A conceptual model on caregivers’ hesitancy of topical fluoride for their children

by Donald L. Chi, Darragh Kerr, Daisy Patiño Nguyen, Mary Ellen Shands, Stephanie Cruz, Todd Edwards, Adam Carle, Richard Carpiano, Frances Lewis

Topical fluoride hesitancy is a well-documented and growing public health problem. Despite extensive evidence that topical fluoride is safe and prevents tooth decay, an increasing number of caregivers are hesitant about their children receiving topical fluoride, leading to challenges in clinical settings where caregivers refuse preventive care.

To explore the determinants of topical fluoride hesitancy for caregivers with dependent children.

In this qualitative study, we interviewed 56 fluoride-hesitant caregivers to develop an inductive conceptual model of reasons why caregivers are hesitant.

The core construct of the conceptual model of topical fluoride hesitancy centered on caregivers “wanting to protect and not mess up their child”. Six domains comprised this core construct: thinking topical fluoride is unnecessary, wanting to keep chemicals out of my child’s body, thinking fluoride is harmful, thinking there is too much uncertainty about fluoride, feeling pressured to get topical fluoride, and feeling fluoride should be a choice.

Topical fluoride hesitancy is complex and multifactorial. Study findings provide insight for future efforts to understand and optimize caregivers’ preventive care decision making.