University of St Andrews

We have reviewed the literature, of the past 30 years, on the effects of dental staff behaviour on anxiety and behaviour of child dental patients (Zhou, Y., Cameron, E., Forbes, G. & Humphris, G. M. (2011), systematic review of the effect of dental staff behaviour on child dental patient anxiety and behaviour. Patient Education and Counseling, 85 (1), 4-13). We found (a) staff behaviour influences child behaviour and anxiety; and (b) some routine clinical behaviours have positive and consistent effects on child cooperation. It is important to document these behaviours to help investigators to research child cooperativeness and for staff to appreciate the significance of their routine behaviour on treatment success. Developing a valid behavioural coding scheme is the first step to measure and investigate the clinical significance of these behaviours.  

In addition, in response to our particular study context (the fluoride varnish intervention delivered by dental nurses to nursery-school children), we would like to develop a coding scheme that is capable of capturing nurses’ encouragement-centred approach as well as being sensitive to the fluoride varnish context.

The SABICS was constructed over 18 months by our research team in two stages:

1. Development stage (10 months): An initial list of behaviours was generated through observation of video recorded interactions and literature review of relevant coding schemes
2. Refinement stage (8 months): Behavioural codes were modified, operational definitions were clarified and examples were compiles through an iterative process of applying the scheme to new data sets

The SABICS contains 48 codes including 9 codes relating to the fluoride vanish protocol (e.g., mirror mouth check). There are 29 behavioural codes applied to dental nurses (22 verbal and 7 non-verbal); and 13 behavioural codes relating to children (6 verbal and 7 non-verbal).

There are ten reasons for selecting the SABICS to analyse nurse-child interactive behaviours, namely:

1. The first known coding scheme to record interactions between dental nurses and young children
2. Capable of recording and displaying complex interaction processes
3. More extensive discrete codes and more explicitly defined codes compared to Weinstein et al’s coding scheme
4. Easily administered on the Observer XT system
5. Satisfactory inter- and intra-coder reliability
6. Evidence for reliability, for example, three behavioural codes discriminated the children who accepted the intervention from those who did not
7. Both duration and frequency can be studied
8. Both verbal and non-verbal behaviours are focused
9. ‘Silence’ and ‘quiet’ are coded for their meaning instead of a demarcation function
10. ‘Crying’ is coded as an important child behaviour which is not included in the widely used Roter interaction analysis system (RIAS)

No, the SABICS is freely available (see Noldus template). Please quote the source of the measure.

• Context-sensitive, suitable for other paediatric contexts when modified·     
• Coding might take longer if duration analysis is required

• Generally codes can be removed or added according to interaction contents  
• Specifically, protocol codes can be modified to be suitable for a particular context·      
• Certain nurse verbal codes that are highly context-sensitive (e.g., fantasy statement) can be either removed or modified by refining its operational definition