Childsmile is Scotland’s national oral health programme for children. Childsmile has contributed to significant improvements in Scottish children’s oral health; nevertheless major disparities remain. Children living in Scotland’s most deprived communities continue to suffer from much higher levels of dental decay than children living in more affluent communities. In addition, families engaged in Childsmile Practice do not always attend their appointments at the dental practice, with a failure to attend rate of 32%. Families failing to attend appointments have been more concentrated in the areas of greatest deprivation. It is with this background that the Oral Health and Health Research Programme, Dental Health Services Research Unit at the University of Dundee, was commissioned to conduct the Developing an inventory to Assess Parental concerns and Enable child dental Registration (DAPER) research programme.
The DAPER research programme was conducted in three phases:
- Phase I was a qualitative exploration with 47 mothers across Scotland. It identified the main concerns that mothers had regarding dental registration and accessing dental care for their children. The results informed the design of the Parental Dental Concerns Scale (PDCS) (Chambers & Freeman, 2010)
- In Phase II the PDCS was tested and found to be valid and reliable. It was also able to discriminate between families who engaged in preventive care and those who did not. (Chambers & Freeman, 2011) & (Chambers et al., 2013)
- Phase III was a field trial of the PDCS to identify parents’ dental-related concerns and assess if a tailored intervention (CHATTERBOX) by Dental Health Support Workers (DHSWs) would enable parents to access dental care for their child. In-depth qualitative explorations were conducted with DHSWs from NHS Highland and NHS Tayside, to investigate the impact of organisational and individual factors upon DHSWs’ engagement with vulnerable families and the CHATTERBOX intervention (Nanjappa & Freeman, 2013)
CHATTERBOX is an evidence-based communication tool developed in collaboration with Duncan of Jordanstone College of Art and Design, University of Dundee. It consists of a set of bespoke tools: a timeline base, reusable activity cards, and appointment postcards. The activity cards are pictorial representations of common everyday activities that families engage in, and of factors that were identified in DAPER I & II as influencing families’ dental attendance patterns.
(Permission to use the photograph provided by Rebecca Lindsay, DJCAD)
Relevant activity cards are selected by parents and placed on the timeline base to construct a visual picture of an average day for each family. The cards can also be used to talk about issues relating to dental attendance such as transportation, childcare, social support available to the family, previous experiences with dental services and any other anxieties or concerns that families might have. The DHSW initiates a structured conversation, using CHATTERBOX, to identify where, when and why problems occur. It serves as a communication tool to help families voice their concerns and difficulties.
Example of Chatterbox timeline
CHATTERBOX was piloted with families in areas of high social deprivation in NHS Tayside and NHS Highland. A detailed process evaluation of the CHATTERBOX intervention is being planned in an NHS Scotland Board with experience of Childsmile Practice to assist in refining the design and future implementation of the intervention by Childsmile.
The findings from DAPER will feed into Childsmile's Central Evaluation and Research Team to inform the future development of the Childsmile programme and specifically the role of the Dental Health Support Worker. The DAPER reports have been disseminated across all NHS Scotland Boards.
Nanjappa, S. & Freeman, R. 2013. Developing an inventory to Assess Parental concerns and Enable child dental Registration (DAPER). Phase 3 report: Field trial of the PDCS using the CHATTERBOX intervention. Dental Health Services Research Unit, University of Dundee. (View)
Chambers, S. A. & Freeman, R. 2011. Developing an inventory to Assess Parental concerns and Enable child dental Registration (DAPER). Year 2 report: A validity and reliability study of the Parental Dental Concerns Scale. , Dental Health Services Research Unit, University of Dundee. (View)
Chambers, S. A. & Freeman, R. 2010. Developing an inventory to Assess Parental concerns and Enable child dental Registration (DAPER). Year 1 report: A qualitative exploration. Dental Health Services Research Unit, University of Dundee. (View)
Nanjappa, S., Lindsay, R., White, H., Freeman, R. (2014) Chatterbox. Peer reviewed and accepted for publication in the proceedings of Value of Design Research, 11th Annual Academy of Design Conference, Paris Descartes University Institute of Psychology. Boulogne Billancourt. France11th European Academy of Design Conference, Paris 2015.
Nanjappa, S. and Freeman, R. (2014) CHATTERBOX: developing and piloting an interactive communication toolkit for engaging families with dental services. J Nurs Care 3: 215. doi:10.4172/2167-1168.1000215.
Chambers, S., Humphris, G. & Freeman, R. (2013). The Parental Dental Concerns Scale (PDCS): its development and initial psychometric properties. Community Dentistry and Oral Epidemiology doi: 10.1111/cdoe.12046. (View)
Nanjappa, S. (2015). CHATTERBOX. The Value of Design Research, 11th Annual Academy of Design Conference, Paris Descartes University Institute of Psychology, Boulogne Billancourt, France.
Nanjappa, S. (2015). Inequalitites: Barriers to the implementation of a toolkit to promote inclusion of socially excluded mothers in dental care. CMDN Research Symposium, Crieff Hydro, Crieff.
Nanjappa, S. (2014). Developing CHATTERBOX: A Toolkit to Facilitate Oral Health Communication and Parental Empowerment Meeting: Childsmile Symposium, Beardmore Hotel, Glasgow,
Nanjappa, S. (2014). CHATTERBOX: engaging with vulerable famililies for oral health. National Oral Health Promotion Group (NOHPG) Study Day, The Grand Central Hotel, Glasgow.
Nanjappa, S. (2014). Developing CHATTERBOX: A Toolkit to Facilitate Oral Health Communication and Empowerment Meeting. 19th Congress of the European Association of Dental Public Health, Gothenburg, Sweden.
Nanjappa, S. (2014). CHATTERBOX: engaging with vulnerable families for oral health. Dundee Dental School Open Seminars, Dundee.
Nanjappa, S. (2014) CHATTERBOX: the impact of individual and organisational factos on DHSWs' engagement with vulnerable families in their homes. Childsmile Evaluation Board Meeting, Glasgow.
Nanjappa, S. (2014). From family functioning to CHATTERBOX: engaging with vulnerable families for oral health. College of Medicne, Dentistry and Nursing Research Symposium, Crieff.
Nanjappa, S. (2013). CHATTERBOX. Oral Health Improvement Network (SOHIN) meeting, Thistle House, Edinburgh.
Nanjappa, S., Chambers, S., Fulke, S., Lindsay, R., Freeman, R. (2012). The Chatterbox intervention to enable child dental registration and attendance: a collaboration between dentistry and design. Annual Public Health conference, Faculty of Public Health, Crieff (View)
Freeman, R., Nanjappa, S., Chambers, S., Fulkem S., Lindsay, R. (2012). Chatterbox: customising services around dental health care. Childsmile Symposium, Glasgow (poster presentation)
Freeman, R., & Nanjappa, S.(2012). Training Material for the CHATTERBOX intervention. (View)
Freeman, R., (2012). Adhering with Childsmile: effects of maternal identity and social networks. University of Newcastle, Ourimbah NSW, Australia
Freeman, R., (2012). From maternal concerns to the Chatterbox intervention: exploring adherence and increasing access to Childsmile Practice. Childsmile Symposium, University of Glasgow, Glasgow