Table 1.

Summary of Themes that Informed the Development of the CBT Self-help Resource.

Themes/Sub-themes that Emerged from Stakeholder Interviews	How This Informed the Content/Format/Delivery of the CBT Resource
Theme 1: “pure vs. guided self-help” • “Advantages and disadvantages of a pure self-help approach” (e.g., less practitioner time required; however, reliance on high levels of motivation, low levels of perceived value/ efficacy). • “Advantages and disadvantages of a guided approach” (e.g., would require more time but higher levels of perceived value/efficacy, time required needs to be feasible). • “Relationship building” (e.g., the resource should help build positive and trusting patient–dentist relationships; therefore, the dentist should have some involvement in the delivery of the resources).	• The analysis of this data revealed stakeholders had a preference for the guided self-help approach delivered by the patient’s dentist; thus, a guided CBT resource was developed. • The CBT self-help resource includes a variety of tools that facilitate effective communication and positive relationships between the patient and the dentist (e.g., dentist message). • The CBT self-help resource was designed so that it could be used flexibly by practitioners: Practitioners can focus on reading/working through specific “self-contained” and “brief” sections of the resource that are most helpful for their patient and are most feasible for them to work through in their particular dental setting.
Theme 2: “supporting everyone involved” • “Parents/carers’ difficulties and challenges” (e.g., helplessness, responsibility/pressure, negative emotions). • “Ways in which parents/carers have tried to manage their child’s anxiety” (e.g., withholding information, persuasion/pressure, reassurance, distraction, positive reinforcement). • “Parent’s need for support” (e.g., better understanding of child’s anxiety, know what they can do to help their child). • “Needs of dental team” (e.g., Help with understanding patients’ anxiety and what can be done in practice to help manage anxiety, specific information about how to introduce the CBT book e.g., a script).	A supporting parent resource was developed, which aimed to help parents/carers: • Understand their child’s dental anxiety and reflect on how helpful/unhelpful their own thoughts and behaviors might be. • Develop ways of supporting their children with their anxiety. A supporting resource for the dental team was developed, which included the following: • Information about to use the guided CBT resource with patients (e.g., scripts for introducing the CBT self-help resource, etc.). • General tips and techniques for the management of dental anxiety. An assessment tool was also included within the “dentist message” section of the children’s CBT resource to help dental practitioners better understand their patients’ anxiety/needs.
Theme 3: “facilitators: engaging, informative and accessible” • “Informative” (e.g., information on treatments, equipment, procedures) • “Simple and age-appropriate” • “Interactive” (e.g., activities to complete) • “Mixed formats” (e.g., online and paper-based)	A paper-based, CBT self-help resource was produced so that the resource could be used easily by patients and dentists within dental clinics. However, as a result of this feedback, we have also developed an online portal where the CBT resource and supporting resources can be accessed for free (www.llttf.com/dental). A number of activities and illustrations are included within the resource to optimize engagement, and children, parents/carers and dental team members were all involved in the development and revision of the content/presentation of material to ensure the CBT resource was age appropriate and accessible.
Theme 4: “potential barriers” • “Too much information” • “Not enough time”	The CBT self-help resource is designed so that it could be used flexibly with patients and dentists to overcome this possible barrier. Therefore, it is not necessary for patients or dentists to require large amounts of time to read/work through the whole CBT resource in one sitting.