Smile4life National Oral Health Improvement Programme: Inclusive Evaluation to Assess the Impact of Co-designed Resources for a Community-based Oral Health and homelessness intervention.

United Nations Habitat estimates that 150 million people are affected by homelessness worldwide. The Covid-19 pandemic further aggravated this scenario of health and social inequalities. The oral health/health needs of homeless people have been perceived within Scottish health policy as part of the broad goal of reducing health inequalities. People affected by homelessness are particularly vulnerable and are four times more likely to die prematurely than others. Inclusive approaches to engage with this population and sustain their engagement with health and social care services is crucial. Smile4life, the Scotland’s national oral health improvement programme for people experiencing homelessness conducted the world’s largest survey on oral health and health needs, revealing poorer oral health and health related quality of life, with limited access to services. Despite this, practitioners working with these groups do not always feel confident to engage and to discuss health needs with this population. The Smile4life programme designed an oral health guide for trainers and its evaluation found that the use of health educational guide resulted in increased homelessness health-related knowledge and capacity building for health promotion. As highlighted by research evidence an essential factor to improve engagement with services and practitioners is the deeper involvement of ‘expert by experience’ in the co-design of educational and training resources. The use of these resources can positively impact practitioners’ ability to communicate and to engage with people experiencing homelessness, welcoming them into the services.

A recent package of varied educational and training resources to help practitioners working with this population, titled ‘Do Not Give Up on Us’, was co-designed with young people and adults experiencing homelessness, service providers, NHS Education for Scotland, and Public Health Scotland. There is now a need to evaluate the impact of this package of resources, including the second Smile4life – Guide for Trainers’.

Aims of PhD project

To evaluate the impact of Smile4life’s ‘Do Not Give Up on Us’ national package of resources for improving the oral health/health knowledge and engagement of people experiencing homelessness, in healthcare and community settings.

Objective 1: To understand what stakeholders think should be the key performance indicators of Smile4life educational and training resources.

Objective 2: To develop an evidence-based framework for the purposes of evaluating impact of educational resources.

Objective 3: To evaluate the Smile4life national package of resources, using this newly developed framework.

Study Design: A multi-method approach involving four study stages underpinned by a community based participatory research methodology will be conducted. Co-design and co-production will be used for a bottom-up development of an innovative and inclusive evaluation process with strong and meaningful involvement of people with lived experience. Co-design has been used for the purposes of quality improvement in healthcare and has been found to be a “meaningful and sustainable” way of enabling patients and healthcare staff to “come together and jointly reflect on their shared experiences”. An advisory team composed by representatives of the Homelessness Community has already been established and invited to shape the research design and methodology. This advisory group will provide valuable feedback throughout all research stages.