A common early intervention approach for preschool children with language problems is parent–child interaction therapy (PCIT). PCIT has positive effects for children with expressive language problems. It appears that speech and language therapists (SLTs) conduct this therapy in many different ways. This might be because of the variety of approaches available, the diverse set of families SLTs work with or the different organizational structures. Understanding the critical components of PCIT would enable SLTs to map the variations that are implemented and researchers to evaluate the effects of such variation. This study aimed to identify the potentially critical components of PCIT based on the practical experience of SLTs and to identify SLTs’ rationales for the way they structure PCIT. Both parameters are important for the long term goal, that is, to develop a framework that can be used to support practice. Semi-structured interviews were conducted with 10 SLTs who had at least one year experience in delivering PCIT with preschool children with language impairment. The interviews were transcribed and analysed, using thematic analysis. Analysis of the SLT interview data identified four potentially critical components that underpin the teaching of strategies to parents: parents’ engagement, parents’ understanding, parents’ reflection and therapists’ skills. SLTs suggested that all four components are needed for the successful delivery of PCIT. The reasons that SLTs give for the way in which they structure PCIT are mainly based on organizational constraints, family needs and practicalities. SLTs consider PCIT to be valuable but challenging to implement. A framework that makes explicit these components may be beneficial to support practice.
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Background: Early childhood caries is considered one of the most prevalent diseases in childhood, affecting almost half of preschool-age children globally. In the Netherlands, approximately one-third of children aged 5 years already have dental caries, and dental care providers experience problems reaching out to these children. Objective: Within the proposed trial, we aim to test the hypothesis that, compared to children who receive usual care, children who receive the Toddler Oral Health Intervention as add-on care will have a reduced cumulative caries incidence and caries incidence density at the age of 48 months. Methods: This pragmatic, 2-arm, individually randomized controlled trial is being conducted in the Netherlands and has been approved by the Medical Ethics Research Board of University Medical Center Utrecht. Parents with children aged 6 to 12 months attending 1 of the 9 selected well-baby clinics are invited to participate. Only healthy children (ie, not requiring any form of specialized health care) with parents that have sufficient command of the Dutch language and have no plans to move outside the well-baby clinic region are eligible. Both groups receive conventional oral health education in well-baby clinics during regular well-baby clinic visits between the ages of 6 to 48 months. After concealed random allocation of interventions, the intervention group also receives the Toddler Oral Health Intervention from an oral health coach. The Toddler Oral Health Intervention combines behavioral interventions of proven effectiveness in caries prevention. Data are collected at baseline, at 24 months, and at 48 months. The primary study endpoint is cumulative caries incidence for children aged 48 months, and will be analyzed according to the intention-to-treat principle. For children aged 48 months, the balance between costs and effects of the Toddler Oral Health Intervention will be evaluated, and for children aged 24 months, the effects of the Toddler Oral Health Intervention on behavioral determinants, alongside cumulative caries incidence, will be compared. Results: The first parent-child dyads were enrolled in June 2017, and recruitment was finished in June 2019. We enrolled 402 parent-child dyads. Conclusions: All follow-up interventions and data collection will be completed by the end of 2022, and the trial results are expected soon thereafter. Results will be shared at international conferences and via peer-reviewed publication.
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Abstract: There is growing evidence for the beneficial effects of starting oral health prevention early in life. Preventing dental caries in very young children requires considerable investment from parents. Therefore, this cross-sectional study aimed to explore parents’ willingness to pay (WTP) and willingness to invest in time (WTIT) for primary oral health prevention in preschool children and describe whether these are related to the parents’ demographic, socio-economic and behavioural characteristics. In a convenience sample of parents of preschool children aged six months to four years (n = 142), data were collected with questionnaires. On average, parents were willing to pay EUR15.84 per month, invest time for 1.9 dental visits per year, and spend 2.4 min per day brushing their child’s teeth. A higher education level of the mother and having a child older than two were associated with a higher WTIT in brushing minutes per day (p = 0.03). In addition, parents who brushed their child’s teeth more frequently were also more willing to invest in brushing minutes (p < 0.01) and money (p < 0.01). Findings emphasise the importance of early oral health interventions and the need to increase awareness of primary prevention’s importance in maintaining healthy teeth and reducing possibly oral health inequalities.
In de voorschool worden pedagogisch medewerkers (PMers) steeds vaker geconfronteerd met overgewicht bij kinderen van 2,5 tot 4 jaar. De PMer is getraind in het ondersteunen van de ontwikkeling en opvoeding van het kind. PMers zijn niet opgeleid voor leefstijladvisering. Ongezonde voeding en inactiviteit zijn de belangrijkste oorzaken van overgewicht. Overgewicht komt op jonge leeftijd al meer voor bij lagere sociaaleconomische en etnische groepen. De gezondheidsverschillen nemen hierdoor toe. PMers geven aan dat zij zich niet bekwaam voelen om verantwoordelijk te zijn voor de gezonde keuzes op de voorschool als ook in de advisering naar ouders toe. De centrale vragen in dit project zijn: Wat heeft de PMer in de voorschool nodig in kennis, vaardigheden en attitude om het handelingsrepertoire tav leefstijladvisering aan alle kinderen van 2,5 tot 4 jaar en ouders met diverse sociaaleconomische en cultureel-etnische achtergronden te professionaliseren. Wat is het effect van het handelen van de PMer op de gezonde (gewichts)ontwikkeling van het kind? Het onderzoek is een gerichte interventiestudie met voor- en nametingen bij PMers, kinderen en ouders. De interventie wordt bij een deel van de PMers uitgevoerd en vergeleken met een controlegroep. Bij kinderen worden fysieke- en gedragsmetingen uitgevoerd. Eindpunten zijn het vertrouwen in leefstijladvisering door PMers en ontwikkelingstrends in gewicht bij kinderen. Fases van het projectplan: I. nulmeting en interventie bij PMers; II. nulmeting bij kinderen en interventie door PMers; III. effectmeting interventie bij PMers en kinderen; IV. ontwikkeling competentieprofiel leefstijladvisering voor PMers. Het PS@HW consortium olv de Hogeschool van Amsterdam, Impuls Kinderopvang, Brancheorganisatie Kinderopvang Amsterdam, Nederlands Jeugdinstituut, RIVM Centrum voor Gezond Leven, VU medisch centrum, HvA-Speerpunt Urban Vitality en Sarphati Amsterdam pakt dit op. Dit project beoogt het ontwikkelen van de HBO competentie leefstijladvisering voor PMers van de voorscholen die kinderen bereiken met een achterstand, voor een gezonde (gewichts)ontwikkeling en het terugdringen van gezondheidsverschillen.
