| Summary: | AIMS: The thesis explored influences on emergence of toothbrushing as a dyadic process through infancy with influences conceptualised throughout using Bronfenbrenner’s ecological model. Influences were used to develop methods to support novice mothers to establish and maintain toothbrushing routines with infants. METHODS: Study One: Qualitative interview study with novice mothers of infants exploring influences on emergence of dyadic toothbrushing routines (n=16). Study Two: Using collected qualitative data to develop and standardise a psychometric scale measuring parental self-efficacy (PSE) for enforcing toothbrushing routines with infants (n=91). Study Three: Cross-sectional observational study of dyadic interactions during toothbrushing episodes, using three age groups of infant, 12-months, 18-months and 24-months (each n=12). Study Four: Development and evaluation of an intervention to increase maternal control of the brush dyadic toothbrushing using three study groups (each n=11). RESULTS: Study One: A total of 25 influences on emergence of dyadic toothbrushing were identified. Many of these influences were identified as lying within the mother-infant dyad. Study Two: Scale items were generated from the 25 sub-themes identified from the qualitative study. Overall reliability of the scale was α= .934 and it was found to contain five components. Study Three: Significant differences (p < .001) were found between the three groups in frequency and duration of maternal and infant control of holding and using the toothbrush during observed episodes. Study Four: The picture book intervention did not significantly affect frequency and duration of either maternal or infant control of holding and using the toothbrush during observed episodes. Conclusion: Many influences on emergence of dyadic toothbrushing come from the mother-infant dyad. Some may pose challenges, such as infant drive for self-toothbrushing. However, some influences such as PSE may facilitate the routine. Further work should focus on supporting caregivers to maintain control of holding and using the toothbrush during dyadic toothbrushing.
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