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John DA, Adams EA, McGowan LJ, Joyes EC, Richmond C, Beyer FR, Landes D, Watt RG, Sniehotta FF, Paisi M, Bambra C, Craig D, Kaner E, Ramsay SE. Factors influencing implementation and sustainability of interventions to improve oral health and related health behaviours in adults experiencing severe and multiple disadvantage: a mixed-methods systematic review. BMJ Open 2024; 14:e080160. [PMID: 38216193 PMCID: PMC10806606 DOI: 10.1136/bmjopen-2023-080160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Among people experiencing severe and multiple disadvantage (SMD), poor oral health is common and linked to smoking, substance use and high sugar intake. Studies have explored interventions addressing oral health and related behaviours; however, factors related to the implementation of these interventions remain unclear. This mixed-methods systematic review aimed to synthesise evidence on the implementation and sustainability of interventions to improve oral health and related health behaviours among adults experiencing SMD. METHODS Bibliographic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, EBSCO, Scopus) and grey literature were searched from inception to February 2023. Studies meeting the inclusion criteria were screened and extracted independently by two researchers. Quality appraisal was undertaken, and results were synthesised using narrative and thematic analyses. RESULTS Seventeen papers were included (published between 1995 and 2022). Studies were mostly of moderate quality and included views from SMD groups and service providers. From the qualitative synthesis, most findings were related to aspects such as trust, resources and motivation levels of SMD groups and service providers. None of the studies reported on diet and none included repeated offending (one of the aspects of SMD). From the quantitative synthesis, no difference was observed in programme attendance between the interventions and usual care, although there was some indication of sustained improvements in participation in the intervention group. CONCLUSION This review provides some evidence that trust, adequate resources and motivation levels are potentially important in implementing interventions to improve oral health and substance use among SMD groups. Further research is needed from high quality studies and focusing on diet in this population. PROSPERO REGISTRATION NUMBER CRD42020202416.
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Affiliation(s)
- Deepti A John
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma A Adams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Laura J McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma C Joyes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona R Beyer
- Evidence Synthesis Group and Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - David Landes
- NHS England and NHS Improvement, Newcastle upon Tyne, UK
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Falko F Sniehotta
- NIHR Policy Research Unit Behavioural Science, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Public Health, Social and Preventive Medicine, Centre for Preventive Medicine and Digital Health (CPD), Heidelberg University Medical Faculty Mannheim, Mannheim, Germany
| | - Martha Paisi
- Faculty of Medicine and Dentistry, Peninsula Dental School, Plymouth University, Plymouth, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Bradley N, Heidari E, Andreasson S, Newton T. Models of dental care for people experiencing homelessness in the UK: a scoping review of the literature. Br Dent J 2023; 234:816-824. [PMID: 37291313 DOI: 10.1038/s41415-023-5904-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/23/2023] [Accepted: 02/07/2023] [Indexed: 06/10/2023]
Abstract
Background People who experience homelessness have poor oral health and face barriers to accessing care. Recommendations have been outlined for health services to address their needs, termed 'inclusion health'. The Smile4Life report recommended three 'tiers' of dental service: emergency, ad hoc and routine care. Other medical services have developed into different models of care, for example mainstream practices with enhanced services for people who experience homelessness. There is little understanding of how inclusion health recommendations have been implemented across dental settings.Aims To describe and compare dental services that exist for people who experience homelessness in the UK.Methods Two Medline searches were performed in October 2020 to assess the models of dental care for people who experience homelessness in the UK.Results Nine dental services in the UK were identified who treated people who experience homelessness. Most did not explore definitions of homelessness. There were a mixture of models, including using blended approaches, such as different sites and appointment types, to flex to the needs of their population.Conclusion Many services that are dedicated to treat this population are based in the community dental services which allows for flexible models of care due to sporadic patient attendance, high treatment requirements and complex needs. More research is required to determine how other settings can accommodate these patients, as well as understanding how more rural populations access dental care.
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Affiliation(s)
| | | | | | - Tim Newton
- King´s College London, London, United Kingdom
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Kopanitsa V, McWilliams S, Leung R, Schischa B, Sarela S, Perelmuter S, Sheeran E, d'Algue LM, Tan GC, Rosenthal DM. A systematic scoping review of primary health care service outreach for homeless populations. Fam Pract 2023; 40:138-151. [PMID: 35809035 DOI: 10.1093/fampra/cmac075] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Homeless populations (HPs) have difficulties obtaining necessary medical care, and primary health care service outreach (PHSO) might be useful to bridge this gap. OBJECTIVE Using the Centre for Evidence-Based Management Critically Appraised Topics framework, to provide systematic evidence of the usefulness of PHSO interventions for HPs. METHODS A systematic search was conducted in 4 electronic databases: PubMed, Web of Science, CINAHL, and Cochrane (publication dates between January 1980 and November 2020). In total, 2,872 articles were identified. Primary research about PHSO for HPs in high-income countries were included. Data were extracted from eligible studies, summarized, and collated into a narrative account. RESULTS Twenty-four studies that described and evaluated PHSO interventions for adults experiencing homelessness were selected in the final synthesis. Most studies had a nonrandomized design. PHSO was found to successfully address some barriers to health care access for HPs through flexible appointments in convenient locations, fostering an understanding relationship between doctor and patients, and provision of additional basic necessities and referrals. Outreach was provided for a range of health care concerns, and several solutions to engage more HPs in primary care, improve continuity of care and to decrease the running costs were identified. Outreach also helped to implement preventative measures and reduced emergency service admissions. CONCLUSION Our review adds to the evidence that PHSO likely improves health care access for HPs. Further studies over longer time periods, involving collaborations with experts with lived experience of homelessness, and utilizing randomized study designs are needed to test outreach efficacy.
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Affiliation(s)
- Valeriya Kopanitsa
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | - Stephen McWilliams
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | - Richard Leung
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | | | - Shazia Sarela
- Faculty of Medical Sciences, University College London Medical School, London, UK
| | - Sara Perelmuter
- Faculty of Life Sciences, University College London, London, UK
| | - Emma Sheeran
- Health Humanities Centre, University College London, London, UK
| | | | - Guan Chwen Tan
- Arts and Sciences Department, University College London, London, UK
| | - Diana Margot Rosenthal
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK.,UCL Collaborative Centre for Inclusion Health, University College London, London, UK
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Crisan EL, Covaliu BF, Chis DM. A Systematic Literature Review of Quality Management Initiatives in Dental Clinics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11084. [PMID: 34769604 PMCID: PMC8582852 DOI: 10.3390/ijerph182111084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 12/17/2022]
Abstract
By considering the recently proposed definitions and metrics, oral healthcare quality management (OHQM) emerges as a distinct field in the wider healthcare area. The goal of this paper is to systematically review quality management initiatives (QMIs) implementation by dental clinics. The research methodology approach is a review of 72 sources that have been analyzed using the Context-Intervention-Mechanism-Outcome Framework (CIMO). The analysis identifies five mechanisms that explain how quality management initiatives are implemented by dental clinics. The simplest QMIs implementations are related to (1) overall quality. The next ones, in terms of complexity, are related to (2) patient satisfaction, (3) service quality, (4) internal processes improvement, and (5) business outcomes. This paper is the first attempt to provide a critical review of this topic and represents an important advancement by providing a theoretical framework that explains how quality management is implemented by practitioners in this field. The results can be used by scholars for advancing their studies related to this emerging research area and by healthcare managers in order to better implement their quality management initiatives.
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Affiliation(s)
- Emil Lucian Crisan
- Faculty of Economics and Business Administration, Department of Management, Babes-Bolyai University, 400591 Cluj-Napoca, Romania;
| | - Bogdan Florin Covaliu
- Faculty of Medicine, Department of Community Medicine, Public Health and Management, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400337 Cluj-Napoca, Romania
| | - Diana Maria Chis
- Faculty of Economics and Business Administration, Department of Finance, Babes-Bolyai University, 400591 Cluj-Napoca, Romania;
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Gamarra S, Bärnighausen K, Wachinger J, McMahon SA. 'We had to take a hammer to get some roots out' - experiences, motivations and challenges among volunteer dentists: a qualitative study. Br Dent J 2021:10.1038/s41415-021-3222-6. [PMID: 34381176 DOI: 10.1038/s41415-021-3222-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/17/2020] [Indexed: 11/08/2022]
Abstract
Objectives To address a gap in the literature by examining the experiences, motivations and challenges among volunteer dentists engaged in short-term missions to low- and middle-income countries.Methods In-depth interviews among volunteer dentists (n = 20) who had provided voluntary dental care in low- or middle-income countries within the preceding five years. Interviews lasted on average 55 minutes and were recorded, transcribed and analysed using NVivo. Routine debriefings complemented analysis. COREQ principles guided this research.Results Motivations to volunteer included: exposure to new dental challenges (enhancing competence); discovering a new setting (tourism); and enhancing the lives of clients (humanitarianism). Volunteers enjoyed undertaking new tasks and developing new skills, but were burdened by a high patient load, challenging clinical conditions, peri- and post-operative complications, and a concern that their work was not addressing root causes of inadequate access to basic dental care. Respondents recommended that more information regarding the vision, equipment status, armamentarium and dental supplies be made available pre-departure, and that more dental schools include training on global oral health. Such measures could facilitate volunteers' abilities to provide care while also enhancing their personal and professional development. Creating an appropriate, sizable and competent capacity-building programme for local dentists was described as essential.
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Affiliation(s)
- Saulo Gamarra
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany; Dentists Serving the Poor - Latin America (DSP-LA), Cusco, Peru.
| | - Kate Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany; University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Jonas Wachinger
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany; Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, Maryland, USA
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