Effectiveness of oral health promotion

Question 1

What is a health promotion evaluation?

Answer 1

Assesses the extent to which an action achieves valued outcomes.
The process of assessing what has been achieved and how it has been achieved.

Question 2

Name of an OHP effectiveness review

Answer 2

Kay and Locker 1996

Question 3

Common findings of oral health promotion effectiveness reviews

Answer 3

• Improving individuals knowledge of oral health can be achieved in the short term but effects on behaviour are limited.
• Interventions at an individual level are effective at reducing plaque levels in the short term
• School based tooth brushing campaigns aimed at improving oral hygiene are largely ineffective
• Mass media campaigns are largely ineffective at promoting either knowledge or behaviour change but may have value in raising awareness
• Few studies have assessed the effect of OHP on sugar consumption
• Water fluoridation is effective in preventing dental caries
• Fluoride toothpaste is effective, use of F supplements in schools has not yet shown to be effective
• Little evidence to show cost effectiveness has been assessed
• Many studies were poorly designed and lacked a contemporary theoretical basis
• Quality of evaluation was poor
• Measures used were of limited value and were not comparable
• Data analysis was very basic - confounding factors not assessed.

Question 4

What are the strengths of OHP reviews?

Answer 4

• Reviewing a large number of studies

- Using standardised and scientific methodologies

Question 5

What are the weaknesses of OHP reviews?

Answer 5

Most studies:

• Used inadequate/inappropriate measures
• Poorly designed with inadequate time scales
• Poor quality
• Not assessing confounding factors
• Lacking a theoretical basis
• Inappropriate inclusion and exclusion criteria, leading to selection bias
• Overemphasise on RCT’s which may not be appropriate for OHP evaluations
• Inappropriate quality assessment criteria
• Too much focus on clinical measures such as DMFT
• Publication bias
• Not assessing quality of interventions, only relying on reported outcomes
• Not assessing process or impact
• Political and funding issues

Question 6

What is the evidence of OHP effectiveness?

Answer 6

• Comprehensive approaches using all 5 Ottawa Charter strategies are the most effective
• Certain settings - such as schools, workplaces, cities, local communities, offer practical opportunities for effective health promotion
• People, including those most affected by health issues, need to be at the heart of HP action programmes for them to be effective
• Real access to education and information is vital
• Health promotion is a key investment - an essential element of social and economic development
• Current traditional curatively-oriented strategies for improving oral health are relatively ineffective and expensive
  -OHP should be aimed at achieving rational use of sugar products, fluoridation of the mouth, effective oral hygiene, reductions in smoking and drinking, prevention of trauma and appropriate use of dental care.
  Traditional approaches = behavioural - information giving and expert advice are ineffective

Question 7

What approaches have seemed to be effective thus far?

Answer 7

1) Interventions using models of health behaviour have been shown to be effective in promoting behaviour change.
2) Motivational interviewing (based on TTM model) has been effective in clinical settings

Question 8

What is the nut beam model?

Answer 8

• Health and social outcomes
  QoL, equity, mortality and morbitity
  -Intermediate health outcomes - healthy lifestyles, effective health services and healthy environments
• Health promotion outcomes
  Health literacy, social influence and action and healthy public policy
• Health promotion actions
  Education, facilitation and advocacy

Question 9

What are some principles of good practice?

Answer 9

Place emphasis on addressing inequalities to achieve sustainable long term improvements in oral health
Adopt CRFA
Recognise underlying social, economic and environmental determinants
Work with community to develop locally sensitive interventions
Adopt a range of complementary public health strategies
Work in collaborative partnerships
Use appropriate evaluation methods and outcome measures to assess of interventions
Community participation
Integrate oral health into general health promotion