The Best of Times at the Worst of Times: How Adults Respond to a Brief Intervention ( RETURN ) to Increase Planned Dental Visiting

Although acute health crises can disrupt routines and open a window for behaviour change, these teachable moments are rarely harnessed by intervention designs. The RETURN intervention (comprising a dental nurse-led conversation, short peer videos and booklets supporting knowledge, skills and action-planning) aimed to change planned dental visiting behaviour among adults previously reliant on urgent care. The RETURN trial recruited 1179 predominantly socio-economically disadvantaged urgent dental care users. OBJECTIVES: This qualitative study explored how RETURN impacted meaning, motivations, and practices related to routine dental visiting. METHODS: In-depth interviews were conducted with 55 participants (39 intervention) at 6, 12 and 18-months post-intervention and analysed using reflexive thematic analysis. RESULTS: Urgent dental problems provide a liminal (transitional) space where routines and dental visiting identities are destabilised. RETURN enabled a reflective pause where participants could distance themselves from previous patterns of behaviour, re-evaluate their oral health trajectory and priorities, reduce shame and self-blame, and rework aspects of their self-identity. Intervention components operated synergistically while enabling individually patterned engagement. Four themes generated were: 1. pausing and labelling the problem; 2. reducing ambivalence and energising motivation; 3. normalising struggle, cultivating hope and grit; 4. developing knowledge and skills to enact change. Booklets functioned as a material artefact extending engagement for over 12 months beyond the brief intervention delivery. For some, capabilities developed transferred to other domains of life. CONCLUSIONS: Findings position urgent care as an under-utilised site for identity work and sustained behaviour change, with the potential to support disadvantaged groups in service use, thus narrowing health inequalities. TRIAL REGISTRATION: The RETURN trial was registered at isrctn.com (ISRCTN84666712).