Developing a grounded theory to understand parental oral health behaviors

Objectives: The purpose of this qualitative study was to develop a grounded theory to facilitate our understanding of the processes that influence parental adoption of dentally-healthy behaviors following their child's dental general anesthetic (GA) for treatment of severe early childhood caries

Methods: Twenty six in-depth individual interviews were conducted with parents of pre-school aged children at various time periods after their child's dental surgery, i.e. shortly after the GA and up to one year following the GA. A conceptual model was generated to explain the process of parental behavior change.

Results: The final model incorporated four theoretical categories that influenced the “core” of the model which was parental behavior change. The three categories peripheral to the core were social influences, family context, and parenting strategies. A fourth category, the GA experience, was intentionally situated differently because this category did not have the same long-term influence on parent's behaviors as the other categories. Within the social influences category, cultural beliefs, actions of dental professionals, and media/advertising were identified by parents as barriers to adoption of healthy behaviors, while professional advice, the community, and “significant others” were motivators or supports for parents. Within the family context category, parent's own beliefs and behaviors had a key influence on health within the family; however, other family members' beliefs and behaviors affected young children in both positive and negative ways. Although greatly influenced by family context and social influences, parenting strategies gradually emerged in a central position in the model. Parents who were further along the stages of change continuum, had high levels of self-efficacy, and whose parenting strategy included taking responsibility for their child's health were the most successful in adopting and maintaining new healthy behaviors.

Conclusions: Social influences, family context, and parenting strategies were identified as key determinants of parental behavior change; the GA experience appeared to have limited long-term influence. This study was supported by CIHR Grant FRN 67817.