Introduction
Dental caries remains one of the most prevalent chronic conditions affecting children worldwide despite being largely preventable through effective oral hygiene practices, dietary management, and regular dental care. In England, dental caries is the leading cause of hospital admissions among children and continues to place a substantial burden on individuals and healthcare services. While previous research has identified factors associated with children’s oral health behaviours, less is known about how these behaviours are shaped through interactions between multiple everyday environments. This study aimed to explore how children’s oral health behaviours are influenced across environmental contexts using Bronfenbrenner’s Ecological Systems Theory.
Methods
This study involved a secondary qualitative analysis of focus group data collected as part of the Strong Teeth intervention. Data were obtained from focus groups of parents and caregivers of children aged 0-5; participants were mostly mothers (n = 41) and dental professionals (n = 27). Bronfenbrenner’s Ecological Systems Theory informed the analysis,
with particular attention given to microsystem and mesosystem influences on children’s oral health behaviours. Framework analysis guided by Bronfenbrenner’s Ecological Systems
Theory was used to organise and interpret the data.
Results
Children’s oral health behaviours were found to be dynamic practices that were continuously negotiated within everyday life. Within the family microsystem, toothbrushing and dietary behaviours were influenced by competing demands, children’s resistance, parental supervision, and the involvement of extended family members. Sugar consumption emerged as a socially embedded practice shaped through family interactions and cultural norms. At the mesosystem level, oral health behaviours were influenced by interactions between home, school, and healthcare settings. Differences in expectations, priorities, and approaches across these settings often created inconsistencies in how preventive behaviours were understood and enacted. Parents frequently navigated competing messages and practices, which could either support or undermine home-based oral health routines.
Conclusion
This study demonstrates that children’s oral health behaviours are shaped through complex
interactions within and between everyday settings rather than by isolated individual factors.
By applying Bronfenbrenner’s Ecological Systems Theory to secondary qualitative data, the
findings highlight the importance of adopting relational and systems-based approaches to oral health promotion. Interventions should consider the interconnected influences of family, educational, and healthcare environments to support the development and maintenance of positive oral health behaviours in young children.
