First Dental Steps intervention: feasibility study of a health visitor led infant oral health improvement programme

In England, dental caries is common (22.4% of 5-year-olds, 2024) and the primary reason for hospital admission of children. First Dental Steps (FDS), an intervention in South West England, includes training for health visitors, integrating oral health advice into home visits and provision of oral health packs (a free flow cup, toothbrush and 1450ppm fluoride toothpaste) to vulnerable families at the 1-year developmental check. The aim was to conduct a feasibility study of FDS to support parents to increase infant toothbrushing.

This study explored the feasibility and acceptability of the FDS intervention and research methods in 5 local authority areas in South West England and 4 comparison sites. Data collection (June 2021-February 2022) included baseline and follow-up questionnaires (mean 5 months), semi-structured interviews with parents (n = 16), health visitors (n = 7), and stakeholders (n = 16). Analysis of questionnaires was descriptive, and interviews were analysed using the framework method.

Parents completed baseline (n = 59) and follow-up questionnaires (n = 26), with 10 parents (40%) reporting an increase in brushing frequency and 4 families (15%) reported visiting a dentist. From the interview data, five themes were identified 1) acceptability of the intervention, 2) feasibility of the intervention (delivery and implementation), 3) possible benefits of the intervention, 4) acceptability of study methods, and 5) suggested improvements. The FDS intervention was seen to be acceptable and feasible to those who took part, however, challenges with recruitment and retention demonstrate that obtaining data for a full trial would not be feasible.

Parents, health visitors and stakeholders who took part in our study found FDS to be acceptable and feasible. Recruitment, retention and study methods (completing participant flow table) were challenging, and the progression criteria for the research methods were not met to progress to a full trial. Modifications were recommended to improve the intervention and further co-production approaches could be used to ensure it is culturally appropriate in a diverse population.