Parental perceptions and experiences of an oral health care promotion intervention for children with congenital heart defects

Figures & data

Table I. Aims, inclusion and exclusion criteria of the ORALPEHDEART-study

Aims The ORALPEDHEART-study is a randomized controlled intervention trial with the primary aims to explore the effect of six-monthly counselling and support to improve awareness and maintenance of good oral health, prevent the development of poor oral health including dental caries, decrease the need for operative dental care, prevent dental anxiety, and improve oral health related quality of life. The secondary aim is to elucidate factors associated with the development of poor oral health and/or orofacial dysfunction as well as family attitudes and needs of support. The intervention is offered during early age to families with a child with complex CHD, or any operated CHD combined with a syndrome.

Inclusion criteria Age < 12 months and prosthetic cardiac valve or patient likely to undergo valve surgery using foreign material including homograft (potentially included in the criteria of endocarditis prophylaxis) Age < 12 months and unrepaired cyanotic CHD including palliative shunts and conduits Age < 12 months and repaired CHD with residual defects at the site or adjacent to the site of the prosthetic patch or device which inhibits endothelialization Age < 12 months and cardiac transplantation recipient or listed for transplantation (potentially included in the criteria of endocarditis prophylaxis) Age < 12 months and cardiomyopathy (potential cardiac transplantation recipient) Age < 12 months and chromosomal abnormality or syndrome and any invasive intervention (surgery or cath) for CHD or likely to require invasive intervention for CHD

Exclusion criteria Neither parent able to comprehend intervention instructions provided in Finnish Child in out-of-home care (e.g., foster care)

Figure 1. The gradual progress of the one and the half year dental hygienist led oral health promotion intervention.

Table II. An example of the analysis process

Original expression	Abstracted description	Subcategory	Main category
“The fact that it has been always reminded about it … about brushing of teeth” (Parent 7)	Reminder of brushing teeth
“it is always a good reminder” (Parent 5)	Good reminder
“The phone call is like … ok, now I need to remember those things” (Parent 1)	After the phone call remember again
” It is always a good reminder of it … that everyone is noticed individually … ” (Parent 5)	Good reminder that has been performed according to a personal situation	Maintaining awareness	Relevancy of the support
”so … that there has been like regular reminder … that this oral health is important thing … even though we have a lot of different schedules in our daily life … so it is good and important … ” (Parent 2)	Regular reminder about important matter in the middle of the hectic daily life
“I think that it has been good … that it has always been reminded of it … that this is the information pamphlet … and the phone calls … and these are the things I need to remember” (Parent 1)	Good reminder

Table III. Background information and representativeness of parental qualitative interview sample

Background information	Interviewed parents N = 9	OPH participating parents N = 71
Age Under 30 y or 30 y 31–35 y 36 or over 36 y	2 3 4	26 18 27
Education Grammar school Vocational school Matriculation examination University of Applied Sciences or University	– 4 – 5	3 27 7 34
Smoking Yes No	1 8	9 62
Family income per year Less than 20 000€ 20 000–39 999 € 40 000–59 999 € 60 000–79 999 € 80 000–99 999 € Over 100 000€	– 3 2 4 – –	-16 32 15 6 2
Child CHD complexity grade 2 3 4	2 5 2	20 31 20
Child age at primary heart procedure 0–1 months 2–3 months 4–6 months Over 7 months	4 3 2 –	38 11 15 7
Days spent in the hospital in conjunction with primary heart procedure ≤ 10 11–20 21-30 31–40 41-50 ≥51	2 2 1 2 1 1	16 21 10 11 3 10
Days spent in the PICU in conjunction with primary heart procedure ≤ 10 11–20 21-30 31–40 41-50 ≥51	5 3 1 – – –	49 10 7 1 1 3

CHD complexity grade 2 = simple CHD with complete surgical repair, grade 3 = complex CHD with complete surgical repair likely requiring reintervention, grade 4 = complex CHD without complete surgical repair (e.g., surgical palliation including single ventricle physiology), OPH = ORALPEDHEART, PICU = Paediatric intensive care unit

Table IV. Description of the subcategories and main categories

Subcategory	Main category
Child’s appropriate age Many new things to think about Burden of time spent in hospital Blurriness of recollections	Timing of the first contact
Opportunity to be prepared for the counselling Easiness of phone counselling Interaction with another person Personal support Regularity	Effortlessness of the intervention process
Comprehensiveness Essentiality	Individuality of the support
Maintaining awareness Usefulness of the provided information Emphasis on the importance of oral health in everyday life	Relevancy of the support