{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:56:45Z","timestamp":1783691805768,"version":"3.55.0"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T00:00:00Z","timestamp":1614038400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Dental caries is the most prevalent preventable childhood disease and a major public health priority. Local authorities in England have a statutory responsibility to improve child health, including oral health, through the \u201cHealthy Child Programme.\u201d The \u201cHealthy Child Programme,\u201d which includes the provision of oral health advice is delivered by health visitors to parents of young children. To date, research has mainly concentrated on individual interactions between health visitors and parents, with less attention given to the broader context in which these oral health conversations between health visitor and parents take place.<\/jats:p><jats:p><jats:bold>Objective:<\/jats:bold> Our study explored the organizational factors that obstruct health visitors from engaging in meaningful conversations with parents about young children's oral health.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Qualitative interviews and focus groups were held with health visiting teams (<jats:italic>n<\/jats:italic> = 18) conducting home visits with parents of 9\u201312-month olds in a deprived, urban area in England.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The study revealed the wide variation in what and how oral health advice is delivered to parents at home visits. Several barriers were identified and grouped into four key themes: (1) Priority of topics discussed in the home visits; (2) Finance cuts and limited resources; (3) Oral health knowledge and skills; and (4) Collaborative working with other professionals. It was evident that organizational factors in current public health policy and service provision play an important role in shaping oral health practices and opportunities for behavior change.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> Organizational practices and procedures play an important role in creating interaction patterns between health visiting teams and parents of young children. They often limit effective engagement with and positive change in oral health. For future oral health interventions to be effective, awareness of these barriers is essential alongside them being founded on evidence-based advice and underpinned by appropriate theory.<\/jats:p>","DOI":"10.3389\/fpubh.2021.578168","type":"journal-article","created":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T04:35:15Z","timestamp":1614054915000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["Organizational Barriers to Oral Health Conversations Between Health Visitors and Parents of Children Aged 9\u201312 Months Old"],"prefix":"10.3389","volume":"9","author":[{"given":"Ieva","family":"Eskyt\u0117","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara A.","family":"Gray-Burrows","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Owen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bianca","family":"Sykes-Muskett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue H.","family":"Pavitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"West","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe","family":"Marshman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter F.","family":"Day","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,2,23]]},"reference":[{"key":"B1","article-title":"Healthy lives, healthy people: Improving outcomes and supporting transparency","volume-title":"Download Part 1: A public health outcomes framework for England, 2013-2016.","year":"2012"},{"key":"B2","unstructured":"SurgeonsRCO\n          Children Almost Twice as Likely to go to Hospital With Preventable Dental Problems Than for Asthma2017"},{"key":"B3","volume-title":"Child Dental Health Survey 2013","year":"2015"},{"key":"B4","volume-title":"National Dental Epidemiology Programme for England: Oral Health Survey for 5-Year-Olds 2019","year":"2020"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e0130602","DOI":"10.1371\/journal.pone.0130602","article-title":"Perceived impact of dental pain on the quality of life of preschool children and their families","volume":"10","author":"Clementino","year":"2015","journal-title":"PLoS ONE"},{"key":"B6","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1111\/cdoe.12055","article-title":"Association between body mass index and caries among children and adolescents","volume":"42","author":"Lempert","year":"2014","journal-title":"Community Dent Oral Epidemiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1341","DOI":"10.1177\/0022034515590377","article-title":"Diet and dental caries: the pivotal role of free sugars reemphasized","volume":"94","author":"Sheiham","year":"2015","journal-title":"J Dent Res."},{"key":"B8","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1590\/1982-0216201510014","article-title":"Interdisciplinary approach between dentistry and speech-language pathology in treatment of children with early childhood caries","volume":"17","author":"Inagaki","year":"2015","journal-title":"Revista CEFAC"},{"key":"B9","first-page":"7","article-title":"Association between the number of early carious lesions and diet in children with a high prevalence of caries","volume":"16","author":"Llena","year":"2015","journal-title":"Eur J Paediatric Dentistry"},{"key":"B10","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1111\/cdoe.12099","article-title":"Impact of dental caries and trauma on quality of life among 5- to 6-year-old children: perceptions of parents and children","volume":"42","author":"Abanto","year":"2014","journal-title":"Community Dent Oral Epidemiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1186\/s12903-017-0358-5","article-title":"An assessment of the impacts of child oral health in Indonesia and associations with self-esteem, school performance and perceived employability","volume":"17","author":"Maharani","year":"2017","journal-title":"BMC Oral Health"},{"key":"B12","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1111\/ipd.12441","article-title":"Does oral health influence school performance and school attendance? A systematic review and meta-analysis","volume":"29","author":"Rebelo","year":"2019","journal-title":"Int J Paediatric Dentistry"},{"key":"B13","first-page":"2017","volume-title":"Hospital Admitted Patient Care Activity","year":"2018"},{"key":"B14","unstructured":"Commissioning Better Oral Health2014"},{"key":"B15","article-title":"Local Authorities Improving Oral Health: Commissioning Better Oral Health for Children and Young People","volume-title":"An Evidence-Informed Toolkit for Local Authorities","year":""},{"key":"B16","first-page":"102","article-title":"Familial and cultural perceptions and beliefs of oral hygiene and dietary practices among ethnically and socio-economicall diverse groups","volume":"21","author":"Adair","year":"2004","journal-title":"Community Dent Health."},{"key":"B17","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1080\/00016350600714498","article-title":"Parental influence on children's oral health-related behavior","volume":"64","author":"Poutanen","year":"2006","journal-title":"Acta Odontol Scand"},{"key":"B18","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/j.medici.2014.07.003","article-title":"The role of parental education and socioeconomic status in dental caries prevention among Lithuanian children","volume":"50","author":"Saldunaite","year":"2014","journal-title":"Medicina"},{"key":"B19","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/1477-7525-12-41","article-title":"A systematic review of the impact of parental socio-economic status and home environment characteristics on children's oral health related quality of life","volume":"12","author":"Kumar","year":"2014","journal-title":"Health Qual Life Outcomes"},{"key":"B20","doi-asserted-by":"publisher","first-page":"860","DOI":"10.2105\/AJPH.2013.301699","article-title":"Socioeconomic status, food security, and dental caries in US children: mediation analyses of data from the National Health and Nutrition Examination Survey, 2007\u20132008","volume":"104","author":"Chi","year":"2014","journal-title":"Am J Public Health"},{"key":"B21","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1111\/ipd.12140","article-title":"Gains in children's dental health differ by socioeconomic position: evidence of widening inequalities in southern Brazil","volume":"25","author":"Kramer","year":"2015","journal-title":"Int J Paediatric Dentistry"},{"key":"B22","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1111\/j.1600-0528.2006.00356.x","article-title":"Cultural factors and children's oral health care: a qualitative study of carers of young children","volume":"35","author":"Hilton","year":"2007","journal-title":"Community Dent Oral Epidemiol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1111\/cdoe.12079","article-title":"The role of family functioning in childhood dental caries","volume":"42","author":"Duijster","year":"2014","journal-title":"Community Dent Oral Epidemiol."},{"key":"B24","first-page":"233","article-title":"Relationship of microbiological, social, and environmental variables to caries status in young children","volume":"12","author":"Crall","year":"1990","journal-title":"Pediatr Dent."},{"key":"B25","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1159\/000072162","article-title":"A life course approach to assessing causes of dental caries experience: the relationship between biological, behavioural, socio-economic and psychological conditions and caries in adolescents","volume":"37","author":"Nicolau","year":"2003","journal-title":"Caries Res"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1460","DOI":"10.4040\/jkan.2004.34.8.1460","article-title":"Predictors of the utilization of oral health services by children of low-income families in the United States: beliefs, cost, or provider?","volume":"34","author":"Kim","year":"2004","journal-title":"J. Korean Acad Nurs."},{"key":"B27","volume-title":"Rapid Review to Update Evidence for the Healthy Child Programme 0\u20135","author":"Axford","year":"2015"},{"key":"B28","volume-title":"Public Health Guideline","year":"2014"},{"key":"B29","doi-asserted-by":"publisher","first-page":"384","DOI":"10.12968\/bjsn.2015.10.8.384","article-title":"Exploring health professionals' perceptions of promoting oral health in children","volume":"10","author":"Coll","year":"2015","journal-title":"British J School Nurs."},{"key":"B30","doi-asserted-by":"publisher","first-page":"E7","DOI":"10.1038\/sj.bdj.2014.100","article-title":"Mind the gap! A comparison of oral health knowledge between dental, healthcare professionals and the public","volume":"216","author":"Richards","year":"2014","journal-title":"Br Dent J"},{"key":"B31","volume-title":"Rapid Review to Update Evidence for the Healthy Child Programme 0\u20135","year":"2015"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e379","DOI":"10.1111\/jocn.14014","article-title":"Examining the social construction of surveillance: A critical issue for health visitors and public health nurses working with mothers and children","volume":"27","author":"Peckover","year":"2018","journal-title":"J Clin Nurs"},{"key":"B33","unstructured":"Health Visiting and School Nursing Partnership - Pathways for Supporting Health Visitor and School Nurse Interface and Improved Partnership Working2017"},{"key":"B34","article-title":"Better start in life and beyond: Improving public health outcomes for children, young people and families","volume-title":"Guidance to support the commissioning of the Healthy Child Programme 0-19: Health Visiting and School Nursing services","year":"2016"},{"key":"B35","volume-title":"Delivering Better Oral Health: An Evidence-Based Toolkit for Prevention","year":"2017"},{"key":"B36","unstructured":"Health Visiting in England: A Vision for the Future2019"},{"key":"B37","doi-asserted-by":"publisher","first-page":"e103","DOI":"10.1093\/pubmed\/fdy107","article-title":"Health visitors' views on promoting oral health and supporting clients with dental health problems: a qualitative study","volume":"41","author":"Lewney","year":"2018","journal-title":"J. Public Health"},{"key":"B38","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1111\/phn.12381","article-title":"Knowledge, attitude and practice among Health Visitors in the United Kingdom toward children's oral Health","volume":"35","author":"Oge","year":"2018","journal-title":"Public Health Nurs"},{"key":"B39","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/1472-6831-14-26","article-title":"Primary care nurses' awareness of and willingness to perform children's oral health care","volume":"14","author":"Rabiei","year":"2014","journal-title":"BMC Oral Health"},{"key":"B40","first-page":"9","article-title":"Oral health education: what lessons have we learned","author":"Stillman-Lowe","year":"2008","journal-title":"Br Dent J"},{"key":"B41","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s13012-016-0416-4","article-title":"Using intervention mapping to develop a home-based parental-supervised tooth brushing intervention for young children","volume":"11","author":"Gray-Burrows","year":"2016","journal-title":"Implement Sci"},{"key":"B42","doi-asserted-by":"publisher","first-page":"937","DOI":"10.1038\/sj.bdj.2017.543","article-title":"Learning from good practice: a review of current oral health promotion materials for parents of young children","volume":"222","author":"Gray-Burrows","year":"2017","journal-title":"Br Dent J"},{"key":"B43","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1177\/2380084416647727","article-title":"Parents experiences of tooth brushing with children: a qualitative study","volume":"1","author":"Marshman","year":"2016","journal-title":"JDR Clin Translational Res"},{"key":"B44","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1111\/ipd.12658","article-title":"Home-based toothbrushing interventions for parents of young children to reduce dental caries: a systematic review","volume":"31","author":"Aliakbari","year":"2020","journal-title":"Int J Paediatric Dentistry"},{"key":"B45","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1016\/j.enpol.2017.02.007","article-title":"Identifying and prioritizing barriers to implementation of smart energy city projects in Europe: an empirical approach","volume":"105","author":"Mosannenzadeh","year":"2017","journal-title":"Energy Policy"},{"key":"B46","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1016\/j.promfg.2017.07.175","article-title":"Use of Design structure matrix for analysis of critical barriers in implementing eco-design initiatives in the pulp and paper industry","volume":"11","author":"Buzuku","year":"2017","journal-title":"Procedia Manufacturing"},{"key":"B47","volume-title":"Qualitative Research Methods: A Health Focus","author":"Rice","year":"1999"},{"key":"B48","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1177\/160940690600500107","article-title":"Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development","volume":"5","author":"Fereday","year":"2008","journal-title":"Int J Qualitative Methods"},{"key":"B49","article-title":"Designing Social Research","volume-title":"The Logic of Anticipation","author":"Blaikie","year":"2010"},{"key":"B50","volume-title":"Qualitative Researching","author":"Mason","year":"2002"},{"key":"B51","volume-title":"A Short Introduction to Social Research","author":"Henn","year":"2006"},{"key":"B52","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1111\/j.1440-1630.2010.00861.x","article-title":"The effect of Education with workplace supports on practitioners' evidence-based practice knowledge and implementation behaviours","volume":"57","author":"Novak","year":"2010","journal-title":"Aust Occup Ther J."},{"key":"B53","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1136\/bmj.327.7405.33","article-title":"The case for knowledge translation: shortening the journey from evidence to effect","volume":"327","author":"Davis","year":"2003","journal-title":"BMJ."},{"key":"B54","unstructured":"GrayM\n          Joint Targeted Area Inspection of the Multi-Agency Response to Abuse and Neglect in Stockton-on-Tees2018"},{"key":"B55","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1111\/j.1600-0528.2007.00348.x","article-title":"From victim blaming to upstream action: tackling the social determinants of oral health inequalities","volume":"35","author":"Watt","year":"2007","journal-title":"Community Dent Oral Epidemiol"},{"key":"B56","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1136\/jech-2017-209921","article-title":"Addressing complexity in population health intervention research: the context\/intervention interface","volume":"72","author":"Minary","year":"2018","journal-title":"J Epidemiol Community Health"},{"key":"B57","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s12874-019-0701-4","article-title":"Advancing complexity science in healthcare research: the logic of logic models","author":"Mills","year":"2019","journal-title":"BMC Med Res Methodol."},{"key":"B58","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s40814-018-0261-0","article-title":"HABIT\u2014an early phase study to explore an oral health intervention delivered by health visitors to parents with young children aged 9\u201312 months: study protocol","volume":"4","author":"Eskyte","year":"2018","journal-title":"Pilot Feasibility Stud."},{"key":"B59","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1038\/sj.bdj.2018.223","article-title":"Oral health knowledge, perceptions and practices among parents, guardians and teachers in South Wales, UK: A qualitative study","volume":"224","author":"Filipponi","year":"2018","journal-title":"Br Dent J."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.578168\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,23]],"date-time":"2021-02-23T04:35:37Z","timestamp":1614054937000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2021.578168\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,23]]},"references-count":59,"alternative-id":["10.3389\/fpubh.2021.578168"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2021.578168","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,23]]},"article-number":"578168"}}