The Behavioural Engagement of Dental Nurses Applying the Fluoride Varnish to Young Children: the BEHAVE Study

A preliminary study has shown the following:

1. Ethical permission for this work is attainable from a Research Ethics Committee.
2. Parents are willing to give consent to their children participating in the study.
3. Dental nurses are willing to give consent for their behaviours to be video recorded within their work settings.
4. Video recordings are feasible with nursery school children, EDDNs and parents present at a nursery school setting.
5. The technical difficulties of collecting audio-visual materials from nursery school settings (e.g., camera placement, storage of video data in the field setting) and anonymising the video data using a specialist masking software can be overcome.
6. Importing video files into the Observer XT coding software is successful.
7. Development of a coding system for nurse-child interaction involving a clinical procedure has been achieved (see Appendix 1 for a brief version of the coding scheme).

We have collected video recordings of more than 50 varnish application sessions in the pilot study of separate children and 6 nurses in three nursery schools. The pilot study has therefore successfully demonstrated the feasibility of collecting high quality data suitable for intensive analysis to improve our understanding of some of the processes involved in the fluoride varnish application in nursery school settings. One of the most interesting findings from the pilot study was that the permission-seeking statements used by EDDNs were negatively correlated with the treatment outcome.

Summary of next phase of study:

• To confirm the suitability of the preliminary coding scheme and to potentially refine and improve the coding scheme using a larger set of observational data collected in nursery school settings across three NHS Health Board regions.
• Further investigation to assess the generalisability of pilot study findings by collecting a larger set of observations of children systematically across a wider set of nurse pairings (with various levels of experience) and children (of different age groups: 3yrs vs 4 yrs) and with or without previous receipt of fluoride varnish application in the Childsmile programme.
• To identify the key features of the nurse-child interaction that can be used to predict a full completion of the fluoride application and to test the hypothesis that frequent targeted reinforcement is effective.
• To explore effects of some additional factors in relation to the relevant participants (e.g., EDDN's level of experience, child's previous dental experience) and some situational factors (e.g., general purpose room or specialist accommodation) on the treatment outcome.
• To develop additional training sessions for EDDNs using the findings of the study to improve the Childsmile programme and to increase acceptability of the varnish application.