Implementing the Smile4life intervention for people experiencing homelessness: a path analytical evaluation

Abstract

Background People experiencing homelessness have high levels of dental decay, oral cancer and poor oral health-related quality of life. The Scottish Government sought to address these issues by developing a national oral health improvement programme for people experiencing homelessness, named Smile4life. The aim was to investigate implementation behaviours and the role of work-related beliefs upon the delivery of the Smile4life programme across NHS Board areas in Scotland. Methods Non-probability convenience sampling, supplemented by snowball sampling, was used to recruit practitioners working across the homelessness sector. The overall evaluation of the implementation of the Smile4life programme was theoretically informed by the Behaviour Change Wheel. The questionnaire was informed by the Theoretical Domains Framework and was divided into three sections, demography and Smile4life Awareness; Smile4life Activities; and Smile4life work-related beliefs. A psychometric assessment was used to develop Smile4life Awareness, Smile4life Activities, Ability to Deliver and Positive Beliefs and Outcomes subscales. The data were subjected to K-R20, exploratory factor analysis, Cronbach’s alpha, t-tests, ANOVA, Pearson’s correlation analysis and a multivariate path analysis. Results One hundred participants completed the questionnaire. The majority were female (79%) and worked in NHS Boards across Scotland (55%). Implementation behaviour, constructed from the Delivering Smile4life scale and the summated Smile4life activities variable, was predicted using a linear model a latent variable. The independent variables were two raw variables Positive Beliefs and Outcomes, and Ability to deliver Smile4life. Results showed relatively good model fit (chi-square (1.96; p > 0.15), SRMR (< 0.08) and R2 (0.62) values). Positive and highly significant loadings were found describing the Implementation Behaviour latent variable (0.87 and 0.56). The two independent variables were associated (p < 0.05) with Implementation Behaviour. Conclusions Work-related factors, such as positive beliefs and outcomes and ability to deliver are required for implementation behaviours associated with the delivery of the Smile4life programme. Future work should include training centred on the specific needs of those involved in the homelessness sector and the development of accessible training resources, thereby promoting implementation behaviours to assist the progression and sustainability of the Smile4life programme.

Factors influencing implementation and sustainability of interventions to improve oral health and related health behaviours in adults experiencing severe and multiple disadvantage: a mixed-methods systematic review

“… 25 28 32 40 41 The risk of bias was assessed for the five articles reporting quantitative findings; among the two RCTs, one had a high risk of bias because of attrition and reporting bias, 34 and the other article had a low risk of bias, 35 the remaining three cross-sectional studies were of moderate quality. 27 30 39 The findings reported in this review are mostly from high or moderate quality articles, with the inclusion of insights from low quality articles employed strategically for completeness of reporting evidence available and to supplement findings from the adequately reported articles.…”

Evaluation of Mobile and Community Dental Service Use among People Experiencing Homelessness

“…Although we found a high demand from people experiencing homelessness for a community dental service, the problems with financial, material and human resources and administrative and legislation problems were the barriers to continuing and sustaining providing the service. Evidence suggests that collaboration with key stakeholders and endusers, including co-design of the services with homeless people; multidisciplinary working with homeless support organizations, dental practitioners, and educational institutions; and public funding are crucial to enhance the acceptability, feasibility and sustainability of community-based dental services [10,11,14,28]. Moreover, based on the evidence, the community-based participatory approach in research is important not only to increase the likelihood of community-based intervention success but also to eliminate oral health disparities [29,30].…”

“…Emergency care is the only care most people experiencing homelessness in Slovakia are eligible to receive because of having debts on health insurance payments [13]. The evidence shows that community-based oral health interventions are crucial for improving the access of homeless people to dental care [10,11,[14][15][16][17]; however, such services have not been developed in Slovakia yet. The only community-based dental clinic providing emergency dental care for people experiencing homelessness was open from 2012 until 2018 in Bratislava.…”

Rethinking Oral Health in Aging: Ecosocial Theory and Intersectionality

“…Bringing an intersectionality approach to oral health recognizes relations of power, inequity, oppression, and social exclusion when addressing the hard-to-resolve problem of poor oral health in older adults (Yuval-Davis 2016; Beaton et al 2020). There has been limited application of intersectionality in oral health research.…”

“…In 2 studies, Schuch et al (2021) and Jamieson et al (2023) considered intersectionality in relation to racial discrimination and oral health in Australia in their quantitative analysis. Recent literature suggests substantial potential using intersectionality in research related to aging and oral health (Cuesta and Rämgård 2016; Beaton et al 2020; Muirhead et al 2020; Macdonald et al 2022; Ramos-Gomez and Kinsler 2022). This approach has the potential to highlight social injustice and build capacity in oral health care providers to improve oral health outcomes in adults across all social indices (Rosenthal 2016).…”