Exploring Microsystem and Mesosystem Influences on Children's Oral Health Behaviour

Objectives: Dental caries is a major global public health challenge, affecting 60–90% of school-aged children worldwide. In England, 23% of five-year-olds are affected. Understanding the socio-ecological factors shaping oral health behaviours is vital to reduce inequalities and improve outcomes. This study explores how the influences of the microsystem and mesosystem influenced children's oral health behaviours using Bronfenbrenner’s Ecological Systems Theory.
Methods: A secondary framework Analysis was conducted on qualitative data from focus groups with 41 parents/caregivers of children aged 0-5 years old from West Yorkshire, UK (a region with a diverse population and high socioeconomic deprivation). The data, originally collected for Strong Teeth oral health intervention was analysed using inductive and deductive approaches guided by Bronfenbrenner’s theory, focusing on the microsystem (e.g., family, school) and mesosystem (e.g., interactions between microsystems).
Results: Preliminary findings revealed within the microsystem, family routines around toothbrushing, with siblings acting as role models was helpful. However, occasionally grandparent’s role as ‘fun caregivers’ led to offering sugary foods. Within the mesosystem, family interactions with health services, such as dentists and health visitors, influenced behaviours, though some parents struggled to implement advice. Peers and school programs positively influenced behaviours such as toothbrushing, but exposure to sugary foods at school proved challenging.
Conclusions: These findings highlight the importance of addressing complex interactions within family, extended family, health services, peers, and schools in shaping children's oral health behaviours. By applying Bronfenbrenner’s Ecological Systems Theory, this study addresses a critical gap in research, moving beyond individual behaviours to examine systemic interactions within the microsystem and mesosystem. These insights enhance understanding of the relational and contextual factors influencing children's oral health practices and provide a foundation for future research and practice improvements.