An effective psychoeducational intervention for early childhood caries prevention: part II.

Because many health problems, including dental caries, are disproportionately associated with low-income and minority groups with the poorest access to care, several programs have been implemented to address this discrepancy of underserved populations. One of the more prominent programs is the Special Supplemental Food Program for Women, Infants, and Children (WIC), which provides nutritional and general health support to low-income pregnant women and children up to age five years. Studies have reported caries rates of 35 percent to 56 percent among WICenrolled children under three years of age.1 The involvement of dental professionals in public health clinics where high-risk populations seek other health care is still minimal. Although medical care providers play an important role in preventing oral disease, health professionals working in busy primary care clinics may not have the time to provide dental health information for caries prevention. Therefore, there is an urgent need to develop and evaluate dental health educational interventions for early childhood caries (ECC) prevention that can be carried out in public health settings attended by high-caries risk populations that do not depend on the availability of either dental and/or medical professionals. A major issue regarding the effectiveness of oral health promotion involves the lack of preventive approaches using psychological/ behavioral strategies.2,3 Although, education can improve knowledge concerning dental health issues, this step alone is usually not sufficient to promote behavioral changes.3 This fact was well observed in a systematic review of the literature, which reported dental health education efforts based on motivational techniques to be more effective in ECC prevention when compared to more traditional provider-centered educational approaches.4 This trend was observed in a study5,6 comparing the effect of a motivational interviewing (MI) counseling visit with traditional health education for mothers of young high-caries risk children. After two years, children in the MI group developed significantly less caries than those of the control group, which was attributed to a greater compliance with recommended fluoride varnish. In the dental domain, a psychological theory of motivation called self-determination theory (SDT) has been applied very successfully. In a study of 90 participants aged 20 to 35 years,7 a one-to-one dental educational intervention formulated by the SDT, when compared to a one-to-one standard dental education, increased patients’ perceived competence and autonomous motivation for dental care, consequently decreasing their plaque and gingivitis scores over a seven-month period. In another study comprised of 208 dental patients,8 patients’ perceptions of autonomysupportive (vs. controlling) on the part of their clinical dental professionals, were positively associated with perceived dental competence and autonomous motivation for treatment, and negatively associated with anxiety for treatment. Furthermore, perceived dental competence and autonomous motivation were directly positively associated with oral self-care behaviors and dental clinic attendance. Although, these dental studies were not targeted to caries prevention among young children, it shows along with several other studies9,10-15 the positive impact of SDT in producing desirable behavioral changes in people’s lives. The overall purpose of this study was to assess the effectiveness of an autonomy-supportive psychoeducational videotaped oral health message informed by the SDT as a preventive means of ECC to be used in public health settings attended by high-caries risk groups. The first part of this study (Part I)16 described the SDT, and reported results regarding the effectiveness of the psychoeducational intervention for ECC prevention where mothers exposed to an autonomy-supportive psychoeducational videotaped oral health message demonstrated greater changes in knowledge and behavioral intentions than did mothers exposed to the neutral message delivered by brochure that represented standard practice. The main Abstract: Purpose: The purpose was to compare whether mothers exposed to an autonomy-supportive psychoeducational videotaped message, informed by self-determination theory (SDT), demonstrated greater changes in behavior concerning their children’s oral health than mothers exposed to a neutral message delivered by brochure. Methods: Data were collected at baseline, oneand six-month follow-ups from 415 12to 49month-old WIC-enrolled children and their mothers: 283 in the video intervention group and 132 in the brochure control group. Mothers completed questionnaires regarding their child’s dietary/oral hygiene habits. Chi-square, Wilcoxon Signed Rank, Mann-Whitney, and McNemar tests were used to analyze data (P<0.05). Results: Significantly more positive changes were observed for dietary/oral hygiene behaviors among the intervention group mothers at oneand six-month follow-ups than for the controls. Significantly fewer mothers in the intervention group shared dining ware with their child at both one(P=0.0046) and six-month follow-ups (P<0.0001); this practice was decreased only at six-months for the control group mothers (P=0.05). Restricting consideration only to mothers who were not checking for white spot lesions at baseline, a significantly greater proportion of mothers in the intervention group performed this behavior at six-months (P=0.0044). Conclusions: Data provided evidence of the effectiveness of the SDT videotaped oral health message relative to a neutral brochure. (Pediatr Dent 2013;35:247-51) Received January 27, 2012 | Last Revision July 30, 2012 | Accepted August 6, 2012