PhD Study : Using the COM-B to identify factors influencing children’s oral health

Apply and key information  

Summary

Northern Ireland continues to have the poorest level of oral health in the United Kingdom, with its children having the highest levels of tooth decay in Europe (Clarke & Stevens, 2019). There are several factors that contribute to this, namely poor toothbrushing practices, not attending routine dental check-ups, and frequent sugary snack consumption (Moynihan et al., 2019). Oral health education programs aimed at preventive actions are urgently needed (de Castilhoa et al., 2013). Research and policy recommend that oral health promotion should take place in schools as part of the school curriculum (WHO, 2020; DHPSS, 2007; Petersen, 2003). In addition to the school environment, research also indicates that the parent/caregiver (usually the mother) has a critical role in the adoption of protective health care behaviours with parental feeding practices having a strong influence on children’s eating behaviours (Moynihan et al., 2019; de Castilhoa et al., 2013).

Building on the short-comings of theoretical frameworks such as the Theory of Planned Behaviour (Ajzen, 1991) and Social Cognitive Theory (Bandura, 1986), the COM-B model (Michie et al., 2014) recognises that behaviour is part of an interacting system. According to the COM-B model there are three factors that need to be present for any behaviour to occur: capability (C), opportunity (O) and motivation (M). Together, these components firstly provide a rationale for why behaviour is not engaged in, and then secondly identifies which of these components needs to be addressed to bring about behaviour change. The COM-B model has been applied successfully in several contexts for the design and evaluation of behaviour change interventions (Hardeman et al., 2002), and whilst research supports its efficacy in the area of oral health (Al Rawahi et al., 2018) the research is limited.

Objectives of the research:

The aims of this study are to identify and explore components of the COM-B model that influence the oral health-related behaviours of primary school children aged 8-11 years, as well as identify what works in improving the oral health of this target group.  In accordance with the COM-B framework when collecting information to understand the target behaviour, data should be collected from different sources as the most accurate picture will be informed by multiple perspectives (Michie et al., 2014).

This proposed project will build upon previous work undertaken by the team (see Davison et al., 2019; 2016) which identified factors influencing toothbrushing practices from the child’s perspective. This current study will add to the existing evidence base by identifying the factors influencing oral health behavior from a parental perspective. The project will adopt a holistic approach to child oral health by exploring toothbrushing, dental visits and sugary snack consumption. It is hoped that the findings from both previous and this current proposed project will be used to inform the design of an oral health intervention using the COM-B model.

Specifically, the objectives of the study are: 1)To explore the effectiveness of theory-based interventions in improving children’s oral health. 2)To determine the perceived capabilities, opportunities and motivations influencing children’s oral health behaviour. 3)To compare barriers and facilitators to children’s oral health behaviour. 4)To identify intervention functions and BCTs to inform the design of a school-based intervention for children aged 8-11 years.

Methods to be used:

This MRes study will adopt a mixed methods design and will be conducted over three phases. Phase one will be a Rapid Evidence Assessment (REA) to systematically review theory-based interventions to explore what is effective in improving children’s oral health. Phase 2 will involve analyzing an existing data set based on the COM-B to explore parents’ views on the factors influencing their child’s oral health. Using the findings and recommendations of Phase 1 and Phase 2, Phase 3 will then map and identify intervention functions and BCTs to inform the design of a school-based oral health intervention for children aged 8-11 years.

Skills required of applicant:

First or upper second-class degree in psychology which confers the graduate basis for registration with the British Psychological Society – or equivalent.

Essential criteria

Applicants should hold, or expect to obtain, a First or Upper Second Class Honours Degree in a subject relevant to the proposed area of study.

We may also consider applications from those who hold equivalent qualifications, for example, a Lower Second Class Honours Degree plus a Master’s Degree with Distinction.

In exceptional circumstances, the University may consider a portfolio of evidence from applicants who have appropriate professional experience which is equivalent to the learning outcomes of an Honours degree in lieu of academic qualifications.

Funding and eligibility

Recommended reading

References:

Ajzen, I. (1991). The theory of planned behaviour. Organizational Behaviour and Human Decision Processes, 50, 179-211.

Al Rawahi, S.H., Asimakopoulou, K. & Newton, J.T. (2018). Factors related to reducing free sugar intake among white ethnic adults in the UK: a qualitative study. BDJ Open, 4 (17024). doi:10.1038/bdjopen.2017.24.

Bandura, A. (1986). Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice Hall.

Clarke, L., & Stevens, C. (2019). Preventing dental caries in children: Why improving children’s oral health is everybody’s business. Pediatrics & Child Health, 29(12), 536-542.

Davison, J., McLaughlin, M. & Giles, M. (2019). Factors influencing children’s tooth brushing intentions: an application of the theory of planned behaviour. Health Psychology Bulletin, 3(1) 58-66.

Davison, J., McLaughlin, M. & Giles, M. (2016). The design and psychometric assessment of a child friendly TPB based questionnaire. Journal of Public Health, 1-10. doi:10.1093/pubmed/fdw120 Department of Health, Social Services and Public Safety. (2007). Oral Health Strategy for Northern Ireland. Belfast: DHSSPS.

de Castilhoa, A.R., Mialheb, F.L., de Souza Barbosac, T., & Puppin-Rontanid, R.M. (2013). Influence of family environment on children’s oral health: a systematic review. Journal Pediatrica, 89,116−23.

Hardeman, W., Johnston, M., Johnston, D., Bonetti, D., Wareham, N., & Kinmonth, A. L. (2002). Application of the theory of planned behaviour in behaviour change interventions: A systematic review. Psychology and health, 17(2), 123-158.

Michie, S., Atkins, L. & West, R. (2014). The Behaviour Change Wheel: A Guide to Designing Interventions. Great Britain: Silverback Publishings.

Moynihan, P., Tanner, L.M., Holmes, R.D., Hillier-Brown, F., Mashayekhi, A., Kelly, S.A.M., Craig, D. (2019). Systematic Review of Evidence Pertaining to Factors That Modify Risk of Early Childhood Caries. JDR Clin Trans Res, 4(3), 202-216. doi: 10.1177/2380084418824262. WHO (2020) Oral Health Factsheet. Media Centre: WHO Publications. Retrieved from https://www.who.int/news-room/fact-sheets/detail/oral-health

The Doctoral College at Ulster University

Key dates

Submission deadline
Friday 18 June 2021
12:00AM

Interview Date
week beginning 5th July 2021

Preferred student start date
mid September 2021

Applying

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Contact supervisor

Dr Marian McLaughlin

Other supervisors