Using theory to develop a culturally appropriate family-based oral health intervention in Brazil: the "Boca boca saudável" study

INTRODUCTION: Early childhood caries impacts on negative quality of life in children and families, and it is a strong predictor of caries in permanent dentition. In Brazil, a slightly reduction of caries prevalence was observed in 5-years old children and 80% of their teeth remain with cavities, which indicates oral health promotion interventions. Our purpose was to design an oral health intervention to prevent early childhood dental caries through family behavior change that would be sustained by Primary Health Care, in Brazil.

METHODS: Intervention Mapping and Theoretical Domain Framework were used to guide the intervention planning process. Systematic literature reviews assessed current oral health interventions. A population-based oral health survey with 1,123 mother-child dyads provided data on family oral health behaviors and children’s prevalence of caries and dental plaque. In-depth interviews with 32 families evaluated their understanding of oral health meaning, beliefs, motivations and barriers to adopt preventive behaviors. Six focus groups with health providers, community health workers and families provided insights into challenges and opportunities in reaching the audience and inputs on program logistic aspects and opinions on educational materials in order to increase program feasibility and acceptability.

RESULTS: Results from different research methods were combined to identify relevant behavioral determinants and define the intervention methods and strategies according to target population needs. The intervention includes two components: a) seven group-based wellness sessions, using a video series as the main communication strategy, b) oral health campaign and printed educational materials for parents and children.

CONCLUSIONS: We demonstrated how the planning protocol is a helpful method for developing a feasible and theory-based oral health intervention. This turns into a clear framework for process evaluation, improving the intervention potential effectiveness. Our study provides further evidence that can be used by others working to reach this population in Latino communities.