Background Since smoking behaviour is determined by social context, the best way to reduce the prevalence of smoking may be to use communitywide programmes which use multiple channels to provide reinforcement, support and norms for not smoking. Objectives To assess the effectiveness of community interventions for reducing the prevalence of smoking.

BackgroundAll children attending General Dental Practice in Scotland are recommended to receive twice-yearly applications of sodium fluoride varnish to prevent childhood caries, yet application is variable. Development of complex interventions requires theorizing and modelling to understand context. This study applies the Functional Resonance Analysis Method (FRAM) to produce a sociotechnical systems model and identify opportunities for intervention to support application.MethodsThe FRAM was used to synthesise data which were: routine monitoring of fluoride varnish application in 2015/16; a longitudinal survey with practitioners (n = 1090); in-depth practitioner and key informant interviews (n = 43); and a ‘world café’ workshop (n = 56).ResultsWe describe a detailed model of functions linked to application, and use this to make recommendations for system-wide intervention.ConclusionsRigorous research is required to produce accessible models of complex systems in healthcare. This novel paper shows how careful articulation of the functions associated with fluoride varnish application can support future improvement efforts.

span and resources to support evaluation and embedded research projects. The addition of a child oral health programme to the NHDP portfolio was a response to the persistently high rates of dental caries among children in Scotland. These high rates are compounded by significant inequalities in oral health 2 and poor use of and access to services. Annual reports of the Scottish Dental Practice Board 3 have shown low rates of NHS dental registration for young children (35% of 0-2 year-olds in 2004), and a review of the provision of dental care to children registered under the capitation payment system highlighted extremely limited preventive activity. 4 This paper describes the establishment and development of the new child oral health programme since 2005; its companion paper reviews monitoring arrangements and summarises programme activity data. 5

Purpose – By applying ecological models of health behaviour to marketing communications to achieve behaviour change, this paper aims to illustrate the importance of taking into account various economic, environmental and social influences. Design/methodology/approach – A two-part study was undertaken. Part one involved exploring the lived worlds of the targeted population. Part two explored how the needs of the target audience informed a social marketing communications strategy. This was illustrated through Childsmile, a Scottish Government funded oral health institution. Findings – A variety of intra- and inter-personal influences where identified that encouraged or discouraged oral health. Complementing this was how these needs are incorporated into an ecological social marketing communications campaign. Although the long term effects of the ecological social marketing campaign will not become evident for a number of years, initial results indicate its important role in changing behaviour. Practical implications – The importance of engaging with various groups within social marketing is shown. Specifically, the need to understand and encourage interaction between individuals, their community, health institutions and the Government. Social implications – Behaviour change, through social marketing communications, is possible among socio-economic deprived groups. Change supported with face to face interactions with health professionals. Originality/value – Previous criticisms of social marketing research being American-centric, and avoiding issues around socio-economic deprivation are addressed. In addressing this, the paper also answers calls for research into ecological models of social marketing communications to understand how influences affect its applicability.

Patient-, organization-, and system-level barriers and facilitators to preventive oral health care: a convergent mixed-methods study in primary dental care Background: Dental caries is the most common chronic disease of adult and childhood, a largely preventable yet widespread, costly public health problem. This study identified patient-, organization-, and system-level factors influencing routine delivery of recommended care for prevention and management of caries in primary dental care.