Development of a novel coding scheme (SABICS) to record nurse-child interactive behaviours in a community dental preventive intervention

A preliminary study to identify data needs for improving fit of hand and wrist orthosis using verbal protocol analysis

The delayed delivery, poor fitting and discomfort of customised orthoses are reported in rehabilitation clinics as resulting in more invasive interventions. The current practice of orthosis customisation relies heavily upon the experience and fabrication processes of therapists. In order to better understand the current practice, and thus identify data that is required for better comfort moving towards a data-driven customisation, this article describes a study generating working models of therapists. Customisations of hand and wrist orthoses for 18 patients were observed. Verbal protocol analysis was employed to extend the current understanding of fabrication processes. Working models of four therapists were established with quantitative evaluation on major phases, interactive activities and iterations of performing tasks during fabrication, revealing different working models between in- and out-patient departments (e.g. fabrication for in-patients was more complex and focussed on ergonomic fitting whereas fabrication for out-patients paid attention to durability) which were qualitatively explained. Practitioner summary: Fit and comfort are imperative for orthosis design and fabrication, however the current practice of customisation of an orthosis relies upon the experience of individual hand therapist. The article presents working models of hand therapists, and relevant data that would enable customisation of orthosis for better fit. Abbreviations: VPA: verbal protocol analysis; h&w: hand and wrist; LTT: low temperature thermoplastic; ANOVA: analysis of variance.

Recording communication in primary dental practice: an exploratory study of interactions between dental health professionals, children and parents

Aim To explore the time taken and the types of communication strategies used by dental health professionals (DHPs) when interacting with and providing fluoride varnish and oral health advice to children with their parents.Methods A video observational study was conducted to explore the types of communication strategies used by DHPs when interacting with child patients and their parents during preventive oral healthcare appointments. Three dentists and two extended duty dental nurses (EDDNs) from four general dental practices were recruited in East of Scotland. Forty-four child-parent dyads participated in the study. Verbal and non-verbal behaviours were coded with Observer XT 10.5 using the PaeD-TrICS coding scheme. Frequencies of communication behaviours were compared using Mann-Whitney U-tests.Results The communication during the preventive care appointment ranged in time from 130 seconds to 1,756 seconds with an average of 736 seconds. The total number of communication strategies (verbal and non-verbal behaviours) based on 44 video observations was 7,299. DHPs used different communication strategies when providing fluoride varnish application (FVA) and oral health advice. Dentists used more direct communication strategies to elicit child patients' cooperation in FVA. EDDNs used communication behaviours to maintain a balanced relationship with children. Consequently, children exhibited different responses to the two different dental professional groups.Conclusions Differences in the style of communication strategies existed between the participating DHPs when interacting with children during preventive dental appointments. Further work is required to confirm these initial findings.

Development of an interaction coding scheme (PaeD-TrICS) to record the triadic communication behaviours in preventive dental consultations with preschool child patients and families: a video-based observational study

Background

There is a paucity of research concerning paediatric dental consultations in primary care. This is potentially due to the difficulty of measuring the communication behaviours in the complex triadic consultations. The present study aims to describe the development and refinement of a coding scheme to record the triadic communication between dental professionals, child patients and parents.

Methods

The PaeD-TrICS was developed from video observation of triadic communications and refined through an iterative process. Its practical applicability was assessed via implementation of the scheme on specialised behavioural coding software. Reliability was calculated using Cohen’s Kappa.

Results

The PaeD-TrICS contains 45 codes. Forty-four dental professional-child-parent communications were successfully coded through administering the scheme on The Observer XT 10.5 system. Cohen’s Kappa was 0.83 (inter-coder) and 0.90 (intra-coder). “Parental verbal facilitation” (mean = 1.68/min) was the most frequent behaviour. Dental professionals’ “dentally engaging talk” (mean = 1.24/min), “praise” (mean = 1.10/min) and “instruction” (mean = 0.62/min) were frequently seen. Children’s common behaviours included “speech other” (mean = 0.66/min) and non-verbal behaviour i.e. “non-verbal agreement” and verbal behaviour “speech yes” (mean = 0.26/min).

Conclusions

The PaeD-TrICS is developed to capture the communication behaviour of the triadic consultations in a preventive dental setting. It demonstrates satisfactory intra- and inter-coder reliability and has been successfully used in paediatric dental consultations.

A mixed-methods feasibility study protocol to assess the communication behaviours within the dental health professional-parent-child triad in a general dental practice setting

Background

The promotion of twice yearly application of fluoride varnish (FVA) to the teeth of pre-school children in the dental practice is one component of Scotland’s child oral health improvement programme (Childsmile). Nevertheless, evidence shows that application rates of FVA are variable and below optimal levels. The reasons are complex, with many contextual factors influencing activity. However, we propose that one possible reason may be related to the communication challenges when interacting with younger children. Therefore, the primary aim of the study is to assess the feasibility of conducting a video observational study in primary dental care. The secondary aim is to assess the communication behaviours of dental professionals and those of the parents to predict child cooperation when receiving FVA using this video observational study design.

Methods

Approximately 50 eligible pairs of parents and child patients aged between 2 years and 5 years from general dental practices will be recruited to participate in the study. The consecutive mixed-method study will consist of two parts. The first part will be cross-sectional observations of the dental health professional-child-parent communication during dental appointments conducted in the general dental practice setting, using video recording. The second part will be a post-observation, semi-structured interview with parents and dental health professionals respectively. This will be implemented to explore their views on the acceptability and feasibility of being observed using video cameras during treatment provision.

Discussion

The mixed-methods study will allow for directly observing the communication behaviours in the clinical setting and uncovering the views of participating dental health professionals and parents. Therefore, the study will enable us to [i] explore new ways to study the nature of triadic interaction of dental health professional-child-parent, [ii] identify dental health professionals’ effective communication behaviours that promote child patient and parent’s experience of using preventive dental service and [iii] to assess the feasibility of the study through uncovering the views of dental health professionals and parents.

Psychological Intrusion - An Overlooked Aspect of Dental Fear

Dental fear/anxiety is a widely recognised problem affecting a large proportion of the population. It can result in avoidance and/or difficulty accepting dental care. We believe that psychological intrusion may play a role in the aetiology and maintenance of dental fear for at least some individuals. In this narrative review we will take a developmental perspective in order to understand its impact across the lifespan. We will consider the nature of 'self,' parenting styles, the details of intrusive parenting or parental psychological control, and briefly touch upon child temperament and parental anxiety. Finally, we draw together the supporting (largely unrecognised) evidence available in the dental literature. We illustrate the paper with clinical examples and discuss possibly effective ways of addressing the problem. We conclude that psychological intrusion appears to play an important role in dental fear, for at least some individuals, and we call for detailed research into the extent and exact nature of the problem. A simple means of identifying individuals who are vulnerable to psychological intrusion would be useful for dentists.

Reassurance and distress behavior in preschool children undergoing dental preventive care procedures in a community setting: a multilevel observational study

BACKGROUND

The effect of reassurance in managing distress among children who receive procedures of a less aversive nature has not been fully investigated.

PURPOSE

This study aimed to investigate the relationship between reassurance by dental staff and distress behavior of preschool children receiving preventive procedures in a community setting.

METHODS

Nurse-child interactions (n = 270) during fluoride varnish application were video recorded and coded. Multilevel logistic regression modeled the probability of the occurrence of child distress behavior as a function of reassurance provision, controlling for child-level and nurse-level variables.

RESULTS

Child distress behavior was positively related to nurse verbal reassurance but negatively linked to the time that this reassurance occurred. Both child initial anxiety and nurse nonprocedural training increased the probability of observable distress behavior.

CONCLUSIONS

The use of verbal reassurance to promote reception of mild invasive procedures was counterindicated, especially when offered early in the intervention ( ClinicalTrials.gov number: NCT00881790).

Prediction of nursery school-aged children who refuse fluoride varnish administration in a community setting: a Childsmile investigation

BACKGROUND

Young children of pre-school age may find a minimal intervention (fluoride varnish application) difficult to tolerate.

AIM

To determine the significant predictors for refusing a fluoride varnish application from child, parental and nurse behaviour factors.

DESIGN

Data included videos from 238 children (52% female, aged 3-5 years) receiving a fluoride varnish application in a Scottish nursery school setting. The St Andrews Behavioural Interaction Scheme (SABICS) was used for video coding and retrieved child refusal status, initial anxious behaviour, and nurse behaviour. A parental survey collected parent's dental anxiety [Modified Dental Anxiety Scale (MDAS)] and the child's home behaviour [Strengths and Difficulties Questionnaire (SDQ)]. Child demographics, dental status, and previous varnish application experience were recorded. Multivariate binary logistic regression was applied to predict child refusal of the varnish application.

RESULTS

The response rate was 79%. Twelve children refused. The significant predictors of varnish refusal included initial anxious child behaviour (β = 5.14, P = 0.001), no previous varnish application (β = -3.89, P = 0.04), and no nurse praise (β = -1.06, P = 0.02). Information giving (P = 0.06) and reassurance (P = 0.08) were borderline significant.

CONCLUSION

Initial anxiety behaviour, previous varnish experience, and not using praise by the nursing staff predicted fluoride varnish application refusal.

The behaviour of preschool children receiving fluoride varnish application in a community setting

BACKGROUND

The behaviour of young children receiving mildly invasive dental preventive procedures in a community setting warrants more extensive research due to limitations in the literature.Objectives To document the behavioural profile of preschool children undergoing a preventive oral health intervention (fluoride varnish application) and to investigate this behaviour across children with different previous experience of the procedure, ages and initial anxiety states.

METHOD

Nurse-child interactions were video recorded and child behaviours coded and analysed using a specially developed coding scheme (SABICS). Behaviour frequency was measured and presented diagrammatically, followed by independent sample non-parametric tests to distinguish behavioural group differences.

RESULTS

Three hundred and three interactions were coded out of 456 recorded application sessions. 'Nonverbal agreement' behaviour was observed most frequently compared to disruptive behaviours. Younger preschool children tended to exhibit 'interact with instrument' behaviour more frequently than older children regardless of whether they had had previous application experience. Children who showed signs of initial anxiety were likely to display more disruptive behaviours during the later stage of the procedure compared with non-anxious children.

CONCLUSIONS

Dental staff working with preschool children are recommended to use encouragement-centred strategies to promote nonverbal cooperative behaviours in children. In addition, procedure instruments could be considered as a tool to gain child cooperation. Evidence of an autocorrelation effect of child behaviour was found, indicating that the early presentation of child behaviour predicted the behaviour of the child at later stages.