Optimising the Role of the Dental Health Support Worker within Childsmile Practice: Mapping Delivery & Exploring Variation

Background: Childsmile is a national oral health improvement programme for Scottish children. Childsmile Practice, a targeted and universal component, aims to promote oral health, and reduce inequalities in oral health and access to dental services. Practice is delivered, in part, by DHSWs who support families to engage with oral health behaviours and dental practice attendance. Objectives: This study comprises part of Childsmile's formative evaluation. Designed as a scoping exercise, we aimed to uncover and explore areas of variation in delivery of the role. The findings were used to design in-depth comparative case studies, with the purpose of learning from within Childsmile, to optimise delivery of the role. Methods: Eight focus groups and eight semi-structured interviews (involving 24 DHSWs and 9 Childsmile Coordinators) explored the delivery process and barriers and facilitators to achieving outcomes. Participants were selected using theoretical sampling. Sessions were recorded and transcribed. Thematic analysis was conducted. Findings: Substantive variation in the delivery of the role, evident between and within health boards, was attributed to: adaptation at a local level; individual attitudes; engagement from Childsmile stakeholders; and DHSW workload. Key points of variation are where the DHSW is situated and how this influences referral of the 'right child', and the nature of support. DHSWs rely on the 'right child' being referred for support and method of referral may impact on programme outcomes. Supporting families may require intensive behaviour change, the extent to which this should be part of the role needs to be considered. Barriers to the role include lack of engagement from dental practices and limited DHSW autonomy. Conclusion: Variation in the DHSW role to suit local context is expected and potentially facilitative. The extent to which variation impacts on programme outcomes will be investigated during planned case studies. The role needs further development prior to summative evaluation