Abstract
Introduction
Early childhood caries is a public health concern in Aotearoa New Zealand, contributing to poor oral health outcomes for children. Prevention should begin early and involve families in establishing positive oral health behaviours. Parents play a crucial role in shaping their child’s oral health through their knowledge, attitudes, and behaviours. Initiatives aimed at preventing dental caries should empower parents in this role and ensure oral health care is a positive, engaging experience for children. Shared storybook reading offers a meaningful opportunity for parent-child bonding and communication. This study evaluates how shared reading of an oral health storybook between a parent and their preschool child influences parental oral health-related knowledge, attitudes, and behaviours.
Methods
This community-based randomised controlled trial used a cross-over design and was conducted across Aotearoa New Zealand. A total of 197 parents/caregivers of children aged 2–5 years were randomly assigned to either an immediate intervention group (group 1, n=98) or a delayed intervention/control group (group 2, n=99). Participants completed online questionnaires at baseline, three months, and six months. A sub-group of 20 participants also took part in dental screenings of their child at each time point and completed a semi-structured interview at six months.
The intervention involved parents reading the oral health storybook Manu’s New Tooth with their child over a three-month period, supported by fortnightly text message reminders. Data were collected via online questionnaires that explored parental knowledge, attitudes, and behaviours related to preschool oral health. Interview transcripts provided qualitative insights into parental perceptions of the intervention. Quantitative data were analysed using descriptive statistics, paired t-tests, Wilcoxon signed-rank tests, chi-square tests, and logistic regression. Thematic analysis was applied to qualitative data. A combined analysis approach provided a deeper understanding of parental perspectives on preschool oral health.
Results
The intervention led to positive changes in parental knowledge, attitudes, and behaviours. While baseline knowledge was already high, improvements in attitudes and toothbrushing routines were observed. At three months, parents in group 1 were significantly more likely to report that their child brushed twice daily (OR=2.33, p=0.028) and had increased interest in toothbrushing (p=0.0009), compared to group 2. These outcomes were maintained at six months. Parents in the intervention group also reported fewer difficulties brushing their children’s teeth. Overall, two-thirds of participants made changes at home to support their child’s oral health. Thematic analysis identified key themes: enhanced parent-child communication about oral health, reflections on parents’ own experiences, and positive perceptions of the storybook. Combined findings showed a clear positive shift in parental engagement with preschool oral health.
Conclusion: Shared reading of an oral health storybook, supported by reminders, shows promise as an effective and engaging strategy to enhance preschool children’s oral health. It strengthens parent-child communication, boosts children’s interest in brushing, and increases the likelihood of twice-daily brushing.