Abstract
Increasing numbers of people in England experience homelessness, substance use, and repeated offending (known as ‘severe and multiple disadvantage’; SMD). Populations experiencing SMD often have extremely poor oral health, which is closely inter-linked with high levels of substance use, smoking, and poor diet. This study aims to undertake an evidence synthesis to identify the effectiveness, resource requirements, and factors influencing the implementation and acceptability of oral health and related health behaviour interventions in adults experiencing SMD. Two systematic reviews will be conducted using mixed-methods. Review 1 will investigate the effectiveness and resource implications of oral health and related health behaviours (substance use, smoking, diet) interventions; Review 2 will investigate factors influencing the implementation of such interventions. The population includes adults (≥18 years) experiencing SMD. Standard review methods in terms of searches, screening, data extraction, and quality appraisal will be conducted. Narrative syntheses will be conducted. If feasible, a meta-analysis will be conducted for Review 1 and a thematic synthesis for Review 2. Evidence from the two reviews will then be synthesised together. Input from people with experience of SMD will be sought throughout to inform the reviews. An initial logic model will be iteratively refined during the review.
Highlights
The overlap between people experiencing homelessness, problematic substance use and involvement with the criminal justice system is substantial and these are key indicators of severe and multiple disadvantage (SMD) [1]
This draws on initial scoping of literature, input from people who have experience of SMD on determinants of oral health, and reflects the collective knowledge of our team
A systematic review of evidence is needed to identify and investigate interventions that are effective in improving the oral health and related health behaviours of SMD populations
Summary
The overlap between people experiencing homelessness, problematic substance use and involvement with the criminal justice system is substantial and these are key indicators of severe and multiple disadvantage (SMD) [1]. Over two-thirds of people experiencing homelessness report problematic substance use or involvement with the criminal justice system; 63% of offenders and 40% of those experiencing problematic substance use experience the other two issues [1]. There is some evidence of a decrease in the number of people sleeping rough over the past two years [2], overall there has been large increases in the numbers of individuals experiencing SMD over the past decade; e.g., rough sleeping increased by 132% in England since 2010 [3]. SMD populations have very high levels of mental and physical ill-health [3,5]
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