Bedtime Routines Intervention for Children (BRIC) using an automated text messaging system for behaviour change : Study protocol for an early phase study

Funding This project is funded by the Medical Research Council (MRC) Public Health Intervention Development Scheme (award ref.: MR/T002980/1).Peer reviewedPublisher PD

Bedtime Routines Intervention for Children (BRIC) project : results from a non-randomised feasibility, proof-of concept study

Acknowledgements The research team would like to thank all of our participants who, despite the challenges faced by a global pandemic and the delicate task of juggling work and family life, dedicated their time for our study. We would also like to thank the parents who helped with the development of the intervention, their help was invaluable. Funding This project is funded by the Medical Research Council (MRC) Public Health Intervention Development Scheme (Award ref.: MR/T002980/1).Peer reviewedPublisher PD

Immigrants’ discourse about the factors that hinder their access to health services in Greece

Στόχος της παρούσας έρευνας είναι να αναδείξει τη σχέση των μεταναστών με τις δομές παροχής υπηρεσιών υγείας στην Ελλάδα και τα προβλήματα τα οποία αυτοί καλούνται να αντιμετωπίσουν, όταν έρθουν σε επαφή μαζί τους. Στην έρευνα έλαβαν μέρος έντεκα (11) συμμετέχοντες, άνδρες και γυναίκες, διαφόρων εθνικοτήτων με διάρκεια παραμονής στην Ελλάδα από δύο (2) έως έντεκα (11) έτη. Η έρευνα βασίστηκε στην ποιοτική ανάλυση περιεχομένου. Η ανάλυση των αποτελεσμάτων ανέδειξε τέσσερις παράγοντες οι οποίοι δυσχεραίνουν την πρόσβαση και υποβαθμίζουν την ποιότητα των υπηρεσιών στις δομές υγείας για τους μετανάστες. Οι παράγοντες αυτοί είναι η γλωσσική επάρκεια, η ενημέρωση και η εξοικείωση με τον τρόπο λειτουργίας του συστήματος υγείας, η ύπαρξη ασφάλισης υγείας και ο φόβος αντιμετώπισης συμπεριφορών διάκρισης από την πλευρά του προσωπικού των δομών υγείας. The objective of this research is to highlight the relationship between immigrants and the health services in Greece and the problems they have to face when they come in contact with them. The research involved eleven (11) participants, men and women of various nationalities with a length of stay in Greece from two (2) to eleven (11) years. The research was based on qualitative content analysis. Analysis of the results revealed four factors that hinder access and degrade the quality of health services for migrants. These factors are linguistic competence, awareness and familiarity with the way the health care system works, existence of health insurance and fear of discriminatory behavior

Portrayal of oral hygiene and risk behaviours in animated movies

BackgroundBehaviours depicted in movies and TV shows can significantly affect one's behaviour. Children are particularly susceptible to these effects as their habits are still forming. Oral hygiene behaviours play a crucial role in preventing or slowing down the progression of dental diseases, which are among the most common yet preventable diseases in the world. Therefore, it is important to understand if popular movies include oral hygiene behaviours or risk-related behaviours, which can in effect influence children's behaviour.AimThe aim of this study is to review the top grossing animated movies of all time to record and collect on screen portrayals of oral hygiene practices and risk behaviours related to oral health.MethodologyTop 30 highest grossing animated feature films (over 40 min duration) were coded using a structured coding instrument to capture oral hygiene and risk-related behaviours related to oral health. Two coders performed coding using the standardised instrument.ResultsOverall, 93% of behaviours were coded as a risk behaviour, with 7% coded as positive oral hygiene behaviour. Within the risk behaviour category, the majority (74%) were based around the consumption of sugar with risk behaviour occurring in 23 out of 30 movies (76%), while oral hygiene practices occurred in 6 out of 30 movies (20%); one movie depicted neither oral hygiene nor oral health risk behaviours. About 53% of behaviours were purely visual, 10% verbal, and 37% a combination of verbal and visual. Anthropomorphic characters and movie settings resulted in more behaviours related to oral health, either hygiene or mainly risk behaviours, depicted.ConclusionDespite their importance in shaping habits and attitudes, animated movies portrayed a significant number of risk behaviours related to oral health with depiction of beneficial behaviours remaining limited. Consideration should be given on how to best portray behaviours that promote and enhance optimal oral hygiene behaviours to achieve and sustain better oral health for children

An Interactive Text Message Survey as a Novel Assessment for Bedtime Routines in Public Health Research: Observational Study.

BACKGROUND: Traditional research approaches, especially questionnaires and paper-based assessments, limit in-depth understanding of the fluid dynamic processes associated with child well-being and development. This includes bedtime routine activities such as toothbrushing and reading a book before bed. The increase in innovative digital technologies alongside greater use and familiarity among the public creates unique opportunities to use these technical developments in research. OBJECTIVE: This study aimed to (1) examine the best way of assessing bedtime routines in families and develop an automated, interactive, text message survey assessment delivered directly to participants' mobile phones and (2) test the assessment within a predominately deprived sociodemographic sample to explore retention, uptake, feedback, and effectiveness. METHODS: A public and patient involvement project showed clear preference for interactive text surveys regarding bedtime routines. The developed interactive text survey included questions on bedtime routine activities and was delivered for seven consecutive nights to participating parents' mobile phones. A total of 200 parents participated. Apart from the completion of the text survey, feedback was provided by participants, and data on response, completion, and retention rates were captured. RESULTS: There was a high retention rate (185/200, 92.5%), and the response rate was high (160/185, 86.5%). In total, 114 participants provided anonymized feedback. Only a small percentage (5/114, 4.4%) of participants reported problems associated with completing the assessment. The majority (99/114, 86.8%) of participants enjoyed their participation in the study, with an average satisfaction score of 4.6 out of 5. CONCLUSIONS: This study demonstrated the potential of deploying SMS text message-based surveys to capture and quantify real-time information on recurrent dynamic processes in public health research. Changes and adaptations based on recommendations are crucial next steps in further exploring the diagnostic and potential intervention properties of text survey and text messaging approaches

Perceived Barriers and Facilitators for Bedtime Routines in Families with Young Children.

OBJECTIVES: Bedtime routines are a highly recurrent family activity with important health, social and behavioural implications. This study examined perceived barriers to, and facilitators of, formulating, establishing, and maintaining optimal bedtime routines in families with young children. DESIGN: Participants completed a semi-structured interview based on the Theoretical Domains Framework (TDF). Analysis followed a deductive approach. PARTICIPANTS: A total of 32 parents participated in the study. Most participants (N = 30) were females, were white (N = 25) and stay at home parents (N = 12). RESULTS: Key barriers included lack of appropriate knowledge and sources of information, problematic skills development, social influences, cognitive overload, and lack of motivation for change. Facilitators included social role, access to resources, positive intentions, beliefs about consequences and reinforcement. In particular, optimal bedtime routines were less likely to be enacted when parents were tired/fatigued and there was a strong effect of habit, with suboptimal routines maintained over time due to past experiences and a lack of awareness about the importance of a good bedtime routine. CONCLUSIONS: Several theory-based, and potentially modifiable, determinants of optimal bedtime routines were identified in this study, providing important information for future interventions. Several of the key determinants identified were transient (tiredness) and/or non-conscious (habit), suggesting that future interventions may need to be deployed in real time, and should extend beyond conventional techniques

Bedtime Oral Hygiene Behaviours, Dietary Habits and Children's Dental Health.

Background: Oral hygiene behaviours as well as dietary habits before bed can affect children's dental health resulting in higher prevalence of dental disease. Dental disease can affect children's health, development and even school performance. If left untreated, dental disease can progress and it can lead to extractions under general anaesthetic causing further distress for children and families. Consistent and appropriate oral hygiene behaviours and dietary habits can prevent dental diseases from occurring in the first place. Objective: This cross-sectional study examines the relationship between oral hygiene behaviours, dietary habits around bedtime and children's dental health. Methods: A total of 185 parents with children between the ages of 3 and 7 years from deprived areas participated in the study. Data on bedtime routine activities were collected using an automated text-survey system. Children's dental health status was established through examination of dental charts and dmft (decayed, missed, filled teeth) scores. Results: In total, 52.4% of parents reported that their children's teeth were brushed every night. The majority of children (58.9%) had dmft scores over zero. In total, 51 (46.7% of children with dmft score over 0 and 27.5% of all children) children had active decay. The mean dmft score for those experiencing decay was 2.96 (SD = 2.22) with an overall mean dmft score of 1.75 (SD = 2.24). There were significant correlations between frequency of tooth brushing, frequency of snacks/drinks before bed and dmft scores (r = -0.584, p < 0.001 and r = 0.547, p = 0.001 respectively). Finally, higher brushing frequency was associated with a lower likelihood of a dmft score greater than 0 (Exp(B) = 0.9). Conclusions: Despite families implementing oral hygiene behaviours as part of their bedtime routines those behaviours varied in their consistency. Results of this study highlight the need for additional studies that consider bedtime routine-related activities and especially the combined effects of oral hygiene practices and dietary habits due to their potentially important relationship with children's dental health

Bedtime Routine Characteristics and Activities in Families with Young Children in the North of England.

Bedtime routines have been shown to have significant associations with health, wellbeing and development outcomes for children and parents. Despite the importance of bedtime routines, most research has been carried out in the United States, with little information on bedtime routine characteristics and activities for families in other countries such as the United Kingdom and England in particular. Additionally, little is known about the possible effects of weekends vs. weekdays on the quality of bedtime routines. Finally, traditional, retrospective approaches have been most used in capturing data on bedtime routines, limiting our understanding of a dynamic and complex behaviour. The aim of this study was to explore bedtime routine characteristics and activities in families in the North of England with a real-time, dynamic data collection approach and to examine possible effects of weekend nights on the quality of bedtime routines. In total, 185 parents with children ages 3 to 7 years old provided data around their bedtime routine activities using an automated text-survey assessment over a 7-night period. Information on socio-economic and demographic characteristics were also gathered during recruitment. A small majority of parents managed to achieve all crucial elements of an optimal bedtime routine every night, with 53% reporting brushing their children's teeth every night, 25% reading to their children every night and 30% consistently putting their children to bed at the same time each night. Results showed significant differences between weekend (especially Saturday) and weekday routines (F(1, 100) = 97.584, p < 0.001), with an additional effect for parental employment (F(1, 175) = 7.151, p < 0.05). Results highlight variability in bedtime routine activities and characteristics between families. Many families undertook, in a consistent manner, activities that are closely aligned with good practices and recommendations on what constitutes an optimal bedtime routine, while others struggled. Routines remained relatively stable during weekdays but showed signs of change over the weekend. Additional studies on mechanisms and elements affecting the formation, development and maintenance of bedtime routines are needed alongside studies on supporting and assisting families to achieve optimal routines

Defining and measuring bedtime routines in families with young children-A DELPHI process for reaching wider consensus

INTRODUCTION: Bedtime routines are one of the most common family activities. They affect children' wellbeing, development and health. Despite their importance, there is limited evidence and agreement on what constitutes an optimal bedtime routine. This study aims to reach expert consensus on a definition of optimal bedtime routines and to propose a measurement for bedtime routines. METHOD: Four-step DELPHI process completed between February and March 2020 with 59 experts from different scientific, health and social care backgrounds. The DELPHI process started with an expert discussion group and then continued with 3 formal DELPHI rounds during which different elements of the definition and measurement of bedtime routines were iteratively refined. The proposed measurement of bedtime routines was then validated against existing data following the end of the DELPHI process. RESULTS: At the end of the four round DELPHI process and with a consistent 70% agreement level, a holistic definition of bedtime routines for families with young children between the ages of 2 and 8 years was achieved. Additionally, two approaches for measuring bedtime routines, one static (one-off) and one dynamic (over a 7-night period) are proposed following the end of the DELPHI process. A Bland-Altman difference plot was also calculated and visually examined showing agreement between the measurements that could allow them to be used interchangeably. DISCUSSION: Both the definition and the proposed measurements of bedtime routines are an important, initial step towards capturing a behavioural determinant of important health and developmental outcomes in children