CHILDSMILE DENTAL HEALTH SUPPORT WORKERS IMPACT ON CHILD DENTAL PARTICIPATION IN SCOTLAND

Abstract

Childsmile, a Scottish government funded national public health programme, aims to improve child oral health and reduce oral health inequality. Dental Health Support Workers (DHSWs) form one of the programme’s targeted strategies; primarily aiming to facilitate parents to access dental services for their children in the early years.

Aim: This study measured the impact DHSWs had on child registration and attendance with dental practice, investigating whether this was similar across social groups.

Method: National level data from three administrative health datasets were linked, including: 1) Child Health assessments (September 2010-December 2012) (n=111,909); 2) Health Informatics Centre data on DHSW contact with (referred) families (September 2010 -September 2012) (n=18,392), and 3) Management Information and Dental Accounting System data on dental participation (registration and/ or attendance) (September 2010-December 2013) (n=76,724). Analysis was undertaken through a secure research portal. Multivariable logistic regression models were used to analyse the effect of DHSW intervention on participation, and whether there was any modification of this effect according to area-based deprivation (using Scottish Index of Multiple Deprivation (SIMD) 2009). Survival analysis was used to analyse time to participation at dental practice. This study was NHS Privacy Advisory Committee (now the Public Benefit and Privacy Panel) approved.

Results: Preliminary results show that, across the whole population, 80.8% (n=14852/18392) of those who received a DHSW intervention participated at dental practice compared to 66.2% (n=61872/93517) who did not receive an intervention (OR=2.1, 95% CI [2.1 to 2.2], p<0.0001). This effect was slightly modified when stratified by area-based deprivation: In children living in the 20% most deprived areas of Scotland, participation was 77.6% (n=12417/20494) for those receiving the intervention vs. 60.6% (5908/7614) for those not. For those living in the 20% least deprived areas the figures were: 84.0% (1178/1403) vs. 69.8% (11607/16631), respectively (p for interaction=0.25). Survival analysis showed that the median age when a child first participated at dental practice was 9 months for those who received a DHSW intervention and 19 months for those who did not.

Conclusions: Participation rates at dental practice were higher for families who received the DHSW intervention, compared to those who did not, the effect only slightly stronger for those living in more deprived areas. Participation at dental practice was facilitated sooner for children receiving DHSW support. Ongoing work is addressing whether these benefits translate to a clinically important reduction in inequalities in oral health.