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Herlitz L, Ashford E, Powell C, Herbert K, Morris S, Woodman J. Access to primary care for children and young people (CYP) in the UK: a scoping review of CYP's, caregivers' and healthcare professionals' views and experiences of facilitators and barriers. BMJ Open 2024; 14:e081620. [PMID: 38816045 PMCID: PMC11141190 DOI: 10.1136/bmjopen-2023-081620] [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: 11/02/2023] [Accepted: 03/19/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVES To examine children and young people's (CYP), caregivers' and healthcare professionals' (HCPs) views or experiences of facilitators and barriers to CYP access to UK primary care services to better understand healthcare inequity. To explore differences across CYP subpopulations with greater health needs from deprived areas, identifying as ethnic minorities, with experiences of state care, special educational needs or disabilities, chronic conditions or mental health problems. DESIGN Scoping review. ELIGIBILITY CRITERIA Included studies were in English, published 2012-2022 and reported: the views/experiences of CYP (0-25 years), caregivers or HCPs about accessing UK primary care; using quantitative or qualitative empirical methods. DATA SOURCES PubMed, CINAHL, Web of Science, PsycINFO and Scopus. RESULTS We included 47 reports (46 studies). CYP/caregivers' decision to access care was facilitated by CYP/caregivers' or their family/friends' ability to identify a health issue as warranting healthcare attention. Barriers to accessing care included perceived stigma (eg, being seen as a bad parent), embarrassment and discrimination experiences. CYP and caregivers believed longer opening hours could facilitate more timely access to care. Caregivers and HCPs reported that delayed or rejected referrals to secondary or adult care were a barrier to having needs met, especially for CYP with poor mental health. CYP and caregivers in numerous studies emphasised the importance of communication and trust with HCPs, including taking their concerns seriously, being knowledgeable and providing continuity of care for CYP. Common barriers reported across high-need subpopulations were caregivers needing knowledge and confidence to advocate for their child, gaps in HCP's knowledge and a lack of connectedness between primary and secondary care. CONCLUSIONS Connecting general practices and community health workers/services, improving CYP/caregivers' understanding of common childhood conditions, addressing HCP's knowledge gaps in paediatric care and integrated approaches between primary and secondary care may reduce inequity in access.
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Affiliation(s)
- Lauren Herlitz
- NIHR Children and Families Policy Research Unit, Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
| | - Emily Ashford
- Thomas Coram Research Unit, UCL Social Research Institute, London, UK
| | - Claire Powell
- NIHR Children and Families Policy Research Unit, Population, Policy and Practice, UCL GOS Institute of Child Health, London, UK
| | - Kevin Herbert
- Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Morris
- Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Jenny Woodman
- Thomas Coram Research Unit, UCL Social Research Institute, London, UK
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El-Yousfi S, Marshman Z, Albers PN, Watt S, Kipping R, Williams JG. Health visiting teams and children's oral health: a scoping review. BMC Oral Health 2022; 22:594. [PMID: 36496377 PMCID: PMC9741786 DOI: 10.1186/s12903-022-02611-6] [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: 06/12/2022] [Accepted: 11/22/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recent policies have recommended early-life interventions to prevent caries. The four nations of the UK each have a national universal children's health programme, through which health visitors and their wider team (HVTs) promote health in the early years. HVT visits offer an opportunity to support parents to improve their child's oral health. A scoping review was conducted to provide a descriptive synthesis of the current literature related to the role of HVTs in improving the oral health of children 0-5 years old and to identify significant gaps for future research. This review informed the feasibility study of the First Dental Steps Intervention, a targeted health visitor-led infant oral health intervention in England. METHODS Electronic database searches for peer-reviewed literature were performed using Medline via Ovid and Web of Science (1946-2021). The quality of included intervention studies was assessed using the Effective Public Health Practice Project tool. Additionally, a grey literature search was conducted (key organisations, bibliographic and thesis databases, forwards and backwards citation, Google). RESULTS Thirty-nine publications, published between 1980 and 2021, were included. The majority of included papers were from the UK. The quality of intervention studies (n = 7) ranged from weak to strong. Thematic analysis identified the following themes: (1) professional knowledge, education, and training; (2) involvement of HVs in the delivery of oral health interventions; (3) effectiveness of interventions; (4) perspectives of HVs providing oral health advice and acceptability; and (5) barriers and facilitators to promoting oral health. The grey literature search identified 125 sources. HVT involvement was reported in a variety of source types: reports, guidance documents, evaluations, reviews, and training resources. HVTs were involved in oral health by providing oral health packs, brushing and oral health advice, registration and attendance, oral health training, risk assessment, and referral to dental services. CONCLUSION The current literature suggests that HVTs are well placed to improve children's oral health. Facilitators and barriers are encountered by HVTs in promoting oral health which should be considered by commissioners. There is a need for future high-quality studies that address the inadequacies found and provide further evidence of the effectiveness of HVT's oral health interventions.
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Affiliation(s)
- Sarab El-Yousfi
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Zoe Marshman
- grid.11835.3e0000 0004 1936 9262School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Patricia N. Albers
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Samantha Watt
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ruth Kipping
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna G. Williams
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Giles E, Wray F, Eskyte I, Gray-Burrows KA, Owen J, Bhatti A, Zoltie T, McEachan R, Marshman Z, Pavitt S, West RM, Day PF. HABIT: Health visitors delivering Advice in Britain on Infant Toothbrushing - an early-phase feasibility study of a complex oral health intervention. BMJ Open 2022; 12:e059665. [PMID: 36216423 PMCID: PMC9557312 DOI: 10.1136/bmjopen-2021-059665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To conduct an early-phase feasibility study of an oral health intervention, Health visitors delivering Advice on Britain on Infant Toothbrushing (HABIT), delivered by Health Visitors to parents of children aged 9-12 months old. DESIGN A mixed-methods, early-phase, non-controlled, feasibility study. PARTICIPANTS Recruitment consisted of Group A-HABIT-trained Health Visitors (n=11) and Group B-parents of children aged 9-12 months old about to receive their universal health check (n=35). SETTING Bradford, West Yorkshire, UK. INTERVENTION A multidisciplinary team co-developed digital and paper-based training resources with health visitors and parents of young children. The intervention comprised of two components: (A) training for health visitors to deliver the HABIT intervention and (B) HABIT resources for parents, including a website, videos, toothbrushing demonstration and a paper-based leaflet with an oral health action plan. PRIMARY AND SECONDARY OUTCOME MEASURES Recruitment, retention and intervention delivery were analysed as key process outcomes for Groups A and B. Group B demographics, self-reported toothbrushing behaviours, dietary habits and three objective measures of toothbrushing including plaque scores were collected at baseline, 2 weeks and 3 months post intervention. RESULTS HABIT intervention delivery was feasible. Although the intended sample size was recruited (Group A=11 and Group B=35) it was more challenging than anticipated. Retention of Group B participants to final data collection was satisfactory (n=26). Total compliance with toothbrushing guidelines at baseline was low (30%), but significantly improved and was maintained 3 months after the intervention (68%). Plaque scores improved post intervention and participants found video recording of toothbrushing acceptable. Dietary habits remained largely unchanged. CONCLUSION This feasibility study has demonstrated that HABIT is an appropriate oral health intervention. Adaptions to the study design are recommended to maximise recruitment and data collection in a definitive study. These quantitative findings have demonstrated an early signal of impact for improved oral health behaviours for young children at high risk of decay. TRIAL REGISTRATION NUMBER ISRCTN55332414.
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Affiliation(s)
- Erin Giles
- School of Dentistry, University of Leeds, Leeds, UK
| | - Faye Wray
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ieva Eskyte
- School of Law, University of Leeds, Leeds, UK
| | | | - Jenny Owen
- School of Dentistry, University of Leeds, Leeds, UK
| | - Amrit Bhatti
- School of Dentistry, University of Leeds, Leeds, UK
| | - Tim Zoltie
- School of Dentistry, University of Leeds, Leeds, UK
| | - Rosemary McEachan
- Born in Bradford, Bradford Institute of Health Research, Bradford, UK
| | - Z Marshman
- University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Sue Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Peter F Day
- School of Dentistry, University of Leeds, Leeds, UK
- Community Dental Service, Bradford District Care NHS Foundation Trust, Bradford, UK
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Owen J, Gray-Burrows KA, Eskytė I, Wray F, Bhatti A, Zoltie T, Staples A, Giles E, Lintin E, West R, Pavitt S, McEachan RRC, Marshman Z, Day PF. Co-design of an oral health intervention (HABIT) delivered by health visitors for parents of children aged 9-12 months. BMC Public Health 2022; 22:1818. [PMID: 36153572 PMCID: PMC9508763 DOI: 10.1186/s12889-022-14174-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dental caries (tooth decay) in children is a national public health problem with impacts on the child, their family and wider society. Toothbrushing should commence from the eruption of the first primary tooth. Health visitors are a key provider of advice for parents in infancy and are ideally placed to support families to adopt optimal oral health habits. HABIT is a co-designed complex behaviour change intervention to support health visitors' oral health conversations with parents during the 9-12-month universal developmental home visit. METHODS A seven stage co-design process was undertaken: (1) Preparatory meetings with healthcare professionals and collation of examples of good practice, (2) Co-design workshops with parents and health visitors, (3) Resource development and expert/peer review, (4) Development of an intervention protocol for health visitors, (5) Early-phase testing of the resources to explore acceptability, feasibility, impact and mechanism of action, (6) Engagement with wider stakeholders and refinement of the HABIT intervention for wider use, (7) Verification, Review and Reflection of Resources. RESULTS Following preparatory meetings with stakeholders, interviews and co-design workshops with parents and health visitors, topic areas and messages were developed covering six key themes. The topic areas provided a structure for the oral health conversation and supportive resources in paper-based and digital formats. A five-step protocol was developed with health visitors to guide the oral health conversation during the 9-12 month visit. Following training of health visitors, an early-phase feasibility study was undertaken with preliminary results presented at a dissemination event where feedback for further refinement of the resources and training was gathered. The findings, feedback and verification have led to further refinements to optimise quality, accessibility, fidelity and behaviour change theory. CONCLUSION The co-design methods ensured the oral health conversation and supporting resources used during the 9-12 month visit incorporated the opinions of families and Health Visitors as well as other key stakeholders throughout the development process. This paper provides key learning and a framework that can be applied to other healthcare settings. The structured pragmatic approach ensured that the intervention was evidence-based, acceptable and feasible for the required context. TRIAL REGISTRATION ISRCTN55332414, Registration Date 11/11/2021.
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Affiliation(s)
- Jenny Owen
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Kara A Gray-Burrows
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK.
| | - Ieva Eskytė
- School of Law, The Liberty Building, University of Leeds, Leeds, LS2 9JT, UK
| | - Faye Wray
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Amrit Bhatti
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Timothy Zoltie
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Annalea Staples
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Erin Giles
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
| | - Edwina Lintin
- Bradford District Care NHS Foundation Trust, Children's Community Services' (currently on secondment to Better Start Bradford), Bradford, UK
| | - Robert West
- Faculty of Medicine and Health, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Sue Pavitt
- Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Zoe Marshman
- School of Clinical Dentistry, Faculty of Medicine, Dentistry & Health, University of Sheffield, Sheffield, S10 2TA, UK
| | - Peter F Day
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, LS2 9JT, UK
- Bradford Community Dental Service, Bradford District Care NHS Foundation Trust, Bradford, UK
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Bhatti A, Wray F, Eskytė I, Gray-Burrows KA, Owen J, Giles E, Zoltie T, Smith V, Pavitt S, West R, McEachan RR, Marshman Z, Day PF. HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing): a qualitative exploration of the acceptability of a complex oral health intervention. BMC PRIMARY CARE 2022; 23:55. [PMID: 35346054 PMCID: PMC8962587 DOI: 10.1186/s12875-022-01659-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 02/28/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND To explore the acceptability of the oral health intervention, HABIT (Health visitors delivering Advice in Britain on Infant Toothbrushing) to parents with young children aged 9-12 months and health visitors. METHODS Following the delivery of the universal oral health intervention called HABIT, qualitative semi-structured interviews with parents and focus groups with health visitors were undertaken. Interviews were audio-recorded and transcribed. Health visitors completed self-reported diaries after delivering the HABIT intervention with parents. The qualitative data was analysed using framework analysis (guided by a theoretical framework of acceptability). RESULTS Seventeen parents were interviewed, and five health visitors and three nursery nurses participated in two focus groups. Parents reported health visitors to be 'trusted' and valued the reassurance provided during the HABIT visit. Health visitors found the HABIT training and resources useful and valued the consistency and increased confidence in undertaking oral health conversations. There were, however, challenges in changing behaviour where families faced competing demands on time and resources. Both health visitors and parents described the importance of the intervention's timing and suggested that multiple visits may be needed to support optimal oral health habits. CONCLUSION The HABIT intervention was acceptable to parents and health visitors. Health visitors would welcome a further refinement to enhance intervention delivery that specifically achieves a balance between using a guided script and retaining the flexibility to adapt the conversation to suit the needs of individual families. This, in turn, will maximise impact and enable parents of young children to adopt and maintain optimal home-based oral health behaviours for their child.
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Affiliation(s)
- Amrit Bhatti
- University of Leeds, Leeds, United Kingdom, England.
| | - Faye Wray
- Bradford Institute for Health Research, Bradford, United Kingdom, England
| | - Ieva Eskytė
- University of Leeds, Leeds, United Kingdom, England
| | | | - Jenny Owen
- University of Leeds, Leeds, United Kingdom, England
| | - Erin Giles
- University of Leeds, Leeds, United Kingdom, England
| | | | - Victoria Smith
- Bradford Institute for Health Research, Bradford, United Kingdom, England
| | - Sue Pavitt
- University of Leeds, Leeds, United Kingdom, England
| | - Robert West
- University of Leeds, Leeds, United Kingdom, England
| | | | - Zoe Marshman
- University of Sheffield, Sheffield, United Kingdom, England
| | - Peter F Day
- University of Leeds, Leeds, United Kingdom, England
- Bradford Community Dental Service, Bradford District Care NHS Foundation Trust, Bradford, United Kingdom, England
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