Overview of health improvement approaches
Rochdale is a town located in Greater Manchester, England and has a borough that works in partnership with the schools, health professionals and providers for improving the oral health status of the residents. The Borough Council focuses on the importance of a healthy mouth and promotes the maintenance of good oral hygiene for preventing the onset of dental problems. The Oral Health Improvement for the Elderly Programme has been enforced and implemented by the Rochdale Borough Council, Rochdale Clinical Commissioning Group, and NHS Heywood, with the aim of enhancing the oral health of the elderly. Furthermore, the area is one of its kind in greater Manchester that has invested adequate funds for creating training provisions for care homes, community services, hospital staff and home care, in order to check and clean the mouths of the older and vulnerable population (National Institute for Health and Care Excellence 2014). The community also takes efforts to lower the likelihood of the vulnerable population to contract hospital acquired pneumonia (Hmr.nhs.uk 2018).
Regardless of the fact that dental caries are a preventable health condition, upon assessment by the local authority, an estimated 47% five year old individuals were found to suffer from dental caries, in Rochdale. This proportion was found to be twice the national average. This justifies the role of the Borough Council in implementing oral health programs. Of all Oral Health Need Assessments (OHNA) that were completed, 35% were done during 2016-2017, and an estimated 50% were completed during 2014-2015 (Public Health England 2018).
The Annual Health Report also suggests that the Borough Council has taken into account the introduction of sweetened beverage duty at a rate of 20paise, for addressing the problems associated with poor dental health that are prevalent in the target population (Public Health England 2018). Some of the common oral health improvement programs that have been enforced and implemented by the UK local authorities encompass oral health training, healthy drink and food policies, targeted provision for toothpaste and toothbrush, monitored tooth brushing in school settings, community water fluoridation programs, and help from peer support workers. The aforementioned data suggest that much efforts have been adopted by the government for improving oral health. However, oral health issues such as, dental caries amid primary school students remains relatively unaddressed.
Marinho et al. (2013) affirmed the use of topically administered fluoride varnishes for the prevention of dental caries in adolescents and children. Upon conducting a meta-regression, the researchers failed to establish a noteworthy association between the application of fluoride varnish and severity of dental caries among children. Owing to the fact that there was less information on the effect exerted by fluoride varnishes on the proportion of kids who develop dental caries, no definite conclusion regarding effectiveness of preventive intervention could be reached. However, Cooper et al. (2013) was effective in determining a potential setting that can be implemented across all primary schools for the implementation of behavioural interventions for supporting children adopt a healthy behaviour.
There is mounting evidence for the fact that child developmental theories typically place a focus on the ways by which children alter and grow over the entire course of their childhood, and also focus on different domains of child development namely, emotional, cognitive and social growth (Dweck 2013). Although Cooper et al. (2013) elaborated on the implementation of different behavioural interventions, none of them were allied with the developmental theories, thereby establishing a gap in the evidence.
Reasoned action theory has been recognised as one of the most extensively used theories in health intervention and behavior research (Montano and Kasprzyk 2015). The theoretical perspective of the theory on beliefs, underpinning behavior proposition a notional understanding of impact that health messages bring about in behavior change. In the words of Conner et al. (2017) this theory also can be implemented in the form of a practical tool for classifying principles that appear favourable for addressing health messages. However, the primary school based oral health intervention techniques have rarely focused on this theory. A detailed analysis of health behaviour modification interventions for dental caries prevention further suggested that behavioural alteration techniques were restricted to information on significances, information-behaviour associations, and education and demonstration of actions. However, none of the implemented interventions were grounded on behaviour change theory (Adair, Burnside and Pine 2013).
Another recent review by Albino and Tiwari (2016) on behavioural techniques to avert childhood caries elaborated on the complex interplay of microbial, genetic, biochemical, physical, environmental, behavioural and social factors, in relation to dental caries etiology. Motivational interviewing was considered as an effective strategy for modifying the decision related to individual oral health. This form of intervention can be allied with the behavioural child development theories that elaborated on the description of human behaviour in terms of a range of environmental influences. The intervention can be further associated with classical conditioning owing to the fact that behaviour are often learnt in childhood by means of repetitive connotation between a stimulus and response. Batliner et al. (2018) also conducted a randomised clinical trial with the aim of determining the effectiveness of motivational interviewing for early caries prevention. They suggested that while this behavioural intervention was responsible for greatly enhancing maternal knowledge on oral health and hygiene, it had little or no effect on the oral health behaviour manifested by the children, who formed the target population. This also led to the establishment of the role of social factors in determining the oral health among children.
Upon evaluating the relationship between parental attitude on dental care of their children with socioeconomic status and parental education, it was found that parents with greater educational attainment obtained satisfactory income cared on instructions related to oral hygiene and preventive dental check-ups (36.7% and 40.8% ; P < 0.01 and P < 0.001). Hence, the behavioural intervention should take into account the educational attainment of parents, their knowledge, and socioeconomic status, prior to its implementation (Sald?nait? et al. 2014). This can be directly correlated with Bandura’s social learning theory that is based on the fact that behaviours are usually learned by children through reflection and modelling. Witnessing the activities of others, counting on peers and parents, help children advance new abilities and attain novel information.
This was in accordance with the fact that a plethora of life course factors such as, biological, sociodemographic, oral and psychological health behaviour, in addition to dental status of the mothers were found associated with the onset and development of dental caries among kids (Abreu et al. 2015). Hence, increasing the knowledge on oral health among parents will prove more effective in making children adhere to activities that prevents dental caries. Blake et al. (2015) suggested the effectiveness of classroom-based interactive educational sessions, delivered by dental professionals in improving the oral health among primary school children. The findings indicated the short-term improvements that the program brought about in children’s oral health knowledge, thus confirming its implementation in primary school settings.
While most of the aforementioned interventions failed to demonstrate any positive correlation with behavioural theories, an analysis of the gathered evidences suggest that the social theory of learning and theory of planned behaviour will prove effective in the implementation of interventions across primary schools. The social learning theory can be addressed during implementation formulation owing to the fact that learning encompasses a cognitive process and occurs during social context and most often occurs via direct instructions and observations (Akers 2017). Hence, even in absence of any specific reinforcement that strengthens good oral behaviour among children, they can be made to show adherence to oral hygiene techniques by modeling. Parents can act as live models by demonstrating desired behaviours that are imperative for preventing dental caries, which when imitated by children, will reduce their chances of getting affected by dental caries. However, the theory of planned behaviour will prove more effective during implementation of the intervention in primary school settings. Owing to the fact that the theory focuses on human behaviour and the interplay between normative beliefs, behavioural beliefs, and control beliefs, taking into account the three factors would ensure success of the intervention (Ajzen 2015).
Furthermore, the model also postulates that oral behaviour is usually anticipated by the goal to perform the actions and also by professed behavioural mechanism when the deeds are not under comprehensive volitional control. In other words, the intention to accomplish good oral behaviour is controlled by the comparative prominence of the aforementioned three factors. One major reason for using this theory in preventing dental caries among children is the fact that an estimated 26% children missed school days due to dental infection and pain, and an average of three days were missed by them due to persistent dental problems. This is further confirmed by the fact that 67% parents report presence of dental pain in their children (Public Health England 2018). This elaborates the fact that oral health prevention programs for children have not been adequately implemented by the Borough Council.
Recent news reports also suggest that 170 youngsters have regular teeth extraction in the hospitals each day in Britain, a condition termed ‘oral health crisis’. An estimated 42,911 individuals aged below 18 years had their tooth extracted the previous year due to dental problems (Telegraph.co.uk 2018). Hence, one major gap lies in the fact that although Rochdale has formulated programs for improving oral health among the elderly, it needs to take efforts for enhancing the same among primary school children.
Among the prevalent health care issues, dental caries is a common health problem, which mostly affects the children. As per the review that has been conducted, the percentage of children suffering from dental caries among the early childhood and middle childhood groups is close to more 80%. As per the statistical survey data, United Kingdom is topping the charts for dental diseases and oral health issues, especially in children (De Leeuw et al. 2015). On a more elaborative note, it has been reported that 170 children have been identified to be affected by oral diseases in UK. Moreover, data also suggests that the dental infection, tooth decay and pain is the major contributing factor leading to 26% of the school aged children having missed days in schools due to dental pain and infection. Hence, the need for a large scale educational intervention is crucial, especially for the communities in North Western England such as for Rochdale (Telegraph.co.uk 2018).
The intervention chosen for this program is an education and counselling based behavioural intervention pursuing the health behaviours of the target population. It has to be mentioned in this context that for addressing any preventable health adversity, it is very important to target behaviour change of the target population. Hence, the theoretical approach of theory of planned behaviour is effective. However, it has to be mentioned that this particular intervention will attempt to address and change the deep rooted self-care ideas and perceptions of a considerably large scale population belonging to different socio-ecological backgrounds, hence, undoubtedly it will receive difficulties and challenges in fruition (Bertram, Blase and Fixsen 2015).
First and foremost, the most important implementation challenge that this project might encounter is the resistance to change among the target population. Elaborating more, this will be a primary school based intervention and it will target all socio-economic groups. Now the level of health literacy and awareness differs drastically among different socio-economic groups. Hence, the lack of participation will be an imperative challenge for the program and its successful implementation. Another notable difficulty that we may encounter while completing the project is the limited availability of resources and manpower. The intervention will need to invest time, money and the skillset and expertise of trained professionals, and the limited availability of such resources, especially in the remote location. Lastly, a key challenge in the implementation of the intervention is the language barrier. It has to be mentioned that ethnic minorities have higher prevalence of dental diseases in the UK, and they have limited English language proficiency. Hence, the intervention program is needed to be more culturally effective and safe however, it will be difficult to have translators and language interpreters on a large scale for all different locations. These limitations also might affect the effectiveness of the intervention program and can limit the success of the program, hence care is needed to be taken beforehand to address if not completely eradicate the possibility of these challenges stalling the progress of the project (Eldredge et al. 2016).
Along with successful implementation of the chosen intervention program, there is also need for effective evaluation of the intervention programs to ensure that the program is meeting the objectives set. There are various evaluation protocols that can be employed to continuously monitor the effectiveness of such behavioural intervention programs. First and foremost, I will use feedback survey as an evaluation tool. The feedback will be collected on a monthly basis, and will incorporate both the children and their parents to observe the pattern of change in the behaviours. The feedback system will also allow the capturing of the individual behaviour change patterns which will in turn help increase the authenticity, relevance and richness of the data. Another key evaluation technique that will be opted for judging the effectiveness of the program is the bimonthly dental clinic audit (Pierce and Kealey 2015). This will be carried out in the clinics closest to the school radius for the selected schools where the interventions have been given. The audit will help discover the change in the rate of primary school children visiting the clinic for dental issues after the introduction of the intervention program and will help provide data to directly correlate the impact of the behavioural intervention in preventing caries. Lastly, it is also important to judge if the results of the intervention have been consistent in follow up to decide whether the intervention had been sustainable in effectiveness or not. To address this objective, care will be taken to implement a follow up oral health assessment after 3 months of completion of the 6 month educational intervention program. This evaluation technique will encompass an interview of the target population to fill out a questionnaire of oral health and hygiene behaviour of the target population. This will not only help provide an opportunity to conduct a final assessment of the effectiveness of the intervention program and whether it has to been successful to change or improve the behaviour of the oral care and hygiene children and their parents (De Leeuw et al. 2015).
A few examples of evaluation approaches for similar intervention programs can be discussed extracted from previously published literature. For instance, Makvandi et al. (2015) has stated that questionnaire based interviews as evaluation techniques have been used to evaluate an educational intervention program for improving oral health young mothers with children. Another article by Petersen et al. (2015) has discussed clinical audits to be effective for evaluation of the oral health intervention programs to improve oral health. In this case however, we will be taking the assistance of a RCT study to check the effectiveness of the intervention. In this case, a small population from one primary school can be selected and a pilot study design can be selected for the RCT to take a preliminary assessment of the effectiveness of the intervention before applying it on the large populations. This will help the researchers understand if there is any applicative issues associated with the intervention and if there is requirement for any improvisations to the intervention and the chosen technique to optimize the outcome. Although, time and financial constraint for an additional pilot study can be a challenge to realization of this concept.
Clear description or examples of the initiative:
The intervention program is designed taking the assistance of theory of planned behaviour and it will encompass a few key strategic interventions. The first intervention will be a thorough counselling of the children and their parents to understand the exact oral health and hygiene. This will incorporate assessment of the existing dental hygiene behaviours of the target group, the existing knowledge on caries and how to prevent it and then counselling to improve the hygiene behaviour of the children. The counselling will be provided in a one to one setting and will implement evidence based education so that the target group easily identifies the benefits associated with proper oral hygiene maintenance and its positive impact on improving the oral health and preventing caries or oral infection. Post the counselling, the next part or the intervention program will be a demonstration based education session where different preventive oral hygiene maintenance programs (Montano and Kasprzyk, 2015). These educational sessions will include right teeth brushing techniques and frequency, right tools for brushing teeth twice a day, flossing techniques, and use of fluoride based mouthwashes as an added layer of protection against any infection or caries. The intervention program will also include monthly workshops where the target children will be involved in interactive sessions on adequate oral hygiene maintenance behaviour and techniques. Quiz and practice sessions will also be arranged to ensure that the children are understanding and retaining the education being provided to them and are implementing in their day to day life. The program will continue for a period of six months and at the end of the 6 month period, a follow up session will also be arranged to check the final outcome of the program and how it affected the health promotional behaviour of the children. Considering the target population for which the intervention program will be arranged, the primary school children, aged 5 to 11, and their parents will be selected randomly from two primary schools in Rochdale. Each school will have individual project team and the target population will involve all different social and cultural backgrounds. The intervention program will be designed in a culturally appropriate manner and a few dominant languages other than English will be included in the informative flyers which will be distributed after each educational intervention session to the target group for the ethnic groups. The session will be arranged on the weekends and on a once a week pattern to ensure utmost participation in the program (Eldredge et al. 2016).
The reach of the project would not be limited to just the target children of primary school, but the reach of the project is also extended to the families of the children as well. One key concept of the theory of planned behaviour which had been chosen as the theoretical approach which has been chosen for the program has three core elements, normative belief, control belief and behavioural intention. Hence, the education intervention has incorporated both children and their parents, to target and improve the behavioural norms of the family regarding oral hygiene. Elaborating further, if the parents understand and implement the oral health promotional behaviours as the family norms and principles, the children and the rest of the family will also implement changes in behavioural intention and introduce the behaviour effectively. The uptake however will depend entirely on the responsiveness of the target population and the efficacy of the professional providing the education. However, the uptake rate of the intervention will also increasingly depend on the help provided by the school professionals co-operating in the intervention program. The school authority will act as a very important channel for the success of the program, facilitating interest and participation among the target population. Sources or resources undoubtedly has the potential to facilitate or restrict successful intervention of the program. The sources such as educational resources, trained nurses and health care professionals, oral hygiene experts and community nurses will be required to lead the program to fruition (Bertram, Blase and Fixsen 2015). The availability of time, money and setting with adequate infrastructure in the primary schools will be a very important aspect associated with the success of the intervention program. Help or assistance from the local authorities will be required to ensure substantial availability of the resources for the successful implementation and completion of the program. In order to promote effectiveness of the intervention among the target population a few strategies to enhance participation and continuation of the program can be implemented. For instance, to boost the rate of participation and follow up adherence, the help of social media campaigning can be taken. Zhang et al. (2015) have suggested social media is a very effective and successful platform to attract attention and influence participation to any change program among target groups. Distribution of flyers in the school campus to let people know of the program before and during the program can also help in enhancing participation and in turn enhance effectiveness of the entire program. Lastly, the help of a monitoring committee to help monitor the program, its implementation and effectiveness can also be of extreme benefit for the program as well.
Socio-ecological models provide a very useful and effective framework to plan and implement intervention or health promotional programs for communities. The socio-ecological model of prevention addresses four core elements, individual determinants, social environment, built environment, and natural environment. The existing approaches for the improvement of the oral health and hygiene has mainly focussed on the individuals and their personal determinants and factors. However, these interventions has not focussed at all on the social, built or natural environment of the target group. Although this designed intervention has aimed to discuss the interrelation between the behavioural characteristics of a child and their parent and how it impacts the overall behavioural change. Along with that, the designed behavioural intervention will also address the social position, socio-economic status of the families and culture, designing and demonstrating oral hygiene maintenance behaviours that are in line with the individual cultural and demographic characteristics of the families. Hence, it can be easily stated that this behavioural intervention program for preventing caries in the primary school children is focussed on the addressing two domains or levels of the socio-ecological model (Eldredge et al. 2016). Although, a few social and socio-ecological elements can influence the interventions and its successful implementation. For instance, the economic or financial condition, literacy level, and parenting behaviour and family environment can restrict the level of behaviour change. The health problem that the study began with is preventing caries for the children and the intervention is addressing the health issues extensively. The intervention targets the oral health maintenance behaviour of the target population so that not just the children but the family also incorporates rigorous and thorough oral hygiene maintenance procedure. Hence, the intervention chosen is effective in not just targeting the issue chosen, but the treatment effect of the behavioural intervention chosen targets the behaviours of the target population thoroughly which will help overcome the frequency and predominance of other related oral health issues as well. Hence, the use of the theoretical approach of the theory of planned behaviour is a very impactful and easy to implement in changing the health promotional behaviour in practical community setting and this project will be fertile ground for further community health behaviour improvement projects as well.
References:
Abreu, L.G., Elyasi, M., Badri, P., Paiva, S.M., Flores?Mir, C. and Amin, M., 2015. Factors associated with the development of dental caries in children and adolescents in studies employing the life course approach: a systematic review. European journal of oral sciences, 123(5), pp.305-311.
Adair, P.M., Burnside, G. and Pine, C.M., 2013. Analysis of health behaviour change interventions for preventing dental caries delivered in primary schools. Caries research, 47(Suppl. 1), pp.2-12.
Ajzen, I., 2015. The theory of planned behaviour is alive and well, and not ready to retire: a commentary on Sniehotta, Presseau, and Araújo-Soares. Health Psychology Review, 9(2), pp.131-137.
Akers, R., 2017. Social learning and social structure: A general theory of crime and deviance. Routledge.
Albino, J. and Tiwari, T., 2016. Preventing childhood caries: a review of recent behavioral research. Journal of dental research, 95(1), pp.35-42.
Batliner, T.S., Tiwari, T., Henderson, W.G., Wilson, A.R., Gregorich, S.E., Fehringer, K.A., Brega, A.G., Swyers, E., Zacher, T., Harper, M.M. and Plunkett, K., 2018. Randomized trial of motivational interviewing to prevent early childhood caries in American Indian children. JDR Clinical & Translational Research, 3(4), pp.366-375.
Bertram, R.M., Blase, K.A. and Fixsen, D.L., 2015. Improving programs and outcomes: Implementation frameworks and organization change. Research on Social Work Practice, 25(4), pp.477-487.
Blake, H., Dawett, B., Leighton, P., Rose-Brady, L. and Deery, C., 2015. school-based educational intervention to improve children’s oral health–related knowledge. Health promotion practice, 16(4), pp.571-582.
Conner, M., McEachan, R., Lawton, R. and Gardner, P., 2017. Applying the reasoned action approach to understanding health protection and health risk behaviors. Social Science & Medicine, 195, pp.140-148.
Cooper, A.M., O’Malley, L.A., Elison, S.N., Armstrong, R., Burnside, G., Adair, P., Dugdill, L. and Pine, C., 2013. Primary school?based behavioural interventions for preventing caries. Cochrane Database of Systematic Reviews, (5).
De Leeuw, A., Valois, P., Ajzen, I. and Schmidt, P., 2015. Using the theory of planned behavior to identify key beliefs underlying pro-environmental behavior in high-school students: Implications for educational interventions. Journal of Environmental Psychology, 42, pp.128-138.
Dweck, C.S., 2013. Self-theories: Their role in motivation, personality, and development. Psychology press.
Eldredge, L.K.B., Markham, C.M., Ruiter, R.A., Kok, G., Fernandez, M.E. and Parcel, G.S., 2016. Planning health promotion programs: an intervention mapping approach. John Wiley & Sons.
Hmr.nhs.uk, (2018). News Rochdale is promoting better mouth hygiene in older people to not just improve smiles but to save lives. Available from https://www.hmr.nhs.uk/index.php/your-health/oral-health-improvement-for-the-elderly-programme-in-rochdale-borough Accessed on 26 December 2018.
Makvandi, Z., Karimi-Shahanjarini, A., Faradmal, J. and Bashirian, S., 2015. Evaluation of an oral health intervention among mothers of young children: A clustered randomized trial. Journal of research in health sciences, 15(2), pp.88-93.
Marinho, V.C., Worthington, H.V., Walsh, T. and Clarkson, J.E., 2013. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews, (7).
Montano, D.E. and Kasprzyk, D., 2015. Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. Health behavior: Theory, research and practice, pp.95-124.
Montano, D.E. and Kasprzyk, D., 2015. Theory of reasoned action, theory of planned behavior, and the integrated behavioral model. Health behavior: Theory, research and practice, pp.95-124.
National Institute for Health and Care Excellence, (2014). Oral health: local authorities and partners. Available from https://www.nice.org.uk/guidance/ph55/resources/oral-health-local-authorities-and-partners-pdf-1996420085701 Accessed on 26 December 2018.
Petersen, P.E., Hunsrisakhun, J., Thearmontree, A., Pithpornchaiyakul, S., Hintao, J., Jürgensen, N. and Ellwood, R.P., 2015. School-based intervention for improving the oral health of children in southern Thailand. Community Dent Health, 32(1), pp.44-50.
Pierce, J.P. and Kealey, S., 2015. Socio-ecological Model and Health Promotion in the Healthy People Initiative.
Public Health England, (2018). Child oral health: applying All Our Health. Available from https://www.gov.uk/government/publications/child-oral-health-applying-all-our-health/child-oral-health-applying-all-our-health Accessed on 26 December 2018.
Public Health England, (2018). Oral health improvement programmes commissioned by local authorities. Available from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/707180/Oral_health_improvement_programmes_commissioned_by_local_authorities.pdf Accessed on 26 December 2018.
Sald?nait?, K., Bendoraitien?, E.A., Slabšinskien?, E., Vasiliauskien?, I., Andruškevi?ien?, V. and Z?bien?, J., 2014. The role of parental education and socioeconomic status in dental caries prevention among Lithuanian children. Medicina, 50(3), pp.156-161.
Telegraph.co.uk, (2018). UK ‘oral health crisis’: 170 youngsters a day have teeth extracted as sugar blamed for epidemic. Available from https://www.telegraph.co.uk/news/2018/01/13/uk-oral-health-crisis-170-youngsters-day-have-teeth-extractedas/ Accessed on 13 January 2018.
Zhang, J., Brackbill, D., Yang, S. and Centola, D., 2015. Identifying the effects of social media on health behavior: Data from a large-scale online experiment. Data in brief, 5, pp.453-457.
Essay Writing Service Features
Our Experience
No matter how complex your assignment is, we can find the right professional for your specific task. Contact Essay is an essay writing company that hires only the smartest minds to help you with your projects. Our expertise allows us to provide students with high-quality academic writing, editing & proofreading services.
Free Features
Free revision policy
$10Free bibliography & reference
$8Free title page
$8Free formatting
$8How Our Essay Writing Service Works
First, you will need to complete an order form. It's not difficult but, in case there is anything you find not to be clear, you may always call us so that we can guide you through it. On the order form, you will need to include some basic information concerning your order: subject, topic, number of pages, etc. We also encourage our clients to upload any relevant information or sources that will help.
Complete the order form
Once we have all the information and instructions that we need, we select the most suitable writer for your assignment. While everything seems to be clear, the writer, who has complete knowledge of the subject, may need clarification from you. It is at that point that you would receive a call or email from us.
Writer’s assignment
As soon as the writer has finished, it will be delivered both to the website and to your email address so that you will not miss it. If your deadline is close at hand, we will place a call to you to make sure that you receive the paper on time.
Completing the order and download