Use of Behaviour Change Theory to Improve Home-Based Toothbrushing Practice in Children: A Scoping Review.

Abstract

Introduction: Behaviour change theories have gained traction in oral health care literature in the context of toothbrushing behaviour modification. This scoping review examines the effectiveness of interventions for improving home-based toothbrushing behaviour in children aged 18 years and below, using behaviour change theory to inform the design and methodology.

Methods: This scoping review adopted the JBI methodology. Three databases (PubMed, Scopus and BASE) were combed for relevant literature published between 1980 and April 2025. The search strategy included keywords related to behaviour change theory, toothbrushing and children. Screening was done independently by three reviewer teams (2 members in each team) in two phases, and inter-rater reliability was assessed. Data from eligible articles were extracted in Microsoft Excel using predefined variables.

Results: Twenty-one studies with wide heterogeneity published between 2011 and 2024 were included in this review. Behaviour change theories used were Social Cognitive Theory, Theory of Planned Behaviour, Health Action Process Approach, Motivational Interviewing and Health Belief Theory. Majority were conducted in China, UK, Iran and USA. A wide variation in the reported outcomes was observed. Notably, 71.4% of these studies reported an increase in self-reported toothbrushing frequency, while three studies did not find significant improvement. Increased self-efficacy and increased knowledge regarding toothbrushing were noted in 11 (52.4%) and seven studies (33.3%) respectively.

Conclusion: Since 2011, toothbrushing interventions have increasingly incorporated behaviour change theories. The utilisation of theory-based interventions has demonstrated effectiveness in improving home-based toothbrushing in children.