A mixed methods evaluation of Childsmile's targeted and tailored Dental Health Support Worker intervention

Hodgins, Faith (2017) A mixed methods evaluation of Childsmile's targeted and tailored Dental Health Support Worker intervention. PhD thesis, University of Glasgow.

Abstract

This thesis contributes to a national evaluation of a Dental Health Support Worker (DHSW) intervention in Scotland. The DHSW intervention is a targeted component of Childsmile; an oral health improvement programme which aims to improve the oral health of children and reduce oral health inequalities. DHSWs facilitate families in registering with, and attending, a dental practice, support oral health behaviour change at home, and signpost families to wider community initiatives.

In programme development, elements proposed to be critical to the success of the DHSW intervention were: effective targeting of ‘the right children’ and ensuring the intervention is ‘tailored to families’ needs’. When the programme was rolled out across Scotland, there was a lack of consensus about how these elements should be implemented. Furthermore, some aspects of the programme were adapted to suit the characteristics of the local Scottish health boards.

This thesis aims to explore how ‘targeting’ and ‘tailoring’ were being implemented in the DHSW intervention, how they should be implemented in order to be optimally effective, and the effect of the DHSW intervention on dental participation at the early phase of implementation.

A systematic review and mixed methods study were conducted. The systematic review synthesised evidence on the implementation of tailoring in effective lay health worker interventions. The mixed methods study looked at how targeting and tailoring were implemented within the Childsmile DHSW intervention and its impact on child dental participation. The mixed methods study involved quantitative analysis of linked administrative health datasets and qualitative analysis of focus groups and interviews with Childsmile stakeholders, synthesising the findings from a pragmatic stance.

Findings show that ‘the right children’ were defined by stakeholders as any child in a family identified as vulnerable (for whatever reason) whose family must be ready to engage with the intervention. The right child is not every child or children in families facing acute health or social issues that may inhibit engagement.

In the early stage of implementation of the intervention, there was some evidence of targeting of the right children from a socio-economic and oral health risk position. Nonetheless, there were differences between health boards in the extent to which this targeted approach was adopted and the extent to which the Childsmile referral pathway was being utilised.

‘Tailoring to families’ needs’ should involve assessing individual families’ needs and then providing differential support matched to those specific needs. There was some evidence that DHSWs were tailoring the intervention in line with some of the features of tailoring found to be effective in other LHW programmes; however, there were many barriers that restricted DHSWs’ freedom to tailor to families’ needs. Barriers included: health visitors not providing background information with the referral; DHSWs having responsibilities outside of
Childsmile Practice; dental practices not notifying DHSWs of children who fail to attend appointments; a lack of consensus within the programme on whether DHSWs should deliver a brief intervention or whether it can be more intensive support where necessary; and, communication difficulties across language barriers.

Despite this, there was clear evidence that the DHSW intervention had been effective at this early stage of implementation. Moderate effects on dental participation were observed across Scotland in all risk groups. Across Scotland, there was a 17% difference in dental participation between groups who did and did not receive the intervention, and children were more likely to participate sooner if they had received an intervention.

Recommendations for the Childsmile programme follow three key themes: (1) reform the referral pathway; (2) develop working policies to help reduce organisational barriers to DHSWs delivering an effective intervention; and, (3) although challenging within the health service system, improve selection criteria of DHSWs and enhance subsequent training to highlight the unique benefits lay people bring to these roles.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Keywords: lay health worker, Childsmile, mixed methods, tailoring, targeting, evaluation, public heath, community dental, early years.
• Subjects: R Medicine > RA Public aspects of medicine
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Supervisor's Name: Sherriff, Dr. Andrea
• Date of Award: 2017
• Depositing User: Miss Faith Hodgins
• Unique ID: glathesis:2017-8086
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 06 Jun 2017 09:45
• Last Modified: 28 Jun 2017 12:30
• URI: https://theses.gla.ac.uk/id/eprint/8086