Abstract
BackgroundPeople 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.MethodsNon-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.ResultsOne 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.ConclusionsWork-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.
Highlights
People experiencing homelessness have high levels of dental decay, oral cancer and poor oral healthrelated quality of life
More recent work supported the need to examine work-related beliefs and behaviours, suggesting that the interplay between organisational factors with skills and beliefs could affect working behaviours of those implementing Smile4life [14, 16]. The aim of this survey was to investigate implementation behaviours and the role of work-related beliefs upon the delivery of the Smile4life programme across National Health Service (NHS) Board areas in Scotland, using a path analytical approach. Study setting This survey took place in Scotland and the participants were those working within the homelessness sector or within NHS Boards where they were associated with services for people experiencing homelessness
Over half of participants (55%) reported that they worked within NHS Boards, with 32% in the Third Sector or Non-Governmental Organisation (NGO), 13% in other localities e.g. community pharmacies and 5% in local authorities
Summary
People experiencing homelessness have high levels of dental decay, oral cancer and poor oral healthrelated quality of life. Social exclusion is a “dynamic, multidimensional and relational process” which can involve interpersonal, societal and political factors, such as poverty, illness, and geographical isolation [3, 4] For those experiencing social exclusion in addition to homelessness, their oral health was typified by a greater prevalence of dental decay experience, oral cancer and poorer oral health-related quality of life [3,4,5]. This may be explained by a number of factors: people experiencing homelessness have been found to be irregular or emergency-only dental attenders [6, 7], and may have poorer oral hygiene and more negative health behaviours when compared to the general population, e.g. increased smoking, alcohol consumption and substance misuse [7, 8]. The limited utilisation of dental services by people experiencing homelessness may be due, in some instances, to the precarious living conditions associated with homelessness, characteristics of the healthcare system (e.g. inflexibility regarding appointments) and sociopolitical phenomena [3, 7]
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