Mother's story of struggle and hope: barriers and enablers of Early Childhood Caries (ECC) preventive behaviours among mothers and caregivers in urban underserved settlements in Colombo, Sri Lanka.

BACKGROUND: Early Childhood Caries (ECC) is a highly prevalent chronic condition that disproportionately affects children from low-income and marginalised communities. Globally, approximately 500 million children have untreated caries in their primary teeth. ECC affects approximately 49% of the global population and up to 90% of the population in some Low- and Middle-Income countries (LMICs), compared with 30-50% in high-income countries. Behavioural science frameworks offer structured approaches to diagnosing behavioural determinants. This study aimed to explore the determinants, barriers, and facilitators of ECC-preventive behaviours among mothers and caregivers of 1-3-year-old children in urban underserved settlements (USS).

METHODS: A qualitative study with five focus group discussions (FGDs) with mothers and caregivers of children aged 1-3 years with ECC and 11 key informant interviews (KIIs) with health professionals and community stakeholders was conducted in the USS of Colombo City. Reporting was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Audio-recorded data were transcribed, translated, and analysed using a framework analysis. The coding was primarily deductive. Behavioural diagnosis was guided by the Behaviour Change Wheel (BCW), with the COM-B model and the Theoretical Domains Framework (TDF) used to map the determinants.

RESULTS: Thirty-four caregivers and 11 professionals participated. The caregivers' mean age was 29.3 years and the informants' mean age was 43.7 years. Twelve themes from FGDs and 18 from KIIs were mapped to the COM-B components. Capability barriers included limited tooth brushing skills, inadequate ECC knowledge, and low prioritisation of oral health. Opportunity barriers included social norms, intergenerational practices, restricted or constrained services and economic hardship. The motivational factors included beliefs, fear, guilt, low perceived severity, competing priorities, and unsupported intentions to improve child oral health. Nevertheless, the participants exhibited clear motivation, readiness, and intention to enhance their oral health practices.

CONCLUSION: The BCW, COM-B, and TDF frameworks identified key deficits in capability, opportunity, and motivation that sustain ECC risk despite mother or caregiver concerns, informing targeted, context-specific interventions to improve early childhood oral health and reduce urban inequities.