The effectiveness of Dental Health Support Workers at linking families with primary care dental practices: a population-wide data linkage cohort study

Abstract

BackgroundLink workers (lay health workers, health support workers) based in the community provide additional support to individuals and families to facilitate engagement with primary care and other services and resources. This additional support aims to tackle the wider socio-economic determinants of health that lead to inequalities. To date, there is no clear evidence of the effectiveness of these programmes. This study evaluates the effectiveness of Dental Health Support Workers (DHSW) at linking targeted families with young children to primary care dental practices. The DHSW role is one component of Childsmile, the national oral health improvement programme in Scotland.MethodsA quasi-experimental approach captured the natural variation in the rollout of the DHSW intervention across Scotland in a cohort of children born between 2010 and 2013. Survival analysis explored “time to attendance” at primary care dental practice. Cox’s regression models compared attendance rates and time until first attendance between those families who received support from the DHSW and those who did not.ResultsThe cohort consisted of 35236 children. Thirty-three percent of the cohort (n = 11495) were considered to require additional support from a DHSW. Of these, 44% (5087) received that support. These families were more likely to attend a dental practice (Hazard Ratio [95% Confidence Interval] =1.87 [1.8 to 1.9]) and, on average, did so 9 months earlier (median time until first attendance: 8.8 months versus 17.8 months), compared to families not receiving additional support.ConclusionsLink workers (DHSW) within the Childsmile programme are effective at linking targeted children to primary care dental services and, most notably, at a younger age for prevention. This is the first study of its kind to evaluate the effectiveness of link-worker programmes using a robust quasi-experimental design on three, population-wide, linked datasets. These results will inform future health programmes which aim to improve health and reduce inequalities by reaching and supporting families from more disadvantaged backgrounds.

Evaluation of a national complex oral health improvement programme: a population data linkage cohort study in Scotland

“…Our previous work has demonstrated the initial success of DHSWs in increasing earlier dental practice attendance in children from more deprived areas. 32 However, the findings of this study are more difficult to interpret. A single contact conferred a reduced odds of caries experience;, two or more had little impact.…”

“…24 There were no socioeconomic inequalities observed with the reach of the primary care dental practice intervention which may in part be explained by findings that DHSWs were effective at getting targeted children from more deprived areas into a dental practice earlier than expected. 32 The Childsmile programme health boards implemented the level of targeting in the fluoride varnish intervention in nurseries in slightly different ways. 24 It was therefore important, at the national population level, to assess the proportion reached across the SIMD distribution, as well as focusing on the most deprived areas.…”

Child health interventions delivered by lay health workers to parents: A realist review

“…LHWs who support families to engage with positive oral health parenting behaviours such as toothbrushing and attending dental appointments (Hodgins et al, 2018).…”

“…"…[LHWs] ran a weekly drop-in breastfeeding support group…the most important aspects of the group were talking about and seeing breastfeeding happen, getting consistent advice, and increase confidence…making new friends and talking about other problems…" (Ingram et al 2005) LHW interventions which include signposting or which directly link families to community services, are reported to be more effective than those which do not (Hodgins et al, 2018). However, findings from this review suggests that trust between LHW and parent is a pre-requisite in facilitating signposting and successful parental engagement with community support.…”

“…While elements of Childsmile are provided to all children, there are targeted components designed to affect change in oral health inequalities. One such targeted component is Childsmile Community and Practice which is delivered in part by dental health support workers (DHSWs): LHWs who support families to engage with positive oral health parenting behaviours such as toothbrushing and attending dental appointments (Hodgins et al, 2018). Childsmile Community and Practice is linked with the Universal Health Visiting Pathway, and families who are deemed, by the health visitor, to require additional oral health support are referred to the DHSW.…”