OP34 Exploring factors that influence implementation and sustainability of interventions to improve oral health and related health behaviours in adults experiencing severe and multiple disadvantage: A mixed-methods systematic review

Background

Severe and multiple disadvantage (SMD) includes overlapping issues of homelessness, substance misuse or repeated offending. Among this population, poor oral health is common and is caused by health risk behaviours, including smoking, substance misuse and high sugar intake. Studies have explored interventions addressing to improve these behaviours; however, an understanding of what matters in their implementation remains unclear. This evidence is needed to inform development of sustainable interventions and create meaningful policy and practice solutions. Thus, this mixed methods systematic review aims to synthesize the existing evidence on implementation and sustainability of interventions to improve the oral health and related health behaviours of adults experiencing severe and multiple disadvantage. These include acceptability, settings, and potential adverse effects.

Methods

Bibliographic databases (MEDLINE, EMBASE, PsychINFO, CINAHL, EBSCO, Scopus) and grey literature were searched from inception to September 2020. Search results were independently screened by two researchers. Qualitative, quantitative, and mixed-method studies were eligible for inclusion if the population included adults (≥18 years) experiencing SMD (homelessness along with substance use or repeat offending). Outcomes included acceptability, settings and adverse effects of interventions aiming to improve oral health and related behaviours (substance use, smoking, diet). Quality appraisal was undertaken, and the results were synthesised using narrative and thematic analyses.

Results

Fifteen papers from twelve studies were included (published between 1995–2022). Ten papers reported qualitative findings and five papers reported quantitative findings, covering views from SMD groups and service providers in relation to interventions on oral health, substance misuse and smoking. From the qualitative synthesis, three main themes were identified: intervention settings, delivery of interventions, and ways to enhance engagement and participation. Communication and trust, adequate staff capacity, along with interest and motivation of both service users and service providers were key factors that influenced implementation and sustainability of interventions in this population. Quantitative synthesis found, no difference in program attendance between the interventions and usual care, although retention of participants over time was higher in the intervention group.

Conclusion

Trusted relationships between service users and service providers, adequate resources (including staffing), and motivation levels are important factors in implementing interventions to improve oral health and substance use in people experiencing SMD. Efforts to promote engagement of both service users and providers needs to be considered while developing practice and policies aimed at improving these health outcomes in SMD groups. Further evidence is needed on interventions related to smoking and diet in SMD groups.