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Title: An investigation of the most effective approach for the delivery of oral health promotion interventions to children
Author: Olajide, Omotayo Joan
ISNI:       0000 0004 5921 7925
Awarding Body: Teesside University
Current Institution: Teesside University
Date of Award: 2015
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Oral health promotion interventions (OHPI) seek to achieve sustainable oral health improvements through actions directed at the underlying determinants of oral health. Clinical trials often promise levels of effectiveness which are not actually achieved in general use, indicating problems with implementation. This study set out to identify an OHPI for which there was strong evidence of effectiveness and then aimed to explore issues that arose in the implementation of that intervention. Research methods A sequential portfolio design was utilised. The first phase involved systematic reviews of literature to identify existing community based OHPI and interventions shown to be effective in reducing dental caries. These were also examined to determine whether the existing evidence base was informative about the process of implementing best evidence. Systematic reviews were undertaken on effectiveness of: supervised toothbrushing with fluoridated toothpastes, supervised fluoridated mouthrinsing and promotion of dietary behaviours, all, in school children. MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE and BNI electronic databases were searched for articles published between 1990 and 2013. In total, 47 studies were included in the reviews: 21 studies on supervised toothbrushing with fluoridated toothpastes, 12 on fluoridated mouthrinsing and 14 studies on healthy dietary behaviours towards caries prevention. The second phase was a qualitative research study, which was undertaken to explore the experiences, and perceptions of participants involved in decision-making, planning and delivery of one specific community based OHPI (supervised toothbrushing) in the North East of England. Nineteen participants (NHS and school staff) participated in the qualitative study. Knowledge translation in oral health promotion One-to-one interviews and focus groups interviews were conducted with the participants. Normalisation Process Theory constructs informed the development of the interview guides and was also used in data analysis. In the third phase of the study, an integration of the findings of the first and second phases of the study was conducted. Results In the systematic reviews of literature conducted, the various levels of clinical effectiveness identified were influenced by appropriate and regular fluoride use, involvement of OHP specialists, supervision by parents and the free provision and availability of materials. There was however a general lack of comprehensive information on all aspects of implementation of OHPI. In the second phase of the study, an exploration of barriers to implementation of an OHPI revealed the following: -inadequate utilisation of research evidence -gaps in leadership and management structures -non- investment in engagement and ownership of the intervention -challenges with partnership working and evaluation of implementation of OHPI. Conclusions Availability of evidence of effectiveness of an intervention does not imply that the intervention will be successful when rolled out. Published articles on evidence-based interventions do not have comprehensive information on the mechanisms and workability of the processes required for effective implementation of OHPI. Normalisation Process Theory (NPT) enabled the exploration of factors that could facilitate knowledge translation and successful implementation of OHPI. In previous studies, NPT was used to evaluate effectiveness of interventions; in this study it was used to explore the implementation process of an OHPI and has highlighted the need for Knowledge translation in oral health promotion oral health promotion strategy makers and commissioners to revisit the “sense-making” aspect of evidence implementation, to reflect on the need for investing in all members of the team, to encourage the ‘ownership’ of interventions being implemented. In addition, there is a need to review existing leadership and management structures and to re-examine and amend the processes by which OHPI are monitored and reported. These measures would enable maximised effectiveness and sustainability of clinically effective OHPI.
Supervisor: Zohoori, Fatemeh Vida Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Oral health ; dental caries ; evidence-based dentistry ; normalisation process theory ; health promotion ; health plan implementation