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BackgroundPregnant women in Australia seldom seek dental care and are unaware of its importance. To address these gaps the midwifery‐initiated oral health dental service (MIOH‐DS) program was comprehensive trialled and found effective. The aim of this study was to undertake a process evaluation of the MIOH‐DS using the perspectives of pregnant women who participated in the trial.MethodsA qualitative research design was utilized, whereby content analysis was undertaken on data from 11 semi‐structured interviews with women who participated in the program.ResultsAll participants were receptive of the MIOH‐DS intervention, and found it to be an acceptable intervention that met their needs, and encouraged future positive oral health practices and health‐seeking behaviours. They expressed that midwives were an appropriate professional to conduct oral health assessments, education and referrals to affordable dental services. Although some participants were initially apprehensive towards receiving treatment during pregnancy, dental staff members were able to appropriately educate and reassure them during treatment.ConclusionsThe MIOH‐DS represents a promising and acceptable intervention strategy for pregnant women to promote their oral health. Findings merit further investigation on whether positive outcomes achieved can be sustained when implemented in other national or international settings similar to the study setting.

Problem: There are significant inequalities in oral health status between Aboriginal and non-Aboriginal children in Australia, particularly where the children have insufficient access to various forms of fluoride. There has been a growing interest in seeing fluoride varnish programs used more widely for Aboriginal children due to proven effectiveness. Despite this, there has been limited scale-up of these programs in Australia. This study investigates the feasibility of using Aboriginal dental assistants to provide regular fluoride varnish applications for Aboriginal children in the primary school setting. Design: A mixed-methods approach including auditing the number of Aboriginal dental assistants trained and then approved by the NSW Chief Health Officer to apply fluoride varnish, and collection and reporting of participant data on the each of the fluoride varnish days in the local patient management system. Setting: Six Aboriginal Community Controlled Health Services from regional NSW were invited to participate in the study. They also nominated a primary school and an Aboriginal dental assistant to participate in the study. Key measures for improvement: Data were obtained from four 'fluoride varnish days' held at the schools over a 12-month period between December 2017 and December 2018. The number of Aboriginal dental assistants were trained and then approved by the NSW Chief Health Officer to apply fluoride varnish is also reported. Strategies for change: In total, 8 Aboriginal dental assistants were trained to apply fluoride varnish during the study. Overall, students participating in the study received three or more fluoride varnish applications. Effects of change: Results showed that Aboriginal dental assistants are able to safely and effectively apply fluoride varnish in a school setting with remote supervision. Lessons learnt: This program can be scaled at the state level in NSW, and this could provide the basis for a nationally consistent program. Initial discussions have been held with several jurisdictions to lead this process via the Australian Health Ministers Advisory Council (AHMAC) based on the results of this study and the support of key stakeholders. The Poche Centre as part of its scale-up planning for the Fluoride | 501

ObjectivesTo critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.Design and settingThe evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.ParticipantsData were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.Cost measuresData included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.Outcome measuresUtility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.ResultsCompared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only ‘cost-effective’ in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was ‘cost-effective’ in all scenarios except at 3 months scenario.ConclusionsThe midwives’ only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives’ and dentists’ combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.Trial registration numberACTRN12612001271897; Post-results.

This led to the co-design of a small-scale oral health therapy graduate year program for ACCHSs known as the Dalang Project, which enabled oral health therapists to engage with local Aboriginal communities and implement culturally competent, practical and evidence-based oral health promotion activities. This article provides an overview of the Dalang Project and its evaluation. Methods: All graduates of the Dalang Project were invited via email and social media to complete an online survey. The survey included questions about their year in the Dalang Project, why they applied, what they liked and disliked about the project, where they planned to work post-placement, and examples of the most significant changes they observed in the communities where they were placed. Host sites were also surveyed and data were collated on clinical services performed as well as oral health promotion activity. Results: Prior to commencing the Dalang Project only 4 of the 15 respondents came from rural or regional areas. Nine of the 15 respondents were considering working in a regional, rural or remote area prior to applying for the Dalang Project. Twelve respondents were working at the time of the survey and half were working in regional, rural or remote locations in NSW and one in the Northern Territory. All reported that they would be more likely to work in an ACCHS as a result of being a part of the Dalang Project. The majority of respondents said they would recommend the program to future graduates. A total of 63 schools, 21 preschools and 15 community health services received regular dental health education through the Dalang Project. A total of 3250 toothbrushes and fluoride toothpastes were distributed to children and families through the Dalang Project. A key part of the program was the installation of refrigerated and filtered water fountains in schools where there was no free filtered or refrigerated water supply. The inclusion of this component in the program was part of the co-design process and links the program to the wider population health strategies in NSW to help prevent childhood obesity. Conclusion: The Dalang Project is an example of a successful codesigned project that has positively impacted oral health service delivery for Aboriginal children and has provided a valuable experience for new graduate oral health therapists working in ACCHSs. Overall, the Dalang Project was found to be a positive professional experience for the oral health therapists with many remaining in rural, remote and regional locations after completing the program.