The reasons for joining or not joining an outreach kindergarten dental service : a qualitative study

Abstract

Early childhood caries (ECC) remains the single most common chronic childhood disease. Untreated caries can cause tooth loss and compromised dentition. Severe ECC can influence nutrition intake, cognitive development, general health and quality of life. In Hong Kong, approximately half of all 5-year-old children suffer from ECC, and more than 90% of them remain untreated. Thus, developing effective strategies for promoting the oral health of preschool children is warranted. The Faculty of Dentistry of the University of Hong Kong has provided dental outreach services to selected kindergartens since 2008. In 2020, the project expanded to serve all kindergarten children in Hong Kong. The service aims to improve oral health through the preventing and controlling ECC among kindergarten children. The service offers dental screening and silver diamine fluoride treatment to kindergarten children. It provides oral health talks to the parents and training to kindergarten teachers. The objectives of this service are to improve oral and general health of preschool children, develop the children’s good oral health-related behaviours, maintain the children’s psychological well-being and reduce the financial and logistical burden on their family. Qualitative research collects non-numerical data that explores human behaviours, attitudes, beliefs and personality characteristics unamendable to quantitative research. The research questions are open-ended, evolving and non-directional. The study design is flexible and iterative. Purposive sampling is commonly used. The sample size is determined by theoretical saturation. Data collection are generally through in-depth interviews, focus groups and observations. Qualitative research commonly uses thematic analysis and framework analysis, though there is no consensus on analysing qualitative data. The reporting format can be comprehensive, a summary, developmental or selective, subject to the research question. Qualitative research’s potential functions are to describe the form or nature of what exists (contextual), to examine the reasons for or associations between what exists (explanatory), to appraise the effectiveness of what exists (evaluative) and to aid the development of strategies (generative). Qualitative research can be time consuming to conduct because it explores evolving questions. It also can be difficult to generalise because it recruits limited participants. It can be arduous to make systematic comparisons because responses are subjective. However, qualitative studies can explore a research question in depth and detail and create openness. It also simulates people’s individual experiences and avoids pre-judgements. No detailed principals’ perspectives regarding the dental programme have been obtained. A qualitative study has been conducted to collect the principals’ perspectives regarding the adoption and experience of this kindergarten-based dental programme. Eight principals were recruited using purposive sampling method. Data were collected through in-depth interviews and thematic analysis was employed as the data analysis method. The study found the principals were generally satisfied with the kindergarten-based outreach dental programme. The principals realised the necessity and importance of the service. They welcomed the service which was free and provided by a reputable university. They had no concerns of the use of silver diamine fluoride, which most parents accepted. However, they needed to gain support from their teachers and the parents before they adopted the service.