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Mishu MP, Aggarwal V, Shiers D, Peckham E, Johnston G, Joury E, Chew‐Graham CA, Goodall K, Elliott E, French P, Harris R, Laverty L, Palmier‐Claus J. Developing a Consensus Statement to Target Oral Health Inequalities in People With Severe Mental Illness. Health Expect 2024; 27:e14163. [PMID: 39097761 PMCID: PMC11297907 DOI: 10.1111/hex.14163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 06/19/2024] [Accepted: 07/17/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Oral diseases are more prevalent in people with severe mental illness (SMI) compared to those without mental illnees. A greater focus on oral health is needed to reverse unacceptable but often neglected oral health inequality in people with SMI. This provided the impetus for developing 'The Right to Smile' consensus statement. We aimed to develop and disseminate a consensus statement to address oral health inequality, highlighting the main areas for concern and recommending an evidence-based 5-year action plan to improve oral health in people with SMI. METHODS The Right to Smile consensus statement was developed by experts from several professional disciplines and practice settings (mental, dental and public health) and people with lived experience, including carers. Stakeholders participated in a series of online workshops to develop a rights-based consensus statement. Subsequent dissemination activities were conducted to maximise its reach and impact. RESULTS The consensus statement was developed to focus on how oral health inequalities could be addressed through a set of 5-year improvement targets for practice, policy and training. The consensus was reached on three 5-year action plans: 'Any assessment of physical health in people experiencing SMI must include consideration of oral health', 'Access to dental services for people with SMI needs to improve' and 'The importance of oral health for people experiencing SMI should be recognised in healthcare training, systems, and structures'. CONCLUSION This consensus statement urges researchers, services and policymakers to embrace a 5-year action plan to improve oral health for people with SMI. PATIENT OR PUBLIC CONTRIBUTION The team included people with lived experience of SMI, their carers/family members and mental and dental health service providers. They were involved in every stage of developing the consensus statement, from conception to development and dissemination.
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Affiliation(s)
| | | | - David Shiers
- Psychosis Research UnitGreater Manchester Mental Health NHS TrustManchesterUK
- University of ManchesterManchesterUK
- School of MedicineKeele UniversityKeeleUK
| | | | | | - Easter Joury
- Institute of DentistryQueen Mary University of LondonLondonUK
| | | | - Katie Goodall
- School of Nursing & Public HealthManchester Metropolitan UniversityManchesterUK
| | | | - Paul French
- Manchester Metropolitan University, Pennine Care NHSManchesterUK
| | - Rebecca Harris
- University of LiverpoolLiverpoolUK
- Royal Liverpool University NHS Foundation Trust, Department of Public Health, Policy and Systems, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | - Louise Laverty
- NIHR Applied Research Collaboration Greater Manchester (NIHR ARC GM)—Digital Health, Centre for Health InformaticsUniversity of ManchesterManchesterUK
| | - Jasper Palmier‐Claus
- Spectrum Centre for Mental Health ResearchLancaster UniversityLancasterUK
- Lancashire & South Cumbria NHS Foundation TrustLancashireUK
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Usmani W, de Courten M, Hanna F. Can oral health care be a gateway to improve cardiovascular disease? A scoping review. FRONTIERS IN ORAL HEALTH 2024; 5:1364765. [PMID: 38846319 PMCID: PMC11155301 DOI: 10.3389/froh.2024.1364765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 05/03/2024] [Indexed: 06/09/2024] Open
Abstract
Background Cardiovascular diseases (CVDs) are a significant cause of morbidity and mortality worldwide, resulting in a high socioeconomic burden. Growing evidence has shown a link between oral diseases and several chronic conditions including CVDs. The focus of this review is to investigate and summaries the evidence surrounding oral health interventions and their potential impact on reducing both the risk and/or severity of CVDs. Methods A scoping review was conducted to examine oral health interventions for managing CVD outcomes and risks. The review adhered to the Joanna Briggs Institute (JBI) framework for evidence synthesis and followed the reporting standards outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analysis- extension to Scoping Review (PRISMA-ScR). A systematic search across EBSCOhost, PubMed, and Scopus databases from 2012 to 2024 was utilized to identify relevant studies. Inclusion criteria focused on English language articles with a sample size of at least 50, evaluating the impact of oral health interventions on CVD outcomes. Results Out of the initial 2,154 studies identified in the search, 12 studies met the inclusion and exclusion criteria and were included in the final analysis. Overall, the studies revealed that along with surgical and non-surgical periodontal therapy, regular oral hygiene care practices, including toothbrushing, tongue brushing, and flossing, significantly reduced the risk of cardiovascular events and mortality. These interventions in patients with or without CVD baseline have shown a decrease in CVD risk markers as well as a reduction in bacterial colonization. Similarly, consistent oral hygiene routines, combined with regular dental visits, were associated with a lower risk of heart failure and CVD risk mortality. Conclusion The evidence extracted from this review suggests that periodontal therapy, regular dental cleaning, and re-enforcing of oral health regimes can stabilize oral health conditions and subsequently improve CVD progression/risks. However, limited to no evidence exists regarding the therapeutic effects of oral health promotion in managing CVD markers and its direct impact on disease outcomes, warranting further investigation.
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Affiliation(s)
- Wania Usmani
- Department of Health, Torrens University Australia, Melbourne, VIC, Australia
| | - Maximilian de Courten
- Health and Education Policy, Mitchell Institute, Victoria University, Melbourne, VIC, Australia
| | - Fahad Hanna
- Public Health Program, Department of Health and Education, Torrens University Australia, Melbourne, VIC, Australia
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Powell T, Taylor H. The relationship between self-reported poor mental health and complete tooth loss among the US adult population in 2019. FRONTIERS IN ORAL HEALTH 2024; 5:1363982. [PMID: 38606312 PMCID: PMC11007132 DOI: 10.3389/froh.2024.1363982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
Objective Very little is known about the association between poor mental health and poor oral health outcomes in the United Sates. This study investigated the prevalence of complete tooth loss among those with and without perceived poor mental health in a nationally representative sample of noninstitutionalized U.S. adults. Methods Using a cross-sectional study design, we analyzed the 2019 Medical Expenditures Panel Survey to determine the unweighted and weighted prevalence of complete tooth loss among adults. Chi-squared and multivariate logit regression with marginal effects were used to measure the association between complete tooth loss and perceived poor mental health, controlling for respondent characteristics. Results The prevalence of adults (ages 18 and older) experiencing complete tooth loss was 6% (95% CI: 5.6-6.4). Individuals who have perceived poor mental health were 1.90 percentage points (pps) more likely to report missing all their natural teeth (P = 0.006: 95% CI: 0.5-3.3). Other relevant predictors of complete tooth loss included current smoking status (5.9 pps; 95% CI: 4.5 to 7.2) and secondary education (-6.4 pps (95% CI: -7.0 to -4.8). Conclusions Overall, self-reported poor mental health was found to be associated with a greater likelihood of reporting complete tooth loss. Findings from this study underscore the need for greater integration of care delivery between behavioral health specialists and dental providers.
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Affiliation(s)
- Tasha Powell
- Comprehensive Care: Dental Hygiene, Indiana University School of Dentistry, Indianapolis, IN, United States
| | - Heather Taylor
- Health Policy and Management, Richard M. Fairbanks School of Public Health, Indianapolis University, Indianapolis, IN, United States
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Ngu ACS, Arora S, Reher P. Medical profile of patients referred to an Australian postgraduate oral surgery clinic. Clin Exp Dent Res 2023; 9:899-905. [PMID: 37680041 PMCID: PMC10582212 DOI: 10.1002/cre2.781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/22/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Thorough knowledge of a patient's medical history and medications is necessary for providing safe oral surgery care, and may be considered a form of risk management. This study investigated the prevalence of medical conditions and medication types in patients referred to an Australian postgraduate oral surgery clinic over 2 years. MATERIALS AND METHODS A retrospective cross-sectional study of the clinical records of 233 randomized patients referred to the Griffith University (Queensland, Australia) postgraduate oral surgery clinic in 2018 and 2019 was performed. Medical conditions and medications were counted and categorized, and descriptive statistics were generated. RESULTS In all, 133 patients (57%) had at least one medical condition. 58% of them (77) had two or more categories of medical conditions, representing nearly a third (33.0%) of all sampled patients. The most prevalent category of medical conditions was psychiatric (25.3%), followed closely by cardiovascular (24.5%) diseases. Cardiovascular medications were the most prevalent, comprising 23.6% of all medications recorded, followed by psychotropics (18.3%). CONCLUSION Over half of patients referred to the postgraduate oral surgery clinic had at least one systemic medical condition. Nearly a third of patients referred had at least two distinct systemic medical conditions. With an ageing population and the accompanying rise in multimorbidity globally, dental school curricula must adapt to prepare students to meet these challenges in their careers.
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Affiliation(s)
| | - Sitanshu Arora
- School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Peter Reher
- School of Medicine and Dentistry, Griffith University, Southport, Australia
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Hilton C, Morris A, Burnside G, Harris R, Aggarwal VR, Procter S, Griffiths R, French P, Laverty L, Lobban F, Berry K, Shiers D, Golby R, Fazekas F, Valemis K, Perry A, Newens C, Kerry E, Mupinga P, Gkioni E, Lodge C, Dawber A, Elliott E, Lunat F, Palmier-Claus J. A two-arm, randomised feasibility trial using link workers to improve dental visiting in people with severe mental illness: a protocol paper. Pilot Feasibility Stud 2023; 9:157. [PMID: 37684682 PMCID: PMC10485965 DOI: 10.1186/s40814-023-01383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND People with severe mental illness (e.g. psychosis, bipolar disorder) experience poor oral health compared to the general population as shown by more decayed, missing and filled teeth and a higher prevalence of periodontal disease. Attending dental services allows treatment of oral health problems and support for prevention. However, people with severe mental illness face multiple barriers to attending routine dental appointments and often struggle to access care. Link work interventions use non-clinical support staff to afford vulnerable populations the capacity, opportunity, and motivation to navigate use of services. The authors have co-developed with service users a link work intervention for supporting people with severe mental illness to access routine dental appointments. The Mouth Matters in Mental Health Study aims to explore the feasibility and acceptability of this intervention within the context of a feasibility randomised controlled trial (RCT) measuring outcomes related to the recruitment of participants, completion of assessments, and adherence to the intervention. The trial will closely monitor the safety of the intervention and trial procedures. METHODS A feasibility RCT with 1:1 allocation to two arms: treatment as usual (control) or treatment as usual plus a link work intervention (treatment). The intervention consists of six sessions with a link worker over 9 months. Participants will be adults with severe mental illness receiving clinical input from secondary care mental health service and who have not attended a planned dental appointment in the past 3 years. Assessments will take place at baseline and after 9 months. The target recruitment total is 84 participants from across three NHS Trusts. A subset of participants and key stakeholders will complete qualitative interviews to explore the acceptability of the intervention and trial procedures. DISCUSSION The link work intervention aims to improve dental access and reduce oral health inequalities in people with severe mental illness. There is a dearth of research relating to interventions that attempt to improve oral health outcomes in people with mental illness and the collected feasibility data will offer insights into this important area. TRIAL REGISTRATION The trial was preregistered on ISRCTN (ISRCTN13650779) and ClinicalTrials.gov (NCT05545228).
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Affiliation(s)
- Claire Hilton
- The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Abigail Morris
- The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Girvan Burnside
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Rebecca Harris
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Sarah Procter
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Robert Griffiths
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Paul French
- Manchester Metropolitan University, Manchester, UK
- Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
| | - Louise Laverty
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Fiona Lobban
- The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Katherine Berry
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - David Shiers
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rebecca Golby
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Fanni Fazekas
- Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
| | - Kyriakos Valemis
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Antonia Perry
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Connie Newens
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Eirian Kerry
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Efstathia Gkioni
- Institute of Population Health, University of Liverpool, Liverpool, UK
- Liverpool Clinical Trials Centre, Clinical Directorate, University of Liverpool, Liverpool, UK
| | - Christopher Lodge
- The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Alison Dawber
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Emma Elliott
- School of Dentistry, University of Leeds, Leeds, UK
| | - Farah Lunat
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Jasper Palmier-Claus
- The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK.
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK.
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Skallevold HE, Rokaya N, Wongsirichat N, Rokaya D. Importance of oral health in mental health disorders: An updated review. J Oral Biol Craniofac Res 2023; 13:544-552. [PMID: 37396968 PMCID: PMC10314291 DOI: 10.1016/j.jobcr.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 06/05/2023] [Accepted: 06/14/2023] [Indexed: 07/04/2023] Open
Abstract
Background Mental disorders are indeed an expanding threat, which requires raised awareness, education, prevention, and treatment initiatives nationally and globally. This review presents an updated review on the relationships between oral health and mental health disorders and the importance of oral health in mental health disorders. Method A literature search was done regarding mental disorders and oral health approaches in Google Scholar and PubMed from the year 1995 until 2023. All the English-language papers were evaluated based on the inclusion criteria. Publications included original research papers, review articles and book chapters. Results Common mental disorders include depression, anxiety, bipolar disorder, Schizophrenia, dementia, and alcohol and drug use disorders. The interplay of oral health and mental disorders involves dysregulated microbiome, translocated bacteria, and systemic inflammation, among others. Conclusion There is a complex relationship between mental disorders and oral diseases. Various oral health problems are associated with mental health problems. The interplay of oral health and mental disorders involves dysregulated microbiome, translocated bacteria, and systemic inflammation, among others. Mental health nurses including physicians and dental professionals should be involved in the oral health care of mental health disorder patients. Therefore, multidisciplinary should be involved in the care of mental health disorders, and they should consider oral health care as an essential part of their care for patients with mental health disorders. Future investigations should strive to elucidate the exact biological relationships, to develop new directions for treatment.
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Affiliation(s)
- Hans Erling Skallevold
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chulalongkorn University, Bangkok, 10330, Thailand
| | | | - Natthamet Wongsirichat
- Faculty of Dentistry, Bangkok Thonburi University, 16/10 Taweewatana, Bangkok, 10170, Thailand
| | - Dinesh Rokaya
- Department of Clinical Dentistry, Walailak University International College of Dentistry, Bangkok, 10400, Thailand
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Matsuda S, Yoshimura H. Impact of oral health management on mental health and psychological disease: a scoping review. J Int Med Res 2023; 51:3000605221147186. [PMID: 36594601 PMCID: PMC9827524 DOI: 10.1177/03000605221147186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The relationship between oral and mental health has been controversial. Few studies have assessed the direct effects of oral health management on mental health and psychological disease. Using evidence from the last 5 years, this scoping review aimed to map and discuss recent progress in understanding this relationship. METHODS Electronic literature searches were performed using PubMed, Web of Science, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature databases. An additional manual search was performed using Google Scholar databases. Studies were selected using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow diagram. RESULTS An eligibility review process identified three randomized controlled trials for inclusion in this review. The oral health interventions and participants' target age, mental health status, and psychological diseases varied across these studies. The only study that reported an improvement included psychosocial support integrated with educational components of oral health as the intervention. The remaining two studies detected no significant impact of oral health interventions on mental health and psychological disease. CONCLUSIONS Evidence of the impact of oral health management on mental health and psychological disease is insufficient in studies published between 2017 and 2021.
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Affiliation(s)
- Shinpei Matsuda
- Shinpei Matsuda, Department of Dentistry
and Oral Surgery, Unit of Sensory and Locomotor Medicine, Division of Medicine,
Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki,
Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan.
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Joury E, Kisely S, Watt RG, Ahmed N, Morris AJ, Fortune F, Bhui K. Mental Disorders and Oral Diseases: Future Research Directions. J Dent Res 2023; 102:5-12. [PMID: 36081351 DOI: 10.1177/00220345221120510] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The poor physical health (including oral health) of people with mental disorders is a global problem. The burden of oral diseases among this group is substantial given their high prevalence and ability to increase the personal, social, and economic impacts of mental disorders. This article summarizes causes of mental disorders and oral diseases, critically reviews current evidence on interventions to reduce the burden of oral diseases in people with mental disorders, and suggests future research directions. The relationship between mental disorders and oral diseases is complex due to the shared social determinants and bidirectional interaction mechanisms that involve interconnected social, psychological, behavioral, and biological processes. Research has, to date, failed to produce effective and scalable interventions to tackle the burden of oral diseases among people with mental disorders. Transformative research and actions informed by a dynamic involvement of biological, behavioral, and social sciences are needed to understand and tackle the complex relationship between mental disorders and oral diseases, as well as inform the design of complex interventions. Examples of future research on complex public health, health service, and social care interventions are provided. The design and testing of these interventions should be carried out in real-world settings, underpinned by the principles of coproduction and systems thinking, and conducted by a transdisciplinary team. We propose this starts with setting research priorities and developing complex intervention theory, which we report to support future research to improve oral health and hence physical and mental health in this disadvantaged group.
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Affiliation(s)
- E Joury
- Centre for Dental Public Health and Primary Care, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, The Royal London Hospital, London, UK
| | - S Kisely
- PA-Southside Clinical Unit, School of Clinical Medicine, Faculty of Medicine, the University of Queensland, Woolloongabba, QLD, Australia
| | - R G Watt
- Research Department of Epidemiology & Public Health, University College London, London, UK
| | - N Ahmed
- Bristol Dental School, Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - A J Morris
- School of Dentistry, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - F Fortune
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, London, UK
| | - K Bhui
- Department of Psychiatry, Medical Sciences Division, University of Oxford, Oxford, UK
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Abdellatif HM. Poor mental health days is associated with higher odds of poor oral health outcomes in the BRFSS 2020. BMC Oral Health 2022; 22:500. [DOI: 10.1186/s12903-022-02543-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
To test the hypothesis that among individuals in the 2020 Behavioral Risk Factor Surveillance System (BRFSS) cross-sectional anonymous health survey in the United States (US), after controlling for confounding, an increasing number of poor mental health (MH) days in the past month is associated with increasing odds of delayed oral health (OH) care utilization and poorer OH outcomes.
Methods
Adjusted logistic regression models were developed with poor MH days as the exposure to examine the association with two dependent variables (DVs): Most recent dental visit longer than one year ago (yes/no), and having lost 6 or more teeth (yes/no).
Results
Approximately one third (32%) reported most recent dental visit more than one year ago, and 17% had lost 6 or more teeth. Those in the second quartile of poor MH days had 11% higher odds of delayed dental visit, and those in the highest quartile had 26% higher odds, compared to the reference group. For having lost 6 or more teeth, compared to the reference group, those in the third quartile had 8% higher odds and those in the fourth quartile had 18% higher odds.
Conclusions
Poor MH days is independently associated with odds of poor OH utilization and OH in the US above and beyond diagnosed mental and physical conditions. Policymakers in the US should expand health insurance plans to include dental insurance, and should increase access to MH care, especially for the aging population, and those with chronic conditions.
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Mishu MP, Faisal MR, Macnamara A, Sabbah W, Peckham E, Newbronner L, Gilbody S, Gega L. Exploring the contextual factors, behaviour change techniques, barriers and facilitators of interventions to improve oral health in people with severe mental illness: A qualitative study. Front Psychiatry 2022; 13:971328. [PMID: 36304558 PMCID: PMC9592713 DOI: 10.3389/fpsyt.2022.971328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
People with severe mental illness (SMI) have significantly poorer oral health compared to people without SMI and interventions targetted to improve oral health in this population failed to show any long-term improvement. Interventions are influenced by many contextual factors ranging from individual to systems level. This study aimed to understand the contextual factors, behaviour change techniques of the available oral health interventions and explore the barriers to and facilitators for engagement with these interventions from the perspectives of people with SMI (service users) and related service providers. Intervention details were extracted from 12 intervention studies identified from a previous systematic review using the template for intervention description and replication checklist (TIDieR) and behaviour change techniques (BCTs) were coded using the behaviour change technique taxonomy v1. Sixteen individual BCTs were identified and out of which "4.1 instructions on how to perform the behaviour" (n = 9) and "6.1 demonstration of behaviour" (n = 6) were most frequently used BCTs. Video vignettes prepared from the different intervention components identified from existing studies were shown to service users and service providers in dyadic or one-to-one interview format to elicit their views on barriers and facilitators for engagement with the intervention components. Interviews were analysed using Framework analysis and were guided by theoretical domains framework (TDF); and capability, opportunity and motivation (COM-B) model of behaviour change. Main facilitators identified to increase capability, opportunity and motivation of service users were the involvement of carers/care coordinators and integration of dental and mental health care, provision of oral health/hygiene information/products at an appropriate level and provision of tailored support according to individual needs and preferences. Barriers identified were related to lack of communication skills of the service providers, provision of coordinated care, lack of support in visiting a dentist and navigating the payment system and long follow up times. Appropriate training was considered as a facilitator, and staff turnovers and workload were considered as main barriers by the service providers. The findings suggest that comprehensive interventions that target barriers and enhance facilitators from individual to systems level are needed to improve oral health outcomes of people with SMI.
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Affiliation(s)
- Masuma Pervin Mishu
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Mehreen Riaz Faisal
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
| | | | - Wael Sabbah
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
| | - Emily Peckham
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
| | - Liz Newbronner
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom
| | - Simon Gilbody
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom.,Hull York Medical School, University of York, Heslington, United Kingdom
| | - Lina Gega
- Department of Health Sciences, Faculty of Sciences, University of York, Heslington, United Kingdom.,Hull York Medical School, University of York, Heslington, United Kingdom
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