‘Something to Smile About’: An evaluation of a capacity-building oral health intervention for staff working with homeless people

Abstract

Objective: To use a qualitative exploration to evaluate whether ‘Something to Smile About’ (STSA), an oral health intervention, had increased the oral health capacity of staff working with homeless people. Setting: A National Health Service board area in Scotland. Method: A purposive sample of 14 staff members from STSA-participating organizations took part in the evaluation. Three focus groups were held and the participants were encouraged to speak freely about their views on the intervention. The qualitative data was analyzed using content analysis. Results: The majority of participants stated they were able to use their newly-acquired oral health knowledge and pass it to their homeless clients. STSA appeared to be less successful with regard to assisting clients to change their oral health behaviours. Staff felt that oral health considerations were a low priority compared to the need for shelter, food, clothing and money. In addition, they stated that the level of success with clients was influenced by the homeless person’s specific and complex needs. Conclusion: STSA was successful in building staff oral health capacity; however, for STSA to be successful with clients, and for clients to achieve adherence with oral health messages, the complex needs and current life circumstances of homeless client groups must be incorporated into STSA.

Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review

“…Anxiety due to previous negative experiences with a dentist (during childhood, adolescence or in the most recent past) and dental fear are common reasons given by homeless people to explain why they do not attempt to attend for dental treatment . The fact that homeless people visit dentists only in emergency cases further increases their anxiety, as by delaying treatment they come to associate dentists with pain . A feeling of lack of control contributes to homeless people feeling anxious during dental appointments .…”

“…The financial penalties for broken appointments and the resulting outstanding fines also impact on homeless people's ability to access dental care and retain their ongoing relationship with a dental practice . Having a hostel address or no fixed abode can preclude homeless people from registering with a dentist …”

“…Flexibility in working hours so that common schedules can be established between the dental staff and the shelters providing temporary accommodation has been recommended . Training can help improve dental staff's understanding about the difficulties that homeless people face …”

“…Providing information on existing dental services, entitlements and eligibility to homeless people, as well as charities and health service providers, has been recommended as a means of promoting uptake of dental services in this population . Support for being accepted for care and attending a dental appointment can enhance homeless people's confidence, motivation and empowerment to access the service …”

“…3,14,33,35,36,41,43 The fact that homeless people visit dentists only in emergency cases further increases their anxiety, as by delaying treatment they come to associate dentists with pain. 44 A feeling of lack of control contributes to homeless people feeling anxious during dental appointments. 11 Embarrassment in relation to the condition of their teeth and the subsequent impact on self-esteem can itself act as a barrier.…”