A Mixed-Methods Study on Topical Fluoride Beliefs and Refusal Behaviors for Caregivers of Children with Special Health Care Needs

• Published in: Maternal and child health journal Vol. 28; no. 1; pp. 104 - 115
• Main Authors: Koh, Madelyn, Kerr, Darragh, Hill, Courtney M., Chi, Donald L.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2024; Springer Nature B.V
• Subjects: Autism; Caregivers; Child; Children & youth; Childrens health; Decay; Dental care; Dental caries; Disabled Children; Fluorides; Fluorides, Topical; Gynecology; Health care; Health Services Accessibility; Health Services Needs and Demand; Humans; Maternal & child health; Maternal and Child Health; Medicine; Medicine & Public Health; Mixed methods research; Naturopathy; Pediatrics; Population Economics; Public Health; Qualitative analysis; Social networks; Sociology; Surveys and Questionnaires; Toothpaste; Vaccines; Fluoride; Children with disabilities; Topical fluoride; Mixed methods; Treatment refusal; Dental care for the disabled; Health belief model
• DOI: 10.1007/s10995-023-03806-1
• ISSN: 1092-7875

Objective To understand topical fluoride-related beliefs and refusal behaviors for caregivers of children with special health care needs (CSHCN). Methods This was an explanatory sequential mixed methods study. For the quantitative analyses, we surveyed 520 caregivers to (a) compare fluoride-related beliefs between caregivers of CSHCN and caregivers of healthy children and (b) evaluate the association between special health care need (SHCN) status and topical fluoride refusal. We used logistic regression models to generate unadjusted odds ratios, confounder-adjusted odds ratios (AOR), and 95% confidence intervals (CI). For the qualitative analyses, we interviewed 56 caregivers who refused or were hesitant about topical fluoride. Data were coded deductively and compared by SHCN status to an existing conceptual model of topical fluoride refusal. Results In the quantitative analysis, 41.3% of caregivers refused or thought about refusing topical fluoride. There were no significant differences in fluoride beliefs by SHCN status ( p -values > 0.05) nor was there a significant association between SHCN status and topical fluoride refusal (AOR: 0.65, 95% CI 0.37–1.14; p  = 0.13). In the qualitative analysis, the relative importance of each domain of the conceptual model was similar between the caregiver groups. Two differences were that all caregivers of CSHCN thought fluoride was unnecessary and wanted to keep chemicals out of their child’s body. Conclusions for Practice While caregivers of CSHCN were not more likely to refuse topical fluoride than caregivers of healthy children, there may be important differences in the underlying reasons for refusing topical fluoride. Significance What is already known on this subject? CSHCN are at increased risk for tooth decay. Topical fluoride helps prevent tooth decay, but large numbers of caregivers refuse topical fluoride. A conceptual model of caregiver topical fluoride refusal has been developed, but its applicability to caregivers of CSHCN has not yet been evaluated. What this study adds? This study provides empirical insight into fluoride refusal behaviors for caregivers of CSHCN. Caregivers of CSHCN may have different reasons for refusing topical fluoride. Findings from this study will help guide the development of tailored communication approaches for caregivers of CSHCN who refuse or may be hesitant about topical fluoride.