# From ambivalence to agency: parents’ conceptions of a theory-based behavioural intervention to prevent dental caries in their preschool children – a qualitative study

## TL;DR

This study explores how parents perceive a health-promoter-led program to prevent tooth decay in young children, highlighting how it helps them move from uncertainty to taking action.

## Contribution

The study introduces a theory-based behavioral intervention delivered by health promoters and reveals how parents' perceptions evolve from ambivalence to agency.

## Key findings

- Parents initially felt ambivalent and feared judgment but later felt supported through personalized care.
- The intervention fostered a sense of empowerment and active decision-making among parents.
- The program was perceived as culturally responsive and practical, promoting sustainable oral health behaviors.

## Abstract

Dental caries remains one of the most prevalent chronic conditions in preschool children and disproportionately affects families in socioeconomically vulnerable contexts, despite publicly funded preventive dental care. In Region Västra Götaland, Sweden, a theory-based behavioural intervention delivered by health promoters was introduced to support families of children at elevated caries risk. The aim of this study was to describe the different ways in which parents conceive a health-promoter-led, theory-based behavioural intervention to prevent dental caries in their preschool-aged children.

A qualitative study using individual, semi-structured interviews were conducted in ten public dental clinics in Region Västra Götaland, Sweden (March 2023–July 2024). Interviews were analysed using phenomenographic analysis to capture variation in parental conceptions. Ten parents (eight women, two men) of three-to-six-year-old children at elevated caries risk completed two or more counselling sessions with university-trained health promoters. Interviews (30–60 min) were audio-recorded, transcribed verbatim and analysed inductively to capture variation in parental perceptions. Flexible delivery (digital/in-clinic) and interpreter support were made available.

Three themes were identified: (1) an invitation met by ambivalence and fear of judgement, (2) empowered alliance through personalised support and (3) active choices through parental agency. These themes coalesced into the overarching theme ‘from ambivalence to agency: embracing health-promoting behaviour’.

Parents conceived the health-promoter-led, theory-based behavioural intervention as non-judgemental, culturally responsive and practically useful. By fostering relational safety and providing actionable tools, the intervention appeared to strengthen parental self-efficacy and catalyse family-level behavioural change. This shift, while modest in scale, may represent a necessary step towards equitable and sustainable oral-health promotion.