Implementation problems and adaptations among organizations delivering school-based dental sealant programs.

Abstract

Although research supports the effectiveness of school-based dental sealant programs (SBDSPs) in increasing access to dental care and reducing dental caries, there is limited information on the implementation processes that impact success at the population level. This study assessed SBDSP program implementation in terms of problems (and adaptations) encountered during school and client (students) recruitment, client attendance, and workforce capacity. These four factors are necessary for reaching eligible youth. We interviewed program personnel (n= 18) at five organizations delivering SBDSPs in Oregon in 2018. Qualitative analysis employed a directed content approach. Specific implementation problems included the following: school recruitment: workforce limitations, school refusals, community objections; client recruitment: ineffective recruitment materials, poor parent/guardian engagement, consent form shortcomings, poor consent forms dissemination and return, low school cooperation; client attendance: poor school cooperation, physical barriers, scheduling conflicts; workforce capacity: insufficient size, high turnover. Participants reported that their respective organizations successfully adapted to resolve these implementation problems with some exceptions (e.g., insufficiencies in workforce capacity). Implementation problems related to school and client recruitment, client attendance, and workforce capacity may impact SBDSP reach. Adaptations to address these problems provide a basis for specific program recommendations. Larger systemic and translational problems were also observed, and recommendations were made regarding organizational communication and the need for additional pre-implementation planning and pilot testing.