Impact of multi-session parental motivational interviewing on parental self-efficacy in oral health care practices and dental caries experience in children with early childhood caries

Objectives:

Stage 1

To study the differences in parental perceptions of self-efficacy about oral health care practices of their children with and without early childhood caries.

To check the reliability and validity of  parental oral health self-efficacy questionnaire

Stage 2

To study the association of parental self-efficacy in oral health care practices with early childhood caries experience of their children and their oral health care practices.

Stage 3

To study the effectiveness of multi-session motivational interviewing of parents on parental self-efficacy in their children’s oral health care practices and dental caries experience of their children with early childhood caries in comparison with conventional dental education method by oral and written instructions, over a 12-month follow-up.

Methodology:

Stage 1: Developing the questionnaire

Objective 1: To study the differences in parental perceptions on self-efficacy about oral health care practices of their children with and without early childhood caries

Study design: Descriptive qualitative study

Study duration: 6 months

Focus group discussions will be conducted until data saturation is obtained. All sessions will be audio recorded. Each session will be approximately 45 minutes, with 6 participants in each group.

Outcome

Differences in parental self-efficacy on oral health practices and the existing oral health care practices among children with and without ECC.

Self-efficacy indicators for oral health care practices among children with ECC, that will help in developing a questionnaire tool.

Objective 2

To check the reliability and validity of parental oral health self-efficacy questionnaire

For the pilot testing of the questionnaire, 500 parents of preschool children from preschools of Mangalore Taluk, based on convenience sampling and fulfilling the inclusion and exclusion criteria will be selected.

Subject experts will evaluate the questionnaire for face validity and content validity. After pre-testing the questionnaire for cognition by parents, pilot testing will be conducted to assess the construct validity. Reliability will be tested after translating to local (Kannada) language.

Stage 2: CASE-CONTROL STUDY

Objective: To study the association of parental self-efficacy in oral health care practices with early childhood caries experience of their children and their oral health care practices.

Study design:  Case-control (Parents of children with and without ECC)

Study duration: 6 months

Sampling (target population): Parents of the children with and without ECC from Anganwadis and preschools at Mangalore taluk, Dakshina Kannada district, Karnataka, using two stage simple cluster random sampling technique.

The questionnaire on self-efficacy that was derived based on the qualitative study outcomes and undergone validity and reliability testing  will be used for the case-control study. A questionnaire on oral health care practices, including home oral hygiene routines, sugar consumption in the child’s diet, and patterns of dental care utilization through dental clinic visits, will be administered to parents.

Chi-square tests and multiple logistic regression will be used to analyze the data and compare between cases and controls.

Stage 3: Randomized Controlled study with Motivational Interviewing Intervention

Objective

To study the effectiveness of multi-session motivational interviewing of parents on parental self-efficacy in their children’s oral health care practices and dental caries experience of their children with early childhood caries in comparison with conventional dental education method by oral and written instructions.

Study design: Randomized controlled trial

Sampling: Two stage simple cluster random sampling method will be used in a similar manner as the case control study. The sample will consist of parent-child dyads with ECC only (cases only). Parents of children with ECC who participated in the phase 1 study will be selected using the lottery method, from each cluster. Each preschool/Anganwadi will be clusters

Study duration: 18 months

Randomization: The parents will be randomly allocated into two groups using block randomization technique with allocation concealment

Group1: Motivational interviewing (MI)

Group 2: Conventional dental health education (DHE) (positive control)

Group 1 (MI Group): A brief one-to-one MI will be conducted for each parent individually by a trained pediatric dentist. The duration of each session will be approximately 20 minutes, with three sessions (Pre-contemplative, contemplative, and preparation stages) conducted at 15-day intervals. The oral health practices will be reviewed at 3-month follow-up (practice stage).

Group 2 (DHE group): The parents will be provided with oral and written information about the importance of primary teeth, the decay process, and oral health practices such as oral hygiene, dietary sugars, and regular dental visits for their child using an educational booklet and study models to demonstrate tooth brushing.

Outcomes: Parents will be followed up at 6 and 12 months after the last stage of intervention and assessed for parental self-efficacy and oral health practices of their children using the same questionnaire as in the Phase 1 case-control study.

Examination: Children will be examined for dental caries experience at 6 and 12-month follow-up using dmft and dmfs index, plaque index and ICDAS II caries scoring system.

Repeated Measures of ANOVA, Chi-square tests and multivariate regression analysis will be used to compare parental self-efficacy, dental caries experience and oral health care practices of their children between the groups over time.