-Moallemi Z, Virtanen JI, Vehkalahti MM, Tehranchi A, Murtomaa H: School-based intervention to promote preadolescents' gingival health: a community trial. Community Dent Oral Epidemiol 2009;37:518-526.
37.
Smith DJ: Dental caries vaccines: prospects and concerns. Expert Rev Vaccines 2010;9:1-3.
38.
Stokes E, Pine CM, Harris RV: The promotion of oral health within the Healthy School context in England: a qualitative research study. BMC Oral Health 2009;9:3.
39.
Sun Y, Shi W, Yang JY, Zhou DH, Chen YQ, Zhang Y, Yang Y, He BX, Zhong MH, Li YM, Cao Y, Xiao Y, Li W, Yu J, Li YH, Fan MW, Yan HM: Flagellin-PAc fusion protein is a high-efficacy anti-caries mucosal vaccine. J Dent Res 2012;91:941-947.
40.
WHO: World conference on social determinants of health: meeting report. http://www.who.int/sdhconference/en/ (accessed 2012).
41.
Worthington HV, Hill KB, Mooney J, Hamilton FA, Blinkhorn AS: A cluster randomized controlled trial of a dental health education program for 10-year-old children. J Public Health Dent 2001;61:22-27.
42.
Zanin L, Meneghim MC, Cortellazzi KL, Pereira AC: Evaluation of an educational program for children with high risk of caries. J Clin Pediatr Dent 2007;31:246-250.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.