Speed presentationJennifer Eaves, NHS Fife & University of Glasgowjennifer.eaves@nhs.netjennifer.eaves@nhs.net

Using behaviour change theoriesUsing behaviour change theories and techniques to optimise on‐the‐

d d li f bli h l hground delivery of public health interventions: the example of the pChildsmile nursery toothbrushing 

programmeprogramme

Faculty of Public HealthScotland conference3 November 2017 

What is Childsmile?• Comprehensive, national dental public health programme

• Funded by the Scottish• Funded by the Scottish Government

• Aims to improve children’s oral health, reduceoral health, reduce inequalities and improve access to dental services.access to dental services.

• Delivered in all 14 health boards in Scotland

Childsmile CoreChildsmile CoreDaily supervised toothbrushing for

• all children attending early learning and childcare settings • Primary 1 and 2 schoolchildren in 

Childsmile NurseryChildsmile Nurseryy

disadvantaged areas

Oral healthcare packs (six from birth to 5 years)

Childsmile SchoolChildsmile Schoolyears)

Childsmile PracticeChildsmile Practice•Fluoride varnish applications are delivered by EDDNs in targeted establishments

•HVs identify families likely to benefit from oral health advice. • DHSWs provide tailored oral health 

establishments

• Children with dental care needs are identified and support given to 

advice, facilitate dental practice attendance. • Dentists and EDDNs continue to 

id il d d i d li i l

pp gfacilitate dental attendance

provide tailored advice and clinical preventions in the dental setting. 

Childsmile CoreChildsmile CoreDaily supervised toothbrushing for

• all children attending early learning and childcare settings • Primary 1 and 2 schoolchildren in

Childsmile NurseryChildsmile Nursery

• Primary 1 and 2 schoolchildren in disadvantaged areas

Oral healthcare packs (six from birth to 5 )

Childsmile SchoolChildsmile School

Daily supervised toothbrushing for all Daily supervised toothbrushing for all children attending early learning & children attending early learning & 

years)

Childsmile PracticeChildsmile Practice•Fluoride varnish applications are delivered by EDDNs in targeted establishments

childcare settings childcare settings •HVs identify families likely to benefit from oral health advice. • DHSWs provide tailored oral health d i f ili d l i

establishments

• Children with dental care needs are identified and support given to 

advice, facilitate dental practice attendance. • Dentists and EDDNs continue to 

id t il d d i d li i l

pp gfacilitate dental attendance

provide tailored advice and clinical preventions in the dental setting. 

Daily, supervised toothbrushing in ELC settings Daily, supervised toothbrushing in ELC settings • All 3‐ and 4‐year‐olds attending ELC settings offered free, daily, supervised toothbrushing

• National Standards for Nursery and School Toothbrushing PProgrammes

• Toothbrushes and toothpaste i li dis supplied

• Supervised by trained ELC staff • Local CS teams give support and guidance to 

bli hestablishments

Assessing delivery of daily, supervised Assessing delivery of daily, supervised toothbrushing in ELC settingstoothbrushing in ELC settingstoothbrushing in ELC settingstoothbrushing in ELC settings

• Theory‐based evaluation of CSy• Includes process evaluation component• Analysis of process evaluation data:• Analysis of process evaluation data:

toothbrushing programme was generally well‐establishedestablished

However, barriers and difficulties were consistently identifiedidentified

E.g. not being implemented and delivered as planned in all nurseries

• Quantitative analysis of data gathered by programme:• Count of participating establishments• Count of participating establishments• Count of participating children

Aim & ObjectivesAim & Objectives

Overarching aim:to develop a behavioural intervention based onto develop a behavioural intervention, based on psychological theories of behaviour change, to 

optimise delivery of the supervisedoptimise delivery of the supervised toothbrushing programme in early learning and 

childcare (ELC) settings in Scotlandchildcare (ELC) settings  in Scotland

Objective 1: Objecti e 3Objective 1: To explore and agree the Theory of Change for the 

Objective 3:To develop an intervention 

underpinned by 

Objective 2:To explore whether the 

t thb hiy gtoothbrushing 

programme in ELC settings with key 

p ybehavioural theory to optimise the delivery of 

daily, supervised 

toothbrushing programme in ELC settings is being 

implemented as intended.strategic programme 

stakeholders.toothbrushing in ELC settings in Scotland.

ApproachApproach

• Intervention Mapping (Bartholomew et al., 2006)

• practical framework to guide intervention developmentdevelopment

• divides intervention development process into six discrete stages to be worked through systematicallythrough systematically

Programme theory• How an intervention is hypothesised to impact on outcomes

•Visually represented in logic models

I t d d th f i t / ti iti• Intended pathways from inputs/activities outputs/outcomes

• 2009: Childsmile evaluation team facilitated consultation with stakeholders to explicate the programme theory

• resulting logic model available on Childsmile website:• resulting logic model available on Childsmile website: 

www child‐smile org uk/professionals/research‐and‐www.child smile.org.uk/professionals/research andevaluation/evaluation‐approach.aspx

MethodsMethods

STAGE 1 Intervention Mapping steps1. Assess/analyse problem of interest

T kTasks• develop draft logic model for the toothbrushing • develop draft logic model for the toothbrushing de e op d a t og c ode o t e toot b us gprogramme in ELC settings• Undertake interviews with strategic programme

de e op d a t og c ode o t e toot b us gprogramme in ELC settings• Undertake interviews with strategic programmeUndertake interviews with strategic programme stakeholders• Use data to further refine logic model

Undertake interviews with strategic programme stakeholders• Use data to further refine logic model• Use data to further refine logic model • Discuss and agree revised logic model with strategic CS k h ld

• Use data to further refine logic model • Discuss and agree revised logic model with strategic CS k h ldCS stakeholdersCS stakeholders

MethodsMethodsSTAGE 2 Intervention Mapping stepsSTAGE 2 Intervention Mapping steps

2. State intervention outcomes & objectives

TasksU d k ib d l li i i i i h• Undertake, transcribe and analyse qualitative interviews with 

strategic stakeholders &  coordinators• Develop theoretical purposive sampling strategy to identify• Develop theoretical purposive sampling strategy to identify areas/participants: 

“operational respondents” e.g. DHSWs, head teachers, ELC p p g , ,staff

• Undertake qualitative interviews: to be guided by an appropriate /theoretical framework to draw out barriers/facilitators to implementing 

and delivering the toothbrushing programme. e g Michie et al’s (2005) Theoretical Domains Frameworke.g. Michie et al s (2005) Theoretical Domains Framework

• Use data to further review and refine logic model

MethodsMethodsSTAGE 3 Intervention Mapping stepsSTAGE 3 Intervention Mapping steps

3. Design intervention4. Produce intervention

Tasks• use appropriate theoretical framework (e.g. TDF) to analyse data gathered during stage 2 and identify relevant behaviours to be targeted • map these behaviours onto theoretical constructs, to select 

ti l b h i h th dpractical behaviour change methods e.g. Abraham and Michie (2008)’s taxonomy of behaviour change techniqueschange techniques

• Endpoint: fully‐developed behavioural intervention to optimise toothbrushing delivery in ELC settings in Scotland ready to betoothbrushing delivery in ELC settings in Scotland, ready to be piloted and evaluated.

I am keen to network with other researchers who have experience of developing theory‐based, behaviour change interventions, g

jennifer.eaves@nhs.net