Sharon M. Casey, Mabeline Velez, Robert McDonough, Julia C. Bond, Raul Garcia, Neha Gondal, Brenda Heaton
Purpose
Individual behaviours are often shared within social networks (homophily), suggesting network-level interventions hold promise for health promotion. Yet, little is known about oral health homophily. This study aimed to identify individual- and network-based predictors of oral health homophily among individual's (ego) social networks of public housing residents.
Methods
Respondents self-reported demographics, oral health status and associated risk behaviours (n = 277). They named social contacts (alters), reported on relationship attributes, demographics and behavioural characteristics (n = 889). Hypothesised predictors of oral health homophily included relationship attributes (e.g., contact frequency), respondent-level and shared characteristics. Oral health homophily was modelled using multilevel (hierarchical) logistic regression evaluating model attributes (AIC) to determine gains in explanatory power.
Results
Relationship strength, including high frequency of shared meals and contact, was associated with higher odds of oral health homophily (OR [95% CI]: 1.92 [1.05, 3.52] and 1.62 [1.00, 2.63], respectively). The best performing model included daily shared meals and contact, respondent age, smoking and oral health status.
Conclusions
Oral health homophily is predicted by relationship strength and ‘excellent/very good/good’ oral health. Respondents with poorer oral health and a smoking history were less homophilous in oral health. Multilevel interventions targeting oral health outcomes may benefit from accounting for social relationships.
{"title":"Modelling Predictors of Homophily on Perceived Oral Health Status Among Social Network Ties in a Population of Public Housing Residents","authors":"Sharon M. Casey, Mabeline Velez, Robert McDonough, Julia C. Bond, Raul Garcia, Neha Gondal, Brenda Heaton","doi":"10.1111/cdoe.13034","DOIUrl":"10.1111/cdoe.13034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Individual behaviours are often shared within social networks (homophily), suggesting network-level interventions hold promise for health promotion. Yet, little is known about oral health homophily. This study aimed to identify individual- and network-based predictors of oral health homophily among individual's (ego) social networks of public housing residents.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Respondents self-reported demographics, oral health status and associated risk behaviours (<i>n</i> = 277). They named social contacts (alters), reported on relationship attributes, demographics and behavioural characteristics (<i>n</i> = 889). Hypothesised predictors of oral health homophily included relationship attributes (e.g., contact frequency), respondent-level and shared characteristics. Oral health homophily was modelled using multilevel (hierarchical) logistic regression evaluating model attributes (AIC) to determine gains in explanatory power.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Relationship strength, including high frequency of shared meals and contact, was associated with higher odds of oral health homophily (OR [95% CI]: 1.92 [1.05, 3.52] and 1.62 [1.00, 2.63], respectively). The best performing model included daily shared meals and contact, respondent age, smoking and oral health status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Oral health homophily is predicted by relationship strength and ‘excellent/very good/good’ oral health. Respondents with poorer oral health and a smoking history were less homophilous in oral health. Multilevel interventions targeting oral health outcomes may benefit from accounting for social relationships.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 3","pages":"329-336"},"PeriodicalIF":1.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.13034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To report the epidemiology and socioeconomic correlates of salivary gland cancers (SGCs) at global, regional and national levels by age, sex and country.
Methods
Data on the incidence and mortality of SGC for the year 2020 were extracted from the Global Cancer Observatory. The relationships between incidence and mortality rates with the human development index (HDI) and the ratio of current healthcare expenditure to gross domestic product were investigated using bivariate correlation tests. Also, projections for new cancer cases or mortalities in a specific nation or region between 2025 and 2040 were estimated by multiplying age-specific incidence or mortality rates, with the anticipated population for the years 2025–2040.
Results
In 2020, the global crude incidence and mortality rates of SGC were 0.69 and 0.29, respectively. Among the World Health Organization regions, the Americas and Africa had the highest SGC age-standardised incidence rate (ASIR) and age-standardised mortality rate (ASMR), respectively. By HDI classification, the very high HDI group had the highest SGC ASIR at 0.69, whereas the low HDI group had the highest SGC ASMR at 0.49. Among different age groups, those aged 70+ had the highest SGC incidence and mortality crude rates. Globally, males had higher SGC incidence and mortality crude rates than females. A strong negative correlation was found between HDI and SGC ASMR and the mortality-to-incidence ratio (p < 0.001). By 2040, the global incidence and mortality numbers of SGC are projected to increase by 50% and 60%, respectively.
Conclusions
These findings provide crucial insight into the global distribution and disparities in SGC care quality. Furthermore, this report has the potential to aid in the planning of SGC control initiatives.
{"title":"Global Epidemiology and Socioeconomic Correlates of Salivary Gland Cancer From 2020 to 2040","authors":"Seyed Ehsan Mousavi, Hoomaan Ghasemi, Morvarid Najafi, Seyed Aria Nejadghaderi","doi":"10.1111/cdoe.13033","DOIUrl":"10.1111/cdoe.13033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To report the epidemiology and socioeconomic correlates of salivary gland cancers (SGCs) at global, regional and national levels by age, sex and country.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data on the incidence and mortality of SGC for the year 2020 were extracted from the Global Cancer Observatory. The relationships between incidence and mortality rates with the human development index (HDI) and the ratio of current healthcare expenditure to gross domestic product were investigated using bivariate correlation tests. Also, projections for new cancer cases or mortalities in a specific nation or region between 2025 and 2040 were estimated by multiplying age-specific incidence or mortality rates, with the anticipated population for the years 2025–2040.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In 2020, the global crude incidence and mortality rates of SGC were 0.69 and 0.29, respectively. Among the World Health Organization regions, the Americas and Africa had the highest SGC age-standardised incidence rate (ASIR) and age-standardised mortality rate (ASMR), respectively. By HDI classification, the very high HDI group had the highest SGC ASIR at 0.69, whereas the low HDI group had the highest SGC ASMR at 0.49. Among different age groups, those aged 70+ had the highest SGC incidence and mortality crude rates. Globally, males had higher SGC incidence and mortality crude rates than females. A strong negative correlation was found between HDI and SGC ASMR and the mortality-to-incidence ratio (<i>p</i> < 0.001). By 2040, the global incidence and mortality numbers of SGC are projected to increase by 50% and 60%, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings provide crucial insight into the global distribution and disparities in SGC care quality. Furthermore, this report has the potential to aid in the planning of SGC control initiatives.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 3","pages":"316-328"},"PeriodicalIF":1.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Annika Wilson, Cailin Davies, Silvana Bettiol, Heather Bridgman, Leonard Crocombe, Ha Hoang
Objective
The current Australian Pregnancy Care guidelines recommend that antenatal care providers discuss oral health, provide advice and refer women to dental professionals as needed. However, the delivery of oral health recommendations in antenatal settings appears substandard. This study aimed to identify the barriers and enablers influencing antenatal care providers' adoption of the oral health guidelines.
Methods
A qualitative study was conducted using semi-structured interviews with a purposive sample of antenatal care providers in Tasmania, Australia. Data analysis followed a thematic coding method using the Capability, Opportunity, Motivation - Behaviour (COM-B) model and Theoretical Domains Framework to identify implementation barriers and enablers and to inform recommendations.
Results
Twenty-five antenatal care providers participated (midwives n = 14, general practitioners n = 10 and obstetrician-gynaecologist n = 1). Thirty-two explanatory themes were identified and mapped directly to six COM-B constructs and 11 Theoretical Domains Framework domains. Eight main themes were identified as both impeding and enabling when viewed in different contexts: (1) perceived patient knowledge and awareness; (2) professional oral health knowledge, training and skills; (3) awareness of the guidelines on oral health; (4) patient education and professional resources; (5) interprofessional collaboration and support; (6) streamlined referral processes and access to dental services; (7) perceived outcomes of oral health interventions; and (8) perceived professional responsibility related to oral health.
Conclusions
Key strategies include improvements to the promotion and dissemination of relevant guidelines, professional education and training, and development and adoption of oral health-centred models of care to support interprofessional collaboration. Future research should focus on developing brief and sustainable interventions that address antenatal care providers’ practice behaviours.
{"title":"Why Aren't Antenatal Care Providers Adopting Oral Health Guidelines? A Qualitative Exploration","authors":"Annika Wilson, Cailin Davies, Silvana Bettiol, Heather Bridgman, Leonard Crocombe, Ha Hoang","doi":"10.1111/cdoe.13030","DOIUrl":"10.1111/cdoe.13030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The current Australian Pregnancy Care guidelines recommend that antenatal care providers discuss oral health, provide advice and refer women to dental professionals as needed. However, the delivery of oral health recommendations in antenatal settings appears substandard. This study aimed to identify the barriers and enablers influencing antenatal care providers' adoption of the oral health guidelines.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative study was conducted using semi-structured interviews with a purposive sample of antenatal care providers in Tasmania, Australia. Data analysis followed a thematic coding method using the Capability, Opportunity, Motivation - Behaviour (COM-B) model and Theoretical Domains Framework to identify implementation barriers and enablers and to inform recommendations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-five antenatal care providers participated (midwives <i>n</i> = 14, general practitioners <i>n</i> = 10 and obstetrician-gynaecologist <i>n</i> = 1). Thirty-two explanatory themes were identified and mapped directly to six COM-B constructs and 11 Theoretical Domains Framework domains. Eight main themes were identified as both impeding and enabling when viewed in different contexts: (1) perceived patient knowledge and awareness; (2) professional oral health knowledge, training and skills; (3) awareness of the guidelines on oral health; (4) patient education and professional resources; (5) interprofessional collaboration and support; (6) streamlined referral processes and access to dental services; (7) perceived outcomes of oral health interventions; and (8) perceived professional responsibility related to oral health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Key strategies include improvements to the promotion and dissemination of relevant guidelines, professional education and training, and development and adoption of oral health-centred models of care to support interprofessional collaboration. Future research should focus on developing brief and sustainable interventions that address antenatal care providers’ practice behaviours.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 3","pages":"286-295"},"PeriodicalIF":1.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.13030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abby L. J. Hensel, Kathryn Nicholson, Kelly K. Anderson, Noha A. Gomaa
Objectives
To investigate the extent of the association of adverse childhood experiences (ACEs) with co-occurring poor self-reported oral health (SROH) and multimorbidity in middle-aged and older adults, and whether these associations differ by age and sex.
Methods
This cross-sectional study used data from 27 765 adults aged 45–85 years from the first follow-up wave (2015–2018) of the Canadian Longitudinal Study on Aging (CLSA). Four categories were generated to assess co-occurring SROH and multimorbidity: (i) good SROH, no multimorbidity; (ii) poor SROH, no multimorbidity; (iii) good SROH, multimorbidity and (iv) poor SROH and multimorbidity. Age-and sex-stratified multinomial logistic regressions were used to examine associations of ACEs (e.g. childhood maltreatment, neglect, parental death, serious illness or separation) with co-occurring poor SROH and multimorbidity, adjusted for the confounders race/ethnicity, income, level of education, smoking status and alcohol consumption.
Results
Over a third of participants reported having multimorbidity (35.3%), 10.4% reported poor SROH, and almost 30% of participants had experienced at least one ACE. There was a gradient in the association between higher ACEs and each of the health outcome categories, with the greater odds being for the co-occurrence of poor SROH and multimorbidity (OR = 1.37, 95% CI: 1.30, 1.44). The associations between ACEs and adverse health outcomes in later life were significant across age groups and sexes, with middle-aged females demonstrating the strongest associations.
Conclusions
ACEs are linked to an increased non-communicable chronic disease burden and poor oral health among middle-aged and older Canadians, highlighting the importance of prevention in early life and the focus on psychosocial factors over the life course for healthy aging.
{"title":"Adverse Childhood Experiences and the Co-occurrence of Poor Oral Health and Multimorbidity: Findings From the Canadian Longitudinal Study on Aging","authors":"Abby L. J. Hensel, Kathryn Nicholson, Kelly K. Anderson, Noha A. Gomaa","doi":"10.1111/cdoe.13032","DOIUrl":"10.1111/cdoe.13032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To investigate the extent of the association of adverse childhood experiences (ACEs) with co-occurring poor self-reported oral health (SROH) and multimorbidity in middle-aged and older adults, and whether these associations differ by age and sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional study used data from 27 765 adults aged 45–85 years from the first follow-up wave (2015–2018) of the Canadian Longitudinal Study on Aging (CLSA). Four categories were generated to assess co-occurring SROH and multimorbidity: (i) good SROH, no multimorbidity; (ii) poor SROH, no multimorbidity; (iii) good SROH, multimorbidity and (iv) poor SROH and multimorbidity. Age-and sex-stratified multinomial logistic regressions were used to examine associations of ACEs (e.g. childhood maltreatment, neglect, parental death, serious illness or separation) with co-occurring poor SROH and multimorbidity, adjusted for the confounders race/ethnicity, income, level of education, smoking status and alcohol consumption.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Over a third of participants reported having multimorbidity (35.3%), 10.4% reported poor SROH, and almost 30% of participants had experienced at least one ACE. There was a gradient in the association between higher ACEs and each of the health outcome categories, with the greater odds being for the co-occurrence of poor SROH and multimorbidity (OR = 1.37, 95% CI: 1.30, 1.44). The associations between ACEs and adverse health outcomes in later life were significant across age groups and sexes, with middle-aged females demonstrating the strongest associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ACEs are linked to an increased non-communicable chronic disease burden and poor oral health among middle-aged and older Canadians, highlighting the importance of prevention in early life and the focus on psychosocial factors over the life course for healthy aging.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 3","pages":"307-315"},"PeriodicalIF":1.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.13032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kamal Hanna, Ninuk Hariyani, Gloria Mejia, Lisa Jamieson, David S. Brennan
Background
Temporomandibular dysfunction (TMD) experience might impair oral health-related quality of life (OHRQoL). Causal inference using population-based cross-sectional data is challenging given the potential for bias. Propensity Score Subclassification (PS-Subclassification) provides a tool to mitigate confounding bias. The aim of this study was to estimate the Population-Average Treatment Effect (PATE) of having TMD experience among Australian adults on OHRQoL using PS-Subclassification and statistically estimated Minimally Important Differences (MID-S).
Method
Australia's National Survey of Adult Oral Health (NSAOH) 2004–06 data were used which included a Computer Assisted Telephone Interview, mailed questionnaire and oral epidemiological examination. Data included demographics, socioeconomics, caries experience (DMFT index), periodontitis, TMD experience using the TMD Diagnostic Criteria Question, the Oral Health Impact Profile (OHIP-14) and perceived stress. Analysis steps included: (1) generating propensity scores (PS) for TMD experience probability using causal model-derived confounders while incorporating survey design elements; (2) PS-Subclassification and weighting; (3) assessing common support and group balance and (4) estimating the PATE for TMD experience on OHIP-14 overall and domains scores using complex samples GLM.
Results
Of the 4063 NSAOH participants, 397 with TMD and 3656 without TMD were included in PS-Subclassification (all data were used) and shared common support for their PS and established adequate covariate balance (SMD < 0.2). Experiencing TMD had higher OHIP-14 total scores (B = 3.498, 95% CI: 2.218–4.778) with a small MID-S (Cohen's F2 = 0.03). TMD experience impaired all OHIP-14 domains (p < 0.05) with physical pain and psychological domains among the highest impaired OHIP-14 domains with a small MID-S.
Conclusion
TMD experience impaired the overall OHRQoL measured by the OHIP-14 among Australian adults with a small MID-S. Physical pain and psychological domains were among the highest impaired OHRQoL domains with a small MID-S. Clinicians and policymakers might consider these findings to support TMD screening and patient-centred management.
{"title":"Using Propensity Score Subclassification to Estimate the Population-Average Causal Effect of Temporomandibular Dysfunction Experience on Oral Health-Related Quality of Life Among Australian Adults","authors":"Kamal Hanna, Ninuk Hariyani, Gloria Mejia, Lisa Jamieson, David S. Brennan","doi":"10.1111/cdoe.13027","DOIUrl":"10.1111/cdoe.13027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Temporomandibular dysfunction (TMD) experience might impair oral health-related quality of life (OHRQoL). Causal inference using population-based cross-sectional data is challenging given the potential for bias. Propensity Score Subclassification (PS-Subclassification) provides a tool to mitigate confounding bias. The aim of this study was to estimate the Population-Average Treatment Effect (PATE) of having TMD experience among Australian adults on OHRQoL using PS-Subclassification and statistically estimated Minimally Important Differences (MID-S).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>Australia's National Survey of Adult Oral Health (NSAOH) 2004–06 data were used which included a Computer Assisted Telephone Interview, mailed questionnaire and oral epidemiological examination. Data included demographics, socioeconomics, caries experience (DMFT index), periodontitis, TMD experience using the TMD Diagnostic Criteria Question, the Oral Health Impact Profile (OHIP-14) and perceived stress. Analysis steps included: (1) generating propensity scores (PS) for TMD experience probability using causal model-derived confounders while incorporating survey design elements; (2) PS-Subclassification and weighting; (3) assessing common support and group balance and (4) estimating the PATE for TMD experience on OHIP-14 overall and domains scores using complex samples GLM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 4063 NSAOH participants, 397 with TMD and 3656 without TMD were included in PS-Subclassification (all data were used) and shared common support for their PS and established adequate covariate balance (SMD < 0.2). Experiencing TMD had higher OHIP-14 total scores (<i>B</i> = 3.498, 95% CI: 2.218–4.778) with a small MID-S (Cohen's <i>F</i><sup>2</sup> = 0.03). TMD experience impaired all OHIP-14 domains (<i>p</i> < 0.05) with physical pain and psychological domains among the highest impaired OHIP-14 domains with a small MID-S.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>TMD experience impaired the overall OHRQoL measured by the OHIP-14 among Australian adults with a small MID-S. Physical pain and psychological domains were among the highest impaired OHRQoL domains with a small MID-S. Clinicians and policymakers might consider these findings to support TMD screening and patient-centred management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 3","pages":"265-277"},"PeriodicalIF":1.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.13027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emma Fletcher, Andrea Sherriff, Denise Duijster, Maddelon de Jong-Lenters, Al Ross
<div> <section> <h3> Background</h3> <p>Scotland's National Oral Health Programme for Children, Childsmile, provides targeted home toothbrushing support for families of young children (0–3 years) in the home setting. The study describes the adaptation of an existing dental practice-based intervention from the Netherlands using pictorial cards (<i>Uitblinkers</i>) for use in the programme. The aims were to modify Uitblinkers for the setting and context in Scotland by: (1) identifying the barriers that parents/carers in need of extra support face in implementing supervised toothbrushing; (2) explore consensus about behaviour change techniques that are appropriate and valid to address these; and (3) making recommendations for the design of a co-produced home-support tool and identifying facilitators for implementation in practice.</p> </section> <section> <h3> Methods</h3> <p>A modified Delphi study was carried out consisting of two survey rounds with a purposively recruited expert panel (<i>n</i> = 21) to develop consensus on home toothbrushing barriers (aim 1), behaviour change techniques (aim 2) and considerations for implementation (aim 3). Proposition statements for the Delphi were derived from literature, discussions with project advisors and from <i>Uitblinkers</i>, an existing behaviour change intervention for parents developed by the Academic Centre for Dentistry Amsterdam (ACTA) and delivered in dental practice. Then 12 in-depth, semi-structured interviews were conducted with Dental Health Support Workers in Scotland (delivering the home support toothbrushing intervention) to gather the views on the proposed toothbrushing barriers, behaviour change techniques and considerations for implementation (aim 1 to 3). Delphi results are presented descriptively in terms of percentage agreement and priority ratings. Interview transcripts were analysed using Template Analysis.</p> </section> <section> <h3> Results</h3> <p>From the Delphi study, a final set of 11 overlapping child, parent and environmental/social toothbrushing barriers was agreed upon (aim 1), to be addressed through a tool based on applied Motivational Interviewing, and a combination of Operant Conditioning, Stimulus Control and Goal-Setting techniques (aim 2). Experts supported the tool as realistic for delivery in the home setting, provided staff were trained. A physical ‘paper’ tool was preferred to a proposed electronic version (aim 3). Themes from interviews were: (1) the barriers present an exhaustive set and are valid from staff experience with families; (2) Motivational interviewing is appropriate and fits with usual practice; (3) the included behaviour change techniques are wo
{"title":"Developing a Prototype Home-Based Toothbrushing Support Tool for Families in Scotland: A Mixed-Methods Study With Modified Delphi Survey and Semi-Structured Interviews","authors":"Emma Fletcher, Andrea Sherriff, Denise Duijster, Maddelon de Jong-Lenters, Al Ross","doi":"10.1111/cdoe.13031","DOIUrl":"10.1111/cdoe.13031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Scotland's National Oral Health Programme for Children, Childsmile, provides targeted home toothbrushing support for families of young children (0–3 years) in the home setting. The study describes the adaptation of an existing dental practice-based intervention from the Netherlands using pictorial cards (<i>Uitblinkers</i>) for use in the programme. The aims were to modify Uitblinkers for the setting and context in Scotland by: (1) identifying the barriers that parents/carers in need of extra support face in implementing supervised toothbrushing; (2) explore consensus about behaviour change techniques that are appropriate and valid to address these; and (3) making recommendations for the design of a co-produced home-support tool and identifying facilitators for implementation in practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A modified Delphi study was carried out consisting of two survey rounds with a purposively recruited expert panel (<i>n</i> = 21) to develop consensus on home toothbrushing barriers (aim 1), behaviour change techniques (aim 2) and considerations for implementation (aim 3). Proposition statements for the Delphi were derived from literature, discussions with project advisors and from <i>Uitblinkers</i>, an existing behaviour change intervention for parents developed by the Academic Centre for Dentistry Amsterdam (ACTA) and delivered in dental practice. Then 12 in-depth, semi-structured interviews were conducted with Dental Health Support Workers in Scotland (delivering the home support toothbrushing intervention) to gather the views on the proposed toothbrushing barriers, behaviour change techniques and considerations for implementation (aim 1 to 3). Delphi results are presented descriptively in terms of percentage agreement and priority ratings. Interview transcripts were analysed using Template Analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From the Delphi study, a final set of 11 overlapping child, parent and environmental/social toothbrushing barriers was agreed upon (aim 1), to be addressed through a tool based on applied Motivational Interviewing, and a combination of Operant Conditioning, Stimulus Control and Goal-Setting techniques (aim 2). Experts supported the tool as realistic for delivery in the home setting, provided staff were trained. A physical ‘paper’ tool was preferred to a proposed electronic version (aim 3). Themes from interviews were: (1) the barriers present an exhaustive set and are valid from staff experience with families; (2) Motivational interviewing is appropriate and fits with usual practice; (3) the included behaviour change techniques are wo","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 3","pages":"296-306"},"PeriodicalIF":1.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.13031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anne Nordrehaug Åstrøm, Berit Mastrovito, Josefine Sannevik, Stein Atle Lie, Anders Johansson, Ann-Katrin Johansson
Objectives
Focusing on two birth cohorts of older adults, this study aimed to (1) describe the development of oral health-related quality of life (OHRQoL) across time from 2007 to 2022 and (2) assess sociodemographic inequalities in OHRQoL and whether these inequalities remain stable, widen or narrow during the follow-up period.
Methods
In 1992 and 2007 the 1942 and 1932 birth cohorts living in the Swedish counties of Örebro and Östergotland participated with 6346 (response 71.4%) and 3735 individuals (response 71.9%), respectively. Of the 6346 1942 birth cohort participants, 2479 (38.5% of baseline) completed postal follow-ups in 1997, 2002, 2007, 2012, 2017 and 2022. Of the 3735 1932 birth cohort participants, 751 (20% of baseline) participated also in 2012, 2017 and 2022. Oral impacts of daily performance (OIDP) and socio-demographic characteristics were assessed at each survey year. A cohort table depicted the prevalence rates of OIDP (OIDP > 0) across time, disentangling age, period and cohort effects. Logistic mixed models with interaction terms of each socio-demographic covariate and time were used to test differences in socio-demographic inequalities of oral impacts over time.
Results
Between 2007 and 2022, OIDP > 0 varied from 22.7% to 28.7% in the 1932 birth cohort (age 75–90) and from 25.3% to 26.6% in the 1942 cohort (age 65–80). Mixed models revealed that cluster specific odds ratios (ORs) for OIDP > 0 varied from 0.2 to 2.5 with respect to avoidance of dental care due to cost and health perceptions in the 1942 cohort. Corresponding OR estimates in the 1932 cohort were 0.2 and 2.1. In both cohorts, inequality estimates according to country of birth and education were smaller in 2022 than in 2007. In the 1932 cohort, inequality according to sex was larger in 2022 than in 2007.
Conclusion
Higher prevalence of oral impacts with increasing age and overtime were observed for both cohorts. Narrowing and widening of oral health socio-demographic disparities occurred. Further examination of the interaction of socio-demographic factors with age or time may allow for targeted policy strategies aimed to alleviate oral health disparities in older ages.
{"title":"Sociodemographic Inequalities in Oral Health-Related Quality of Life in Older Adults: 15 Years Follow-Up of the 1932 and 1942 Birth Cohorts in Sweden","authors":"Anne Nordrehaug Åstrøm, Berit Mastrovito, Josefine Sannevik, Stein Atle Lie, Anders Johansson, Ann-Katrin Johansson","doi":"10.1111/cdoe.13029","DOIUrl":"10.1111/cdoe.13029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Focusing on two birth cohorts of older adults, this study aimed to (1) describe the development of oral health-related quality of life (OHRQoL) across time from 2007 to 2022 and (2) assess sociodemographic inequalities in OHRQoL and whether these inequalities remain stable, widen or narrow during the follow-up period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In 1992 and 2007 the 1942 and 1932 birth cohorts living in the Swedish counties of Örebro and Östergotland participated with 6346 (response 71.4%) and 3735 individuals (response 71.9%), respectively. Of the 6346 1942 birth cohort participants, 2479 (38.5% of baseline) completed postal follow-ups in 1997, 2002, 2007, 2012, 2017 and 2022. Of the 3735 1932 birth cohort participants, 751 (20% of baseline) participated also in 2012, 2017 and 2022. Oral impacts of daily performance (OIDP) and socio-demographic characteristics were assessed at each survey year. A cohort table depicted the prevalence rates of OIDP (OIDP > 0) across time, disentangling age, period and cohort effects. Logistic mixed models with interaction terms of each socio-demographic covariate and time were used to test differences in socio-demographic inequalities of oral impacts over time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2007 and 2022, OIDP > 0 varied from 22.7% to 28.7% in the 1932 birth cohort (age 75–90) and from 25.3% to 26.6% in the 1942 cohort (age 65–80). Mixed models revealed that cluster specific odds ratios (ORs) for OIDP > 0 varied from 0.2 to 2.5 with respect to avoidance of dental care due to cost and health perceptions in the 1942 cohort. Corresponding OR estimates in the 1932 cohort were 0.2 and 2.1. In both cohorts, inequality estimates according to country of birth and education were smaller in 2022 than in 2007. In the 1932 cohort, inequality according to sex was larger in 2022 than in 2007.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher prevalence of oral impacts with increasing age and overtime were observed for both cohorts. Narrowing and widening of oral health socio-demographic disparities occurred. Further examination of the interaction of socio-demographic factors with age or time may allow for targeted policy strategies aimed to alleviate oral health disparities in older ages.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 2","pages":"235-244"},"PeriodicalIF":1.8,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143187670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andréia Coelho Gomes Ripardo, Adriana Corrêa de Queiroz, Ana Paula Corrêa de Queiroz Herkrath, Fernando José Herkrath, Janete Maria Rebelo Vieira, Juliana Vianna Pereira, Maria Augusta Bessa Rebelo, Mario Vianna Vettore
Objectives
To assess the associations between periodontal conditions, dental caries, sex, psychosocial factors, socioeconomic status, oral health-related quality of life (OHRQoL), and self-rated oral health among adolescents living in socially deprived neighbourhoods.
Methods
A school-based survey was conducted in a random sample of 406 12-year-old adolescents in 11 neighbourhoods in the East region of Manaus, Brazil. Gingival status, dental calculus (Community Periodontal Index), and dental caries (DMFT index) were registered through clinical examinations. Adolescents self-completed questionnaires to assess psychosocial factors (self-esteem, sense of coherence, and oral health beliefs), socioeconomic status (family income, parent's schooling, number of goods, and house crowding), oral health-related quality of life (OHRQoL) (CPQ11–14), and self-rated oral health. Direct and indirect relationships between variables were tested using structural equation modelling guided by the Wilson and Cleary model.
Results
Greater gingival bleeding was directly associated with worse self-rated oral health. Poor OHRQoL was directly linked to the number of teeth with dental calculus, more teeth with dental caries experience, and worse psychosocial factors. Worse socioeconomic status and dental calculus were associated with gingival bleeding. Dental calculus and socioeconomic status were indirectly associated with self-rated oral health via gingival status. OHRQoL mediated the association of dental caries experience and psychosocial factors with self-rated oral health.
Conclusions
Gingival bleeding and dental calculus may negatively affect self-reported oral health in adolescents. Socioeconomic status and psychosocial factors were also relevant determinants for oral health in this age group.
{"title":"The Association Between Periodontal Status, Oral Health-Related Quality of Life and Self-Rated Oral Health in Socially Underprivileged Adolescents","authors":"Andréia Coelho Gomes Ripardo, Adriana Corrêa de Queiroz, Ana Paula Corrêa de Queiroz Herkrath, Fernando José Herkrath, Janete Maria Rebelo Vieira, Juliana Vianna Pereira, Maria Augusta Bessa Rebelo, Mario Vianna Vettore","doi":"10.1111/cdoe.13028","DOIUrl":"10.1111/cdoe.13028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To assess the associations between periodontal conditions, dental caries, sex, psychosocial factors, socioeconomic status, oral health-related quality of life (OHRQoL), and self-rated oral health among adolescents living in socially deprived neighbourhoods.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A school-based survey was conducted in a random sample of 406 12-year-old adolescents in 11 neighbourhoods in the East region of Manaus, Brazil. Gingival status, dental calculus (Community Periodontal Index), and dental caries (DMFT index) were registered through clinical examinations. Adolescents self-completed questionnaires to assess psychosocial factors (self-esteem, sense of coherence, and oral health beliefs), socioeconomic status (family income, parent's schooling, number of goods, and house crowding), oral health-related quality of life (OHRQoL) (CPQ<sub>11–14</sub>), and self-rated oral health. Direct and indirect relationships between variables were tested using structural equation modelling guided by the Wilson and Cleary model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Greater gingival bleeding was directly associated with worse self-rated oral health. Poor OHRQoL was directly linked to the number of teeth with dental calculus, more teeth with dental caries experience, and worse psychosocial factors. Worse socioeconomic status and dental calculus were associated with gingival bleeding. Dental calculus and socioeconomic status were indirectly associated with self-rated oral health via gingival status. OHRQoL mediated the association of dental caries experience and psychosocial factors with self-rated oral health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Gingival bleeding and dental calculus may negatively affect self-reported oral health in adolescents. Socioeconomic status and psychosocial factors were also relevant determinants for oral health in this age group.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 3","pages":"278-285"},"PeriodicalIF":1.8,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.13028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kara A. Gray-Burrows, Sarab El-Yousfi, Kristian Hudson, Samantha Watt, Ellen Lloyd, Hanin El Shuwihdi, Tom Broomhead, Peter F. Day, Zoe Marshman
Objectives
Supervised toothbrushing programmes (STPs), whereby children brush their teeth at nursery or school with a fluoride toothpaste under staff supervision, are a clinically and cost-effective intervention to reduce dental caries. However, uptake is varied, and the reasons unknown. The aim was to use an implementation science approach to explore the perspectives of key stakeholders on the barriers and facilitators at each level of implementation of STPs.
Methods
This qualitative study involved individual interviews and focus groups with a purposive sample of stakeholders involved at all levels of implementation of STPs: (1) policymakers; (2) providers of STPs; (3) nursery/school staff; (4) parents/carers; and (5) children (aged 2-6 years old) across England. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR).
Results
A total of 159 stakeholders were interviewed (40 individual interviews and 17 focus groups) across all levels of implementation. Barriers and facilitators to STP implementation were identified across 35 of the 39 CFIR constructs. Four themes were identified that determined STP implementation: (1) acceptability of STPs; (2) external ‘make or break’ conditions; (3) the importance of engagement across the system; and (4) desire for centralised support.
Conclusions
This is the first study to qualitatively explore the barriers and facilitators to STP at all levels of implementation underpinned by an implementation science framework. The findings have strong implications for policymakers who wish to implement STPs, highlighting the need for careful consideration of the adaptability of the programmes, the role of formal and informal engagement systems, and the need for centralised support. This work has facilitated the co-design and piloting of a supervised toothbrushing implementation toolkit, which provides a central hub of resources and good practice to optimise implementation of STPs at scale.
{"title":"Supervised Toothbrushing Programmes: Understanding Barriers and Facilitators to Implementation","authors":"Kara A. Gray-Burrows, Sarab El-Yousfi, Kristian Hudson, Samantha Watt, Ellen Lloyd, Hanin El Shuwihdi, Tom Broomhead, Peter F. Day, Zoe Marshman","doi":"10.1111/cdoe.13026","DOIUrl":"10.1111/cdoe.13026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Supervised toothbrushing programmes (STPs), whereby children brush their teeth at nursery or school with a fluoride toothpaste under staff supervision, are a clinically and cost-effective intervention to reduce dental caries. However, uptake is varied, and the reasons unknown. The aim was to use an implementation science approach to explore the perspectives of key stakeholders on the barriers and facilitators at each level of implementation of STPs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This qualitative study involved individual interviews and focus groups with a purposive sample of stakeholders involved at all levels of implementation of STPs: (1) policymakers; (2) providers of STPs; (3) nursery/school staff; (4) parents/carers; and (5) children (aged 2-6 years old) across England. Data collection and analysis were guided by the Consolidated Framework for Implementation Research (CFIR).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 159 stakeholders were interviewed (40 individual interviews and 17 focus groups) across all levels of implementation. Barriers and facilitators to STP implementation were identified across 35 of the 39 CFIR constructs. Four themes were identified that determined STP implementation: (1) acceptability of STPs; (2) external ‘make or break’ conditions; (3) the importance of engagement across the system; and (4) desire for centralised support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This is the first study to qualitatively explore the barriers and facilitators to STP at all levels of implementation underpinned by an implementation science framework. The findings have strong implications for policymakers who wish to implement STPs, highlighting the need for careful consideration of the adaptability of the programmes, the role of formal and informal engagement systems, and the need for centralised support. This work has facilitated the co-design and piloting of a supervised toothbrushing implementation toolkit, which provides a central hub of resources and good practice to optimise implementation of STPs at scale.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 3","pages":"256-264"},"PeriodicalIF":1.8,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.13026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143058360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paul Brocklehurst, Joe Langley, Rebecca Wassall, Sana Daniyal, Saif Sayeed Syed, Michelle Harvey, Nia Goulden, Andrea Sherriff, Anja Heilmann, Zoe Hoare, Craig Smith, Richard Watt, Ciaran O'Neill, Frank Kee, Peter Cairns, Nat Lievesley, Gerald McKenna, Georgios Tsakos
<div> <section> <h3> Background</h3> <p>A theoretically informed process evaluation was undertaken in parallel to a study examining the feasibility of an oral health intervention based on an existing guideline for care homes. The objectives were to explore the factors that influenced the implementation of the intervention in order to understand the potential pathway to impact. The research team initially utilised Pfadenhauer et al.'s framework, which focuses on a number of different implementation factors: intervention characteristics, context, theory, process, strategy, agents, outcomes and setting.</p> </section> <section> <h3> Methods</h3> <p>Nine semi-structured interviews were undertaken with care home managers and staff, predominantly within the intervention arm of the study. Interview schedules were originally based on Pfadenhauer et al.'s framework. These were coded and analysed using thematic analysis. Given the range of themes that emerged, the research team ran a reflexive workshop to determine whether Pfadenhauer et al.'s framework was able to capture and frame the authentic voice of those interviewed.</p> </section> <section> <h3> Results</h3> <p>The research team found that a systems lens approach better fitted the data from the interviews, capturing the idiosyncrasy of the different settings and the importance of values and beliefs of the key stakeholders. It was clear that unlike the structure proposed by Pfaednhauer et al., many of the factors were interdependent and hierarchical in nature, that is, paradigm and goals within the care home had a direct impact on the system structure, which fed into how the care home was maintained, which led onto how the different actors (care home managers and staff) behaved. The process also highlighted key factors for intervention delivery: time poverty, competing needs, staff turnover, differences between shift patterns and between permanent and agency staff. Cognitive capacity of the residents and staff attitudes were also key.</p> </section> <section> <h3> Conclusions</h3> <p>Adding a reflexive workshop enabled the research to critically review the Pfadenhauer et al.'s framework and change to a systems lens approach, which better explained the interdependent and hierarchical nature of the findings. It also highlighted a number of key factors that could influence the pathway to impact for the intervention.</p> </section> <section> <h3> Trial Registration</h3> <p>ISRCTN10276613</p>
{"title":"A Theoretically Informed Process Evaluation in Parallel to a Feasibility Study of a Complex Oral Health Intervention Using NICE Guidelines in a Care Home Setting","authors":"Paul Brocklehurst, Joe Langley, Rebecca Wassall, Sana Daniyal, Saif Sayeed Syed, Michelle Harvey, Nia Goulden, Andrea Sherriff, Anja Heilmann, Zoe Hoare, Craig Smith, Richard Watt, Ciaran O'Neill, Frank Kee, Peter Cairns, Nat Lievesley, Gerald McKenna, Georgios Tsakos","doi":"10.1111/cdoe.13016","DOIUrl":"10.1111/cdoe.13016","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A theoretically informed process evaluation was undertaken in parallel to a study examining the feasibility of an oral health intervention based on an existing guideline for care homes. The objectives were to explore the factors that influenced the implementation of the intervention in order to understand the potential pathway to impact. The research team initially utilised Pfadenhauer et al.'s framework, which focuses on a number of different implementation factors: intervention characteristics, context, theory, process, strategy, agents, outcomes and setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Nine semi-structured interviews were undertaken with care home managers and staff, predominantly within the intervention arm of the study. Interview schedules were originally based on Pfadenhauer et al.'s framework. These were coded and analysed using thematic analysis. Given the range of themes that emerged, the research team ran a reflexive workshop to determine whether Pfadenhauer et al.'s framework was able to capture and frame the authentic voice of those interviewed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The research team found that a systems lens approach better fitted the data from the interviews, capturing the idiosyncrasy of the different settings and the importance of values and beliefs of the key stakeholders. It was clear that unlike the structure proposed by Pfaednhauer et al., many of the factors were interdependent and hierarchical in nature, that is, paradigm and goals within the care home had a direct impact on the system structure, which fed into how the care home was maintained, which led onto how the different actors (care home managers and staff) behaved. The process also highlighted key factors for intervention delivery: time poverty, competing needs, staff turnover, differences between shift patterns and between permanent and agency staff. Cognitive capacity of the residents and staff attitudes were also key.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Adding a reflexive workshop enabled the research to critically review the Pfadenhauer et al.'s framework and change to a systems lens approach, which better explained the interdependent and hierarchical nature of the findings. It also highlighted a number of key factors that could influence the pathway to impact for the intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Trial Registration</h3>\u0000 \u0000 <p>ISRCTN10276613</p>\u0000 ","PeriodicalId":10580,"journal":{"name":"Community dentistry and oral epidemiology","volume":"53 2","pages":"152-159"},"PeriodicalIF":1.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/cdoe.13016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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