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Background: Little is known about patients' or carers' reported experiences of dental care provided using dental behaviour support (DBS) techniques. Qualitative literature can provide unique insight into these experiences. Aim: To explore and synthesize qualitative literature related to patient experience of dental behaviour support. Methods: A PROSPERO‐registered systematic review of qualitative articles was undertaken. Studies were identified through MEDLINE, Embase and PsycINFO. Abstracts were screened by two reviewers and data were extracted to summarize the qualitative findings included within them. A thematic summary approach was used to synthesize the qualitative data identified. Results: Twenty‐three studies were included. Studies primarily explored experiences of dental care of children by speaking to their parents (n = 16), particularly regarding paediatric dental general anaesthesia (DGA) (n = 8). Studies of adults' experiences of DBS (n = 7) covered a range of techniques. Nine studies explored broader dental care experiences and did not study specific DBS approaches. A thematic synthesis identified five themes applicable across the studies identified: Trust and the therapeutic alliance supporting effective care delivery; considered information sharing often alleviated anticipatory anxiety; control and autonomy‐reduced anxieties; variations in the perceived treatment successes and failures of DBS techniques; and DBS techniques produced longer positive and negative impacts on patients beyond direct care provision. Conclusion: Qualitative research has been under‐utilized in research on DBS techniques. Care experiences of most DBS techniques outside of paediatric DGA are poorly understood. Building trust with patients and enabling autonomy appear to support positive patient‐reported experiences of care. [ABSTRACT FROM AUTHOR]

Objectives: Dental behaviour support (DBS) describes all specific techniques practiced to support patients in their experience of professional oral healthcare. DBS is roughly synonymous with behaviour management, which is an outdated concept. There is no agreed terminology to specify the techniques used to support patients who receive dental care. This lack of specificity may lead to imprecision in describing, understanding, teaching, evaluating and implementing behaviour support techniques in dentistry. Therefore, this e‐Delphi study aimed to develop a list of agreed labels and descriptions of DBS techniques used in dentistry and sort them according to underlying principles of behaviour. Methods: Following a registered protocol, a modified e‐Delphi study was applied over two rounds with a final consensus meeting. The threshold of consensus was set a priori at 75%. Agreed techniques were then categorized by four coders, according to behavioural learning theory, to sort techniques according to their mechanism of action. Results: The panel (n = 35) agreed on 42 DBS techniques from a total of 63 candidate labels and descriptions. Complete agreement was achieved regarding all labels and descriptions, while agreement was not achieved regarding distinctiveness for 17 techniques. In exploring underlying principles of learning, it became clear that multiple and differing principles may apply depending on the specific context and procedure in which the technique may be applied. Discussion: Experts agreed on what each DBS technique is, what label to use, and their description, but were less likely to agree on what distinguishes one technique from another. All techniques were describable but not comprehensively categorizable according to principles of learning. While objective consistency was not attained, greater clarity and consistency now exists. The resulting list of agreed terminology marks a significant foundation for future efforts towards understanding DBS techniques in research, education and clinical care. [ABSTRACT FROM AUTHOR]

Background: Dental behavior support (DBS) describes all techniques used by dental professionals to ensure that dental care is safe, effective, and acceptable. There is a need to standardize outcome measures across DBS techniques to reduce heterogeneity, limit selective reporting, promote consistency, and optimize outcomes across DBS research. A comprehensive review of existing measures is a prerequisite to understanding potential outcomes related to the area of interest. Aim: This review had three aims: first, to identify the outcome measures (OMs) reported in trials of dental behavior support; second, to categorize the component DBS techniques reported within interventions according to emerging agreed terminology; and, third, to map outcome measures to intervention type. Methods: A scoping review of trials evaluating DBS techniques was undertaken from 2012 to 2022. The review was prospectively registered. Studies were identified through Medline, Embase, and PsycINFO. Study abstracts were screened by two reviewers. Data were extracted by single selector. Outcome measures were sorted according to measurement domains (physiological, behavioral, psychological, and treatment). Responses were assimilated and summed to produce a refined list of distinguishable outcome measures. Intervention types were categorized according to accepted descriptors. Frequencies were presented; associations between outcome domain and DBS type were also reported (Chi‐square test of independence). Results: A total of 344 trials were included in the review from an initial 14,793 titles / title and abstracts screened. Most involved children (n = 215), most were from India (n = 104), involving basic dental care (n = 117). The median number of outcome measures per trial was four (range = 1–12); 1,317 individual outcomes were reported, categorized as: psychological (n = 501, 38.0%); physiological (n = 491, 37.3%), behavioral (n = 123, 9.3%) or, treatment‐related (n = 202, 15.3%). DBS interventions were split between 239 (45.7%) pharmacological and 283 (54.1%) non‐pharmacological; 96.6% of interventions mapped to accepted descriptors. A significant relationship was noted between the type of intervention and the outcome domain reported. Conclusion: The findings demonstrate massive variation in outcome measures of DBS interventions that likely lead to unnecessary heterogeneity, selective reporting, and questionable relevance in the literature. A large range of DBS interventions were mapped according to BeSiDe list. There is a need for consensus on a core outcome set across the spectrum of DBS techniques. [ABSTRACT FROM AUTHOR]

Aim: To evaluate a modular didactic training intervention called Keep My Teeth designed by special care dentists, for a range of healthcare students to provide oral homecare for people with intellectual developmental disorders (PwIDD). Methods: To evaluate the intervention a one‐group pre‐test post‐test pre‐experimental research design was utilized. The intervention was delivered by virtual platforms or face‐to‐face, with a sub‐sample of participants also receiving practical training. Healthcare students included Speech and Language Therapy (SLT), Registered Nurse Intellectual Disability (RNID), Dental Science (DS), Dental Nursing (DN), and Dental Hygiene (DH). Results: Sixty‐three of the 147 trainees completed all surveys. A significant change in perspective on barriers was seen for most groups post‐training, with an increase in confidence in delivering oral care to PwIDD across disciplines; 67% of DH/DN students who took part in the practical training felt that the didactic training was just as effective without the practical training, while 42% of the DS students felt that was true. Conclusions: The training interventions provided seem to have increased the awareness of study participants in relation to barriers to care, and increased their self‐efficacy towards, and intention to perform, oral homecare behaviors. [ABSTRACT FROM AUTHOR]

Objectives: This paper describes treatments completed under dental general anesthesia (DGA) for a cohort of adults with disabilities. This patient cohort was followed up a number of years later to determine outcomes and identify factors that predict further use of DGA. Methods: A retrospective patient record review and cross‐sectional survey was carried out on a convenience sample of 64 patients who had previously received dental treatment under general anesthesia. Patient record review extracted data on patient demographics and treatment provided under DGA. Cross‐sectional survey a number of years post‐DGA collected data on oral care habits and current oral health based on a standardized clinical examination. Statistical analysis was carried out to identify predictors of repeat DGA. Results: Participants received extensive treatment under DGA including preventive care, restorations, extractions, and root canal treatment. At follow‐up 89.1% of participants had gingival disease and 56.3% had active dental caries. The mean number of teeth present was 21.2 (SD 6.9, range 6–32). Only caries risk status was found to be a significant predictor (p = 0.03) with those with a high caries risk status 6.9 times (95%CI 1.2–39.3) more likely to receive a second DGA. Conclusions: Dentists extract teeth for people with disabilities under DGA in the mistaken belief that this will avoid the need for further DGA. This study found that extraction of teeth does not prevent the need for repeated episodes of DGA. Therefore, dentists should stop extracting teeth for this reason. Rather, if dentists want to avoid further DGA, they should do the basics well: consistent, evidence‐based caries risk assessment and risk reduction. [ABSTRACT FROM AUTHOR]

Introduction: There is no agreed taxonomy of the techniques used to support patients to receive professional oral healthcare. This lack of specification leads to imprecision in describing, understanding, teaching and implementing behaviour support techniques in dentistry (DBS). Methods: This review aims to identify the labels and associated descriptors used by practitioners to describe DBS techniques, as a first step in developing a shared terminology for DBS techniques. Following registration of a protocol, a scoping review limited to Clinical Practice Guidelines only was undertaken to identify the labels and descriptors used to refer to DBS techniques. Results: From 5317 screened records, 30 were included, generating a list of 51 distinct DBS techniques. General anaesthesia was the most commonly reported DBS (n = 21). This review also explores what term is given to DBS techniques as a group (Behaviour management was most commonly used (n = 8)) and how these techniques were categorized (mainly distinguishing between pharmacological and non‐pharmacological). Conclusions: This is the first attempt to generate a list of techniques that can be selected for patients and marks an initial step in future efforts at agreeing and categorizing these techniques into an accepted taxonomy, with all the benefits this brings to research, education, practice and patients. [ABSTRACT FROM AUTHOR]

Background: Realist methods offer a novel approach to intervention design. Such novelty is needed for effective oral health promotion interventions with people with intellectual developmental disabilities (IDD) and their carers because existing interventions are poorly described and lack theoretical underpinning. In this study, the steps between inception and final intervention development are presented, with an aim to expand understanding of how realist theorizing can be used to develop interventions, and to demonstrate theory‐driven intervention development in the field of oral health promotion. Methods: In this intervention development study, the use of realist methods to develop an intervention aiming to improve the oral hygiene of people with IDD is presented. Realist theories (RTs) arising from a mixed synthesis were used to develop the Keep My Teeth intervention. The use of realist theory in intervention development was mapped across seven domains and 18 actions with emphasis on how theory informed key actions. Results: Realist theories informed many but not all actions in the development process. Where gaps arose, this was augmented with other systems of intervention development, such as the Behaviour Change Wheel (BCW) and Behaviour Change Technique (BCT) systems. The resulting intervention and underlying theory are presented using TiDieR criteria. Conclusions: It is demonstrated how realist methods could be integrated with substantive theory when developing an intervention. RTs enhanced the contextualization of the intervention that was developed but were insufficient in their own right to guide the development process from conception to intervention. This was overcome by augmenting with substantive theory, in this case, using the BCW and BCT behaviour change systems, to select and specify the behaviours that needed to change. In essence, the BCTs guided which techniques to select, while the RTs guided how to develop and intervene. Robust intervention development in the field of oral health promotion is also presented in this study. [ABSTRACT FROM AUTHOR]

Introduction: Autism spectrum disorders (ASD) is a lifelong condition affecting communication and social interaction, characterised by repetitive or repeated patterns of behaviour. People with ASD experience poor systemic and oral health. They face reduced access to dental care related to provider barriers associated with lack of understanding of ASD, lack of training and a consequent reluctance to treat people with ASD. Materials and Methods: The effectiveness of training given by a person with autism to student dental care professionals was evaluated by measuring change in 62 students' openness to autism scale scores and confidence treating a person with autism. These students included third year dental students and second year dental nursing and hygiene students. This cohort was recruited as part of their curriculum and opted in for inclusion in the study. Data were analysed using SPSS®. Results: An increase in openness scale scores of 7.6% (p <.05) and in confidence of 4.9% (p <.05) between pre‐ and post‐training was observed. Openness scale score predicted level of confidence at baseline (OR = 0.21 (95% CI = 0.02–0.39)). Conclusion: An educational intervention delivered by a person with autism promoted modest increases in openness towards autism and confidence amongst dental care pre‐service professionals. Whilst the results suggest that peer‐led dental care professional teaching by people with autism may be beneficial, more research is needed. [ABSTRACT FROM AUTHOR]

Aims: This paper explores the variables which influence decision‐making processes in dentists providing dental care for people with disabilities under general anesthesia (GA). Methods: Face‐to‐face semi‐structured interviews were undertaken on a purposive sample. Audio recordings were transcribed and checked for accuracy. Using thematic content analysis methods open codes were developed inductively. Codes were analyzed further by three authors adopting a deductive approach, leading to final coding, sorting and themes, subtheme and framework development. Results: Three themes emerged. The first theme explored Shared Decision Making, or lack thereof, as it influenced clinical reasoning. The second (Systematic, Analytical) and third (Intuition, and heuristics) themes explored features of clinical judgment as considered under dual process theory. Dentists primarily used intuitive decision‐making processes and heuristic styled processes (or cognitive mental frames) assisted in intuition to extract teeth, without engaging type 2 processes. Conclusion: The dentists experience subtle modifiers to their decision‐making that ultimately promote extraction of teeth under GA for people with disabilities. Bias training, simulation and post‐hoc reflection are examples of recommendations which may be used to improve decision‐making in this area. [ABSTRACT FROM AUTHOR]

Aims: To share the need for agreement in terminology around how people are supported to receive dental care. Method: In this position paper, we make the case for a shift in behavior support in dentistry from an art to a science. Results: We outline why we need agreement on the definition of behavior support across dentistry, agreement on underlying theory, aims and values, and why we need agreement on terms for specific techniques. Conclusions: We share how patients and dental teams can benefit through better science, education and practice of dental behaviour support. [ABSTRACT FROM AUTHOR]

Joint Position Statement on Equity for People with Intellectual and Developmental Disabilities Regarding COVID-19 Vaccine Allocation and Safety. The COVID-19 global pandemic has challenged scientists' and clinicians' ability to produce and test sufficient sound evidence regarding different strategies to limit the spread of coronavirus and its consequences. 1 All these COVID-19 vaccines appear to be effective (range 74%-95%) and safe and double-dose vaccination is recommended. [Extracted from the article]

Introduction: An understanding of how dentists develop patient support techniques for use with adults with intellectual developmental disorders (IDD) may lead to a better understanding of how these techniques can be taught. In this study, we explored how skilled dentists developed non‐physical, non‐pharmacological patient support techniques (nPSTs) for use with adults with IDD. Materials and methods: Adopting a qualitative descriptive design, a synchronous online group interview was undertaken with six dentists. Informants were subsequently contacted in pairs, or individually, for further interview. All data were analysed using thematic content analysis. Author biases and rigour are considered. Results: Three categories emerged: Motivation to learn; Formal learning; and Informal learning, and the latter had three subcategories: Observation; Trial; and error and Experience. Motivators to learn PST skills included perceived empathy and a sense of responsibility towards patients with IDD. Formal undergraduate learning was lacking leaving dentists to rely on paediatric training "A paediatric model from your training... needs to be restructured and re‐emphasised with people with disabilities as they progress through the lifespan.", whereas specialist training was reported to be helpful where available. Over time, practitioners developed an individualised skillset through observation, trial and error and experience. "You learn. Just like any job, you learn on the job. You learn a lot from experience and mistakes." Discussion: Essential patient support skills appear to be acquired in an ad hoc manner. How dentists learn their skills has implications for dental training for future and current dental professionals. Conclusions: Specific recommendations to improve education are made. [ABSTRACT FROM AUTHOR]

Aims: To identify the nonpharmacological patient-support techniques (nPSTs) reported, used or recommended for people with intellectual-developmental-disorders (IDD) to receive dental treatment; to identify their active ingredients and evaluate their effectiveness by adopting an existing taxonomy of behavior-change techniques (BCTs).Methods and Results: Following a protocol, a search strategy was undertaken using Medline, Embase, Cochrane Library, Scopus, Cinahl, and Psychinfo (EBSCO). Selection criteria were applied, with review and extraction in duplicate. A comprehensive list of nPSTs were identified and coded by their constituent behavior-change techniques (BCTs), where BCT-taxonomy-Version-1 criteria were satisfied. Quality assessment was undertaken and effectiveness of BCTs reported. From 915 screened articles, 23 were included. In 207 instances nPSTs were identified, representing 46 distinct nPST techniques, such as positive-reinforcement (n = 18) and tell-show-do (n = 9). Of the 207 nPST codes, 135 were coded as BCTs (65.2%). The most commonly coded BCT was demonstration of the behavior (BCT6.1; n = 25). Considering studies of interventions (n = 11), all were at moderate to critical risk of bias. No interventions or outcome measures were comparable across studies.Conclusion: This is the first review to bring together techniques dentists use in practice and theory-driven BCTs. A significant overlap between nPSTs and BCTs was evident supporting the use of BCT taxonomy to code dental interventions. No strong evidence supporting any intervention was identified. [ABSTRACT FROM AUTHOR]

Summary: Objectives: This study tests whether total tooth loss is a risk indicator for difficulty eating among a population with intellectual disability and whether complete denture wear mediates this risk. Methods: Dentate status and difficulty eating were reported for a Nationally representative sample of 690 adults over forty with intellectual disabilities as part of The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS‐TILDA). A logistic regression model tested the relationship between the Difficulty eating and Dentate status, controlling for the effects of other factors. Results: Of the 690 participants, 505 had some teeth (Group 1), 56 had no teeth and reported wearing dentures (Group 2) and 129 had no teeth, not using dentures (Group 3). A parsimonious regression model was developed including all 406 cases with no missing data. Adjusting for the effects of other factors, it was found that, compared to Group 1, the odds of difficulty eating was twice as great (OR = 2.01, 95% CI = 1.02‐4.03) among people without teeth, not using dentures (Group 3). Conversely, edentulous participants who had dentures (Group 2) had far lower odds (OR = 0.21, 95% CI = 0.06‐0.64) of reporting difficulty eating compared with Group 1. Conclusions: For adults with ID, total tooth loss was predictive of difficulty eating only when untreated. People with disabilities should be encouraged to maintain a functional dentition through preventive and conservative treatment. When adults with ID become edentulous, oral rehabilitation may reduce the risk of difficulty eating. Dental assessment should be undertaken if people with ID present with difficulty eating. [ABSTRACT FROM AUTHOR]

Aim: This review reports the prevalence of edentulism among adults with intellectual disabilities (IDs) in the literature.Methods: A systematic search strategy led to the screening of 1,089 titles and abstracts from PubMed and six additional articles. Inclusion criteria were applied. An estimate of the prevalence of edentulism was calculated.Results: Nineteen studies (from 20 publications) met inclusion criteria: eighteen were cross-sectional surveys. Sample sizes ranged from 50 to 9,620 (n = 23,853). Samples were heterogeneous, with four studies drawing from Special Olympics Special Smiles (n = 14,862); nine from institutions (n = 2,447); five from disability registers (n = 1,812) and one patient cohort (n = 4,732). By pooling the participants of all the studies reviewed, 6.6% of people with IDs were found to be edentulous. This is similar to the general population. This conceals the fact that the prevalence of edentulism varied greatly across studies (0-50%), by age and across sampling techniques adopted.Conclusions: Much like for the general population, edentulism should be seen as a key measure of disease experience and management. Such focus is needed to reduce the prevalence of edentulism for people with IDs globally. This can only be measured by adopting representative samples, which include people with IDs. [ABSTRACT FROM AUTHOR]

For some reason, once my patient is under general anesthesia (GA), I am more likely to extract teeth than if they were being treated awake. 3 Roberts GJ, Mokhtar SM, Lucas VS, Mason C. Deaths associated with GA for dentistry 1948 - 2016: the evolution of a policy for general anesthesia (GA) for dental treatment. Elective dental GA is safe even for most people with disabilities.3 In this sense, having to repeat treatment under GA is not a very risky outcome. [Extracted from the article]

Accessible summary This study asked a group of people with learning disabilities in Ireland what was important to them about their dental services., The group easily ordered their priorities according to five topics: Access, Cost, Information, Quality of Care and Treatment., The group's discussion revealed a disempowered group who had little control over how they interacted with dental services., We suggest ways to empower people with learning disabilities in their interactions with dental services., Abstract Background: In Ireland, people with learning disabilities have poor oral health. This is in part due to inappropriate oral health services. Recognising the value of inclusive approaches to research and healthcare planning, this study sought to include a group of people with learning disabilities in priority setting for oral health services in Ireland. This study discusses the feasibility of the methods used to promote inclusive approaches in oral healthcare planning. Materials and Methods: A single focus group of six participants with communication and cognitive impairments agreed priorities for dental services using evidence-based research tools across five topics: Access, Cost, Information, Quality of Care and Treatment. Sorting was recorded photographically and discussion was video-recorded, transcribed and analysed using deductive content analysis. Results: The group ranked priorities within each topic but found it difficult to meaningfully rank between topics. Across topics, issues of control, empowerment and choice were observed. Conclusions: Participants were largely disempowered in their interactions with dental services. The method used in this study to empower potential service users with disabilities was successful and can be used by others who have an interest in inclusive healthcare priority setting. [ABSTRACT FROM AUTHOR]

ABSTRACT This study assessed the impact of a multitiered oral health educational program on the oral health and oral hygiene of people with intellectual disabilities (ID). In a controlled pretest, posttest trial, with cluster randomization, a pyramidal training program was delivered to residential staff who cared for a randomly allocated, purposively stratified intervention group of people with ID living in community care homes. A control group lived in centers where staff received no training. Clinical measures were carried out pre- and posttest. Difference in Modified Gingival Index (MGI) and Plaque Index (PI) was measured posttest using ANCOVA. Seventy-six participants took part, representing 49.0% of the invited sample (n = 155). Fourteen did not receive clinical examination. There was one dropout 6-9 months later. A 10.5% and 8.5% reduction in mean MGI and PI was evident at posttest but did not show statistically significant difference, when controlling for baseline covariates ( p > 0.05, ANCOVA). Mean MGI and PI scores were not significantly different among people with ID whose care staff had and had not received oral health training. Limitations are discussed. The results indicate that this program failed to significantly improve oral health or oral hygiene, despite the intervention being 'educationally' successful. More research is needed. [ABSTRACT FROM AUTHOR]

Objectives The objectives of this study were to describe the reported dentate status and complete denture use of older people with intellectual disability ( ID) and compare with those of older people in the general population in Ireland. Methods The first wave of the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing ( IDS- TILDA) study provides opportunity to measure edentulism and complete denture use in a nationally representative sample of older people with ID in Ireland. Data drawn from the first wave of IDS- TILDA were matched using propensity score matching with data from The Irish Longitudinal Study on Ageing ( TILDA), a study among older adults in Ireland. All IDS- TILDA variables showing significant association ( P < 0.05) with edentulism were entered into a regression model to identify predictors of edentulism. Result The proportion of the 478 IDS- TILDA participants with no teeth was higher (34.1 percent) than the proportion of participants with no teeth in the 478 matched TILDA participants (14.9 percent). Only age was predictive of edentulism among older adults with ID. Edentulism was prevalent earlier for those with ID. Notably, 61.3 percent of edentulous older people with ID were without dentures. Conclusion Older people with ID are more likely to be edentulous than those without ID in Ireland and when they lose their teeth, they are unlikely to use dentures. This suggests a need for targeted measures to maintain the teeth of this group and, in the short term, the provision of replacement teeth in this population, where indicated. [ABSTRACT FROM AUTHOR]

Background: This study aimed to generate prioritised goals for oral health services for people with disabilities as a first step in meeting the need for evidence based oral health services for people with disabilities in Ireland. Methods: The study used a three round modified e-Delphi method, involving dental service professionals and people with disabilities or their representatives, in Ireland. Three rounds were completed online using SurveyMonkey. Round 1 asked: “List what you think dental services for people with disabilities in Ireland should be like.” Items for subsequent rounds were generated from responses to Round 1. Round 2 and Round 3 used 5 point Likert scales to rank these items by priority: from No Priority (1) to Top Priority (5). Consensus was achieved on each item where at least 80% of respondents considered an item either High or Top Priority. A consensus meeting concluded the process. Results: Sixty-one panelists started and 48 completed the survey. The Delphi panel agreed on level of priority for 69 items and generated 16 consensus statements. These statements covered a range of topics such as access to care, availability of information and training, quality of care, dental treatment and cost. A recurrent theme relating to the appropriateness of care to individual need arose across topics suggesting a need to match service delivery according to the individual's needs, wants and expectations rather than the disability type/diagnosis based service which predominates today. Conclusions: This process produced a list of prioritised goals for dental services for people with disabilities. This creates a foundation for building evidence-based service models for people with disabilities in Ireland. [ABSTRACT FROM AUTHOR]

Objectives To assess the impact of a multi-tiered oral health education programme on care staff caring for people with intellectual disability ( ID). Methods Postal questionnaires were sent to all care staff of a community-based residential care service for adults, randomly assigned to control and intervention groups. A specifically developed training programme was delivered to residential staff nominees, who then trained all staff within the intervention group. The control group received no training. Post-test questionnaires were sent to both groups. Paired-samples t-test was used to compare oral health-related knowledge ( K) and behaviour, attitude and self-efficacy ( BAS) scores. Results Of the initial 219 respondents, 154 (response rate between 40% and 35.8%, with attrition rate of 29.7% from baseline to repeat) returned completed questionnaires at post-test ( M = 8.5 months, range = 6.5-11 months). Control and intervention groups were comparable for general training, employment and demographic variables. In the intervention group, mean Knowledge Index score rose from K = 7.2 to K = 7.9 ( P < 0.001) and mean BAS scale score rose from BAS = 4.7 to BAS = 5.4 ( P < 0.001). There was no statistically significant increase in mean scores from test ( K = 7.0, BAS = 4.7) to post-test ( K = 7.2, BAS = 4.9) for the control group. Conclusions Mean scores regarding knowledge, attitude, self-efficacy and reported behaviour increased significantly at 8.5 months in staff where training was provided. The results indicate that a multi-tiered training programme improved knowledge, attitude, self-efficacy and reported behaviour amongst staff caring for people with ID. [ABSTRACT FROM AUTHOR]