The STEPS project
Evaluation of the National Supervised Toothbrushing Programme for England
About the STEPS project
In England, 27% of children aged 5 years experience dental caries (tooth decay) with negative impacts on their daily lives and wide social inequalities. Evidence from national oral health programmes including Childsmile in Scotland has shown supervised toothbrushing (STB) to be effective at reducing caries experience and cost-effective. STB is daily toothbrushing by young children with fluoride toothpaste in nurseries, schools or childminders.
In April 2025, the government announced a national STB Programme with funding to Local Authorities (LAs) confirmed for four years. The programme aims to reach up to 600,000 children aged 3–5 years living in the 20% most deprived areas. An evaluation plan was announced, the STEPS project aims to evaluate the mid- to long term outcomes and was funded by an NIHR Public Health Research Programme commissioned call. STEPS will be a theoretically-informed evaluation undertaken based on Medical Research Council/NIHR frameworks.
Aims and objectives
The aim of STEPS is to evaluate the effectiveness and cost-effectiveness of the national STB Programme for 3–5-year-olds living in the 20% most deprived areas in England.
Objectives
A natural experiment study to investigate the effectiveness of the national STB Programme and of STB in England more generally, and its impact on socioeconomic inequalities
An analysis of child-level outcome data comparing those undertaking STB and those who are not
A cost-effectiveness analysis of the national STB Programme
A process evaluation to assess context, implementation and mechanisms of impact of the national STB Programme
Outcomes
The primary outcome will be caries experience including the prevalence and severity of dental caries into dentine. Secondary outcomes will include:
inequalities in the prevalence and severity of dental caries
child oral health-related quality of life (OHRQoL) and quality of life (QoL)
oral health behaviours of children and awareness of staff and parents
dental service use including hospital admissions for dental extractions under general anaesthesia (GA) and primary care treatments
school absence for dental reasons and readiness
health and social care resource use
Research inclusion will be considered throughout, being sensitive to social inequalities and collecting data on ethnicity, Special Educational Needs and/or disabilities and English as an Additional Language. Engagement strategies will use inclusive approaches and participant information will be appropriate for each group.
In developing the proposal for this project, a range of stakeholders have been engaged including parents, early years professionals and STB providers. They will continue to be involved throughout the research lifecycle with appropriate training and reimbursement.
The dissemination strategy will ensure the findings are shared with the stakeholders and the impact on policy and practice maximised.
The project will involve five integrated work packages
STEPS research team
The project is led by the School of Clinical Dentistry at the University of Sheffield in collaboration with a team with expertise in evaluation of child oral health improvement programmes from across the UK.
Investigator | Institution |
|---|---|
University of Sheffield | |
University of Sheffield | |
University of Leeds | |
University of Glasgow | |
University of Glasgow | |
University of Birmingham | |
University of Birmingham | |
University of Leeds | |
University of Manchester | |
Newcastle University | |
University of Glasgow | |
University of Glasgow | |
University of Glasgow | |
Mrs Hina Qureshi | Parent Co-Applicant |
NIHR funding
The STEPS project builds on research conducted into the implementation of STB across England as part of the NIHR-funded BRUSH programme.
The early phase evaluation of the national STB programme has been conducted by NIHR PHIRST-PHRESH.
NIHR Public Health Research Programme commissioned call
Get in touch
For more information, please contact Zoe Marshman.
