Optimising the role of the dental health support worker in Childsmile Practice: a comparative Realist approach

Young, Mairi Anne (2017) Optimising the role of the dental health support worker in Childsmile Practice: a comparative Realist approach. PhD thesis, University of Glasgow.

Abstract

Background: Childsmile, the national oral health improvement programme for children in Scotland, aims to reduce oral health inequalities and improve access to dental services. Childsmile is delivered, in part, by a new category of lay or community-based worker known as a Dental Health Support Worker (DHSW) who supports families to improve oral health behaviours and attend a dental practice. Findings from Childsmile’s national process evaluation indicated there was widespread variation in delivery of the DHSW role and additional research was required to further understand and develop programme theory for the DHSW role; and clarify areas of variation which were adaptive and which were a risk to the programme meeting its desired objectives.
Aims: The overarching aim was to gain further understanding of which factors and variants (contextual and those associated with programme delivery) impact on effectiveness of the DHSW role within Childsmile Practice. This research is a component study of the national Childsmile evaluation strategy. Findings will be fed back to the Childsmile programme to optimise delivery of the role and to enable future evaluation of the role’s impact.
Methods: Learning and evidence generation was triangulated from two phases of research, comprising three component studies. Phase 1 comprised the sensitising study and comparative case studies: both provided learning from within Childsmile. The sensitising study was designed as a scoping exercise using qualitative data collection methods. The aim was to establish existing programme theory and explicate delivery of the DHSW role, while uncovering deviation (from programme theory) and variation within and between NHS boards. Findings were used to design three comparative case studies, comprising one DHSW and key stakeholders involved in delivery of the role from three NHS boards. The comparative case studies employed qualitative data collection methods; and were designed to address the overarching aim, and explore the casual links between context, delivery, and outcomes in delivery of the role using Realist-inspired analysis. Phase 2 comprised a Realist Review to provide learning from out with Childsmile. The aim was to gain an understanding of which components of child health interventions, delivered by lay health workers to parents, could influence ‘child health parenting behaviours’.
Findings and Conclusions: Findings indicated that in terms of motivational readiness to engage with positive oral health parenting behaviours (POHPBs) there were three types of families referred to the DHSW for support: low, moderate, and high-risk. It was established that to address programme aims DHSWs ought to support moderate-high risk families, yet DHSWs only had capacity to support low-moderate risk families. Findings demonstrated that the Public Health Nurses/Health Visitors were best placed to triage families according to their needs and motivational readiness. The peer-ness of the DHSW role was found to positively influence parental engagement with the programme and facilitate person-centred support. However, an embedded ‘sweetie culture’ and health damaging environments were found to negatively impact on parents’ self-efficacy and perceived locus of control to engage with POHPBs. Learning indicated that: delivery over a prolonged period of time; incorporation of the programme into the Early Years Pathway and GIRFEC policy; and recent changes to the Children and Young Person (Scotland) Act (2014), served to embed Childsmile within the NHS boards and facilitated stakeholder buy-in, which positively impacted on delivery of the role.
From the learning derived within and out with Childsmile the recommendations for the DHSW role included: (1) DHSW support should move away from a primarily information provision and facilitation of families into dental practice role, and incorporate socio-emotional and person-centred support; (2) The DHSW role should be redefined to support moderate-high risk families; and interpretation and application of referral criteria should be addressed to ensure continuity with who is referred for support; and (3) Programme theory for the DHSW role should be refined and future evaluative effort should concentrate on assessing impact.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Keywords: Childsmile, oral health, Realist, case study, inequalities, lay health workers, child health, parents, health behaviours, NHS.
• Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine; R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services; R Medicine > RK Dentistry
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Dental School
• Supervisor's Name: Gnich, Dr. Wendy, Andrea, Dr. Sherriff and Ross, Dr. Alastair
• Date of Award: 2017
• Depositing User: Dr. Mairi. A. Young
• Unique ID: glathesis:2017-8111
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 03 May 2017 13:42
• Last Modified: 09 May 2017 11:22
• URI: https://theses.gla.ac.uk/id/eprint/8111