An evaluation of initiatives to improve dental attendance and outcomes in young children

Salomon-Ibarra, Candy Cecilia ORCID: 0000-0001-8028-7766 (2021). An evaluation of initiatives to improve dental attendance and outcomes in young children. University of Birmingham. Ph.D.

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Abstract

This research explored dental attendance (DA) by young children in England. It showed that DA rates for young children were generally low with substantial variations across local authorities (LAs). Only a small proportion of children visited the dentist before their first birthday and, unexpectedly, more deprived LAs were more likely to report higher DA rates. DA was, however, only partially explained by deprivation; a further analysis in children aged 5 years and under showed a linear association between DA and LA deprivation, after being hypothesised that this relationship might be curvilinear. DA rates decreased with deprivation and the association was moderated by the effect of ethnicity, single parenthood and prevalence of dental caries. The low DA rates and variations observed suggest a complex causality. To explore the potential role of dental services in promoting DA and improving oral health outcomes, this work evaluated a new NHS England and NHS Improvement (NHSE&I) initiative “Starting Well” which aimed to improve both DA and preventive practice for young children. Qualitative research showed that there was potential in using dental practices to promote dental attendance and, with support and internal leadership, practices can adopt a more preventive focus. The creation of new roles such as practice-based prevention champions and tasks like promoting DA by children who are at a greater risk of dental disease, identified a particular need for support with training and development. LAs, local commissioners and Public Health England were identified as key to facilitate links between practices and other parts of the local health system that had a potential role in supporting greater dental care uptake by young children. The programme was more complex to commission than routine dental services, requiring considerable facilitation and monitoring to ensure delivery and challenges with commissioning capacity were reported. Localities where the commitment to the programme was shared across the health and social care system seemed to have greater chance of successful implementation.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):