Intersectoral oral health promotion interventions for schoolchildren living in remote rural Andean communities: a realist evaluation

Abstract

Background: Intersectoral oral health promotion entails the participation of local communities. IOHP interventions were introduced in Peru in primary schools in 2013 but oral health among schoolchildren living in rural Andean communities remains suboptimal. Objectives: To understand the contextual elements and the underlying mechanisms associated with intersectoral oral health promotion interventions’ current effects on schoolchildren living in remote rural Andean communities. Method: A realist evaluation was carried out in three rural Andean communities where intersectoral oral health promotion interventions aimed at schoolchildren have been implemented. Following an evaluation of the effects among schoolchildren, contextual elements and mechanisms were explored with various stakeholders involved in intersectoral oral health promotion through focus groups and semi-structured interviews. Subsequently, an iterative data analysis and a validation process resulted in the identification of context-mechanism configurations. Results: Previous positive experiences of collaboration, a focus on communication, feelings of being respected and considered, and development of leadership and trust among stakeholders involved in intersectoral oral health promotion were elements of configurations that positively influence intersectoral oral health promotion. On the other hand, unfavorable physical, social and political environments, previous negative health experiences, feelings of not being respected or considered, demotivation, development of mistrust and insufficient leadership were shown to negatively influence outcomes. Conclusion: This research highlights the complexity associated with the deployment of intersectoral oral health promotion interventions in rural communities. Local stakeholders should be further involved to build trust, to facilitate coordination processes among remote rural communities and oral health professionals, and to optimize deployment of intersectoral oral health promotion interventions.

Mecanismos de evaluaciones realistas en intervenciones de atención primaria en salud en poblaciones rurales y urbanas marginales

“…( 15 ) en Ecuador y Bergeron y cols. ( 31 ) en Perú reportan mecanismos individuales relacionados con la confianza, legitimidad, y enfoque integral lo cual refleja importantes similitudes con los mecanismos individuales reportados en contextos diferentes pero en intervenciones similares como las reportados por Ranmuntala y cols. ( 1 ) en Australia y Levay y cols.…”

Oral health status of schoolchildren living in remote rural Andean communities: A cross-sectional study

“…OH and the implementation OHP interventions are generally complex[ 1 4 , 23 ] and the results described in this study likely arose from multiple factors at different hierarchical levels. [ 1 4 , 37 ] First, OH in children is often not perceived as a priority by governments because it contributes little to reduce the infant mortality rate, and societal costs associated with low OH status among children are underestimated. [ 1 ] Next, rural communities in Latin America have undergone, in last decades, major changes in their traditional lifestyle, including the introduction of various processed foods rich in refined sugar, which increase the prevalence of DC among children.…”

“…These suboptimal results highlight the complexity of implementing OHP interventions and the need to consider different factors that may influence success. [ 1 4 , 37 ] These results contribute to the discussion of how to reorient health promotion interventions in remote rural communities to improve OH status and reduce the negative consequences for schoolchildren. [ 28 39 ]…”

Implicaciones de los actores locales en las intervenciones para la promoción de la salud bucodental destinadas a niños de edad preescolar y escolar en entornos vulnerables

“…Sin embargo, pensamos que sería necesario tener un enfoque intersectorial más integral, que incluyan otros actores locales, como líderes y autoridades locales. Los resultados de una investigación que hemos realizado recientemente en la región del Cusco, demuestran la necesidad de un liderazgo por parte de actores locales para la implementación de las intervenciones de PSBD, destinadas a los alumnos que viven en un entorno vulnerable con la fi nalidad de mejorar la efi ciencia y la perennidad y continuidad de las intervenciones (3) .…”