{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:03:05Z","timestamp":1789534985739,"version":"build-2803163510"},"reference-count":49,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Paed Dentistry"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Public fluoride varnish (FV) programs, often delivered as part of a multi\u2010component oral preventive package, rely on the patient's continued participation. However, continued adherence is often poor in real\u2010world settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To synthesize child, family, provider, and systemic level barriers and facilitators influencing adherence and attrition in public FV programs for children &lt;\u200918\u2009years in multi\u2010ethnic high\u2010income countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review was conducted in accordance with . Six databases were searched for studies reporting barriers and facilitators to repeated FV applications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 3616 records, 22 studies were included. Child\u2010level barriers included behavioral distress, sensory aversion, and temporary medical exclusions. Family\u2010level barriers included caregiver capacity, health literacy, and mobility. Provider\u2010level barriers included workforce constraints, training, role boundaries limiting task\u2010sharing, and weak school\/community coordination. System\u2010level barriers included inequitable reach to high\u2010risk groups and geographic constraints. Facilitators included culturally safe, relationship\u2010based engagement, task\u2010sharing, school\/community\u2010based delivery with active follow\u2010up systems, and child\u2010centered engagement strategies. Meta\u2010analysis demonstrated a pooled attrition rate of 23% (95% CI 8%\u201343%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200914\u2009455).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adherence and attrition in public FV programs are shaped by interacting determinants across child, family, provider, and system levels. Retention should be considered when designing and implementing these programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>CRD420251044425 (PROSPERO)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ipd.70144","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:20:28Z","timestamp":1789532428000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Adherence and Attrition in Public Fluoride Varnish Programs: A Mixed\u2010Methods Systematic Review"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8471-4275","authenticated-orcid":false,"given":"Nathan","family":"Zeyang\u2010Liu","sequence":"first","affiliation":[{"name":"Faculty of Dentistry University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4919-9958","authenticated-orcid":false,"given":"Rahul","family":"Gupta","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1238-139X","authenticated-orcid":false,"given":"Joseph","family":"Chiang","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6789-6089","authenticated-orcid":false,"given":"Jolanta","family":"Aleksejuniene","sequence":"additional","affiliation":[{"name":"Faculty of Dentistry University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034520908533"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12903\u2010017\u20100444\u20108"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2021\u2010051481"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.17269\/cjph.107.5299"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.14219\/jada.archive.2013.0057"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.20007"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002279.pub2"},{"issue":"2","key":"e_1_2_11_9_1","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1111\/cdoe.70032","article-title":"Fluoride Varnish for Caries Prevention in Preschoolers: An Overview of Reviews","volume":"54","author":"Couto F. 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