Table 2 Detailed description of intervention using TiDIER guidelines

Name

First Dental Steps

Why

Describe any rationale, theory, or goal of the elements essential to the intervention

The primary objective of the First Dental Steps intervention is to improve oral health and the uptake of dental services of young children. This is in support of the larger initiative to reduce the number of children requiring extractions under a general anaesthetic.

The primary objective of the First Dental Steps Programme will be achieved by maximising the role of health and social care professionals involved in early years care, e.g. health visiting teams

In this intervention health visiting teams will, as part of the one-year development check:

1. Provide families with an oral health pack

2. Provide families with evidence based oral health care advice and information

3. Remind families of the importance of children seeing a dentist by the age of one

4. Where appropriate provide signposting to local community dental services

5. Identify vulnerable children at risk of developing decay, and refer to the community dental services

What

Materials: Describe any physical or informational materials used in the intervention, including those provided to participants or used in intervention delivery or in training of intervention providers. Provide information on where the materials can be accessed (such as online appendix, URL)

1. Training of health visitor teams:

Prior to the delivery of the intervention components at the 12-month mandated check health visiting team members will receive additional training on child oral health, this training can be delivered by any certified provider. The training material is based on the ‘NICE Public Health Guidelines [PH55] Oral Health: local authorities and partners’ [12] as well as the ‘PHE Delivering better oral health: an evidence-based toolkit for prevention’ (17). The training was delivered in 2-h sessions which were delivered between January 2019 and March 2021.

2. Material provided to families:

The family will be provided with a pack, which includes a free flow cup, an age-appropriate toothbrush, and 1450 ppm fluoride toothpaste.

Procedures: Describe each of the procedures, activities, and/or processes used in the intervention, including any enabling or support activities

First Dental Steps includes a universal and targeted element, the targeted element is being assessed in this study.

Universal element:

The universal element includes offering oral health training delivered to health visitors or community nursery nurses preparing the attendees to be “Oral Health Champions”. The training aims to enhance their ability and confidence to provide families with evidence-based oral health advice on diet, oral health, and oral hygiene, when to attend the dentist, and signposting to dental services.

Targeted elements:

Under the current health visiting model, health visiting services offer services on four levels, with Universal Plus and Universal Partnership Plus, being the final two offered to the more vulnerable families. Universal Plus offers rapid response from the local health visiting team when specific expert help is needed. While Universal Partnership Plus, a level provided for the most vulnerable families, delivers ongoing support from health visiting teams and a range of local services (usually social care and other partners) to address more complex issues over a period of time.

The targeted element of the First Dental Steps intervention will be for families receiving the Universal Plus or Universal Partnership Plus tier of the HV service. Oral Health Champion trained health visitors will distribute packs (described above) to these vulnerable families. Where possible they will also, set up a direct referral pathway for children identified as being at high risk of developing tooth decay to the local Community Dental Services where they can access specialist preventative advice and treatment.

Who provides

For each category of intervention provider (such as psychologist, nursing assistant), describe their expertise, background, and any specific training given

The First Dental Steps intervention will be delivered by health visiting team members who will receive additional training on being an Oral Health Champion (described above).

How

Describe the modes of delivery (such as face to face or by some other mechanism, such as internet or telephone) of the intervention and whether it was provided individually or in a group

The targeted element of the First Dental Steps intervention will be delivered individually to the vulnerable families by the trained health visiting teams. In some local authorities this will be delivered face-to-face, while in others this will be carried out over video conferencing or telephone call. In these situations, the oral health packs will be delivered to the family either by drop-off from a member of the health visiting team or via a collection point or postage.

Where

Describe the type(s) of location(s) where the intervention occurred, including any necessary infrastructure or relevant features

For both the universal and targeted elements of First Dental Steps, the intervention will take place as part of the professional’s normal operating, as such, some level of advice or sign posting may occur telephonically or remotely. However, for the targeted element, the First Dental Steps intervention will also occur as part of the health visiting team’s mandated checks with vulnerable families, these checks will likely take place in the family home or in established clinics. No additional infrastructure is required.

When and how much

Describe the number of times the intervention was delivered and over what period of time including the number of sessions, their schedule, and their duration, intensity, or dose

The health visiting team training workshops will take place prior to the study period. The oral health advice and distribution of oral health packs will take place as part of the 12-month mandated check, during a 5-month period. Each child will receive only one pack during the study period. However, families may be in contact with health visiting teams more than once during the study period and may receive additional advice, information, or signposting during the study period.

Tailoring

If the intervention was planned to be personalised, titrated or adapted, then describe what, why, when, and how

Nothing planned

Modifications

If the intervention was modified during the course of the study, describe the changes (what, why, when, and how)

The research team will document this throughout the study and report, as need be, with the results.

How well

Planned: If intervention adherence or fidelity was assessed, describe how and by whom, and if any strategies were used to maintain or improve fidelity, describe them

Intervention fidelity will be assessed through two primary methods.

Recording:

As part of their standard operating procedure, health visiting teams record a family appointment on an electronic record sheet. For this study, the health visiting team will be requested to record the delivery of advice and the pack as part of this record. To facilitate this, an add-on template was developed by Public Health England in collaboration with Health Visiting Team Leads.

The health visiting team will also complete a pre-agreed upon table (called SPIRIT or Participant flow table (Table 4)) documenting each families movement through the study, these data will be anonymous and returned to the research team.

Training observations:

Attendance at the training will be monitored through an attendance log.

Actual: If intervention adherence or fidelity was assessed, describe the extent to which the intervention was delivered as planned

The research team will document this throughout the study and report, as need be, with the results.