Factors affecting implementation of interventions for oral health, substance use, smoking and diet for people with severe and multiple disadvantage: a community-based qualitative study in England

N. Jain, E. Adams, E. C. Joyes, Gillian McLellan, M. Burrows, M. Paisi, L. McGowan, Lorenzo Iafrate, David Landes, R. Watt, F. Sniehotta, Eileen Kaner, S. Ramsay
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Abstract

Populations facing severe and multiple disadvantage (SMD), co-occurring homelessness, substance use and repeat offending have high levels of physical and mental ill-health. Poor oral health is one of the most common health problems in this population and is closely linked with substance use, smoking and poor diet. Issues related to the implementation of interventions among SMD populations to address oral health and related health behaviours are poorly understood. This study aimed to understand the factors that affect implementation (relevance of setting, acceptability and adverse effects of interventions) and the sustainability of interventions targeting oral health, substance use, smoking and diet for people experiencing SMD.Between August 2021 and April 2023, interviews and focus group discussions were conducted with two groups of participants: (1) people experiencing SMD in Newcastle Upon Tyne/Gateshead and (2) frontline staff, volunteers, policymakers and commissioners from London, Plymouth and Newcastle Upon Tyne/Gateshead. Information was gathered on factors related to the implementation and acceptability of interventions related to oral health and related behaviours. The data were analysed iteratively using thematic analysis.Twenty-eight people experiencing SMD (age range: 27–65 years; 21% females) and 78 service providers, commissioners and policymakers (age range: 28–72 years; 63% females) were interviewed or included in focus groups. The data were organised into three overarching themes: environmental, organisational and interpersonal factors. Environmental factors included funding and integrated services; organisational factors included inclusive services, health promotion, prevention and training healthcare providers; interpersonal factors included the presence of support workers and motivation among service providers.The implementation and sustainability of health interventions for people experiencing SMD are influenced by factors across environmental, organisational and interpersonal levels that interact with the inherent challenges of disadvantaged groups. The findings highlight the need for tailoring healthcare interventions according to the needs of people experiencing SMD. Further research on the implementation of diet interventions and co-producing interventions is needed.
影响针对严重和多重弱势人群实施口腔健康、药物使用、吸烟和饮食干预措施的因素:英格兰一项基于社区的定性研究
面临严重和多重不利条件(SMD)、同时出现无家可归、药物使用和屡次犯罪的人群,其身体和精神健康状况很差。口腔健康状况不佳是这类人群最常见的健康问题之一,与药物使用、吸烟和不良饮食习惯密切相关。人们对在 SMD 群体中实施干预措施以解决口腔健康和相关健康行为的问题知之甚少。2021 年 8 月至 2023 年 4 月期间,对两组参与者进行了访谈和焦点小组讨论:(1) 纽卡斯尔泰恩/盖茨黑德的 SMD 患者;(2) 伦敦、普利茅斯和纽卡斯尔泰恩/盖茨黑德的一线工作人员、志愿者、决策者和专员。收集的信息涉及与口腔健康及相关行为有关的干预措施的实施和可接受性的相关因素。28 名 SMD 患者(年龄范围:27-65 岁;21% 为女性)和 78 名服务提供者、专员和决策者(年龄范围:28-72 岁;63% 为女性)接受了访谈或参加了焦点小组。数据被归纳为三大主题:环境因素、组织因素和人际因素。环境因素包括资金和综合服务;组织因素包括包容性服务、健康促进、预防和培训医疗服务提供者;人际因素包括支持工作者的存在和服务提供者的积极性。研究结果突出表明,有必要根据 SMD 患者的需求量身定制保健干预措施。还需要进一步研究饮食干预措施的实施和共同生产干预措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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