An NIHR funded piece of research that, through co-design, explored the motivations and barriers to tooth brushing amongst young people from deprived areas.

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There were 3 schools included in this project: Harris Academy in Scotland, Dearne Academy in South Yorkshire, and Pontypridd High School in Wales. We tested 30 children at each school, between the ages of 11 and 14.

The workshops involved young people in identifying the behaviour change techniques to employ in the lesson plan and text messages. The team needed to:

  • Understand what motivates the young people to brush their teeth and the barriers to tooth brushing
  • Outline in more detail young people’s preferences for the content of the lesson plan and text messages
  • Co-design the lesson plan and text messages
  • Develop a variety of messages with appealing message content
  • Co-produce classroom activities seeking to embed helpful habits

Due to the number of objectives we needed to cover we decided to divide the young people in the workshops into three groups. The young people would rotate around the room spending 30 minutes at each station.


Station 1: Activities included: the completion of a basic routine sheet to indicate rough times for potential text messaging to the young people, a quiz to clarify basic levels of knowledge, and skeleton personas and storyboard to capture the view of their peer group and explore potential common ‘stories’ about the challenges of brushing teeth.

Station 2: Activities included the use of the Kawa model (Teoh & Iwama 2015 ) to facilitate a less direct conversation about the blocks and challenges of brushing their teeth regularly. The
model uses the metaphor of a river to elicit discussions and we used an abstract, urban river with blocks such as a mattress, shopping trolley, tyres, boots and tree trunks for the children to use. The size of the object was related to how large the barrier was perceived to be and the largest was then focused on to identify ideas to reduce its impact.

Station 3: Included activities designed to generate insights into what type of messages, language and information could be used to motivate young people to clean their teeth. The station consisted of an exercise that involved rating various images, factual statements and motivational statements on a scale. They were placed according to ‘how much they make you want to clean your teeth’. The other exercise, ‘putting words in your mouth’, involved focusing on the most motivating items from the first exercise and discussing the type of feelings associated with them.

Learning points

Through our creative exercises across the three stations we were able to identify key barriers to teeth brushing; typically young people prioritised their time using social media and mainstream TV, Netflix and YouTube, rather than spend time brushing their teeth. This was also linked to poor sleep hygiene practice and feelings of ‘addiction’ to using their smartphones.

The participants also responded better to the statement: “On a daily basis, 100 million micro creatures are swimming, feeding, reproducing, and depositing waste in your mouth.”


“mHabitat were recommended to us by a colleague and they have been a pleasure to work with and delivered high quality work which surpassed our expectations. Their skills in working with young people were excellent and the team provided insights that would have been difficult to reach ourselves” 

Dr Zoe Marshman, Academic Director, Oral and Dental Directorate, University of Sheffield.

Image credit Alex@worthyofelegance

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