Oral Health Improvement for People with Experience of Drugs (OHIPED)

Funders

The Corra Foundation have provided funding for the comics development in this project.

The Dental Health Services Research Unit, the Scottish Drugs Forum, NHS Fife Dental Public Health and the Scottish Centre for Comic Studies are collaborating on an exciting project focused on improving oral health in people with experience of drug use. The project involves an interdisciplinary team including service users to co-design resources and training.

Previous work within oral health has focused on priority groups identified in the Scottish Government Dental Action Plan of 2005. This included people experiencing homelessness, prisoners and older people. This work has resulted in a number of key resources to promote oral health amongst these priority groups and have provided a basis for this project.

Drug use affects oral health through direct physiological routes such as dry mouth, an increased urge for snacking, clenching and grinding of teeth, infections of the mouth lining and chemical erosion from applying substances directly to teeth and gums. A lifestyle that often accompanies problematic drug use also affects oral health through high sugar diets, malnutrition, poor oral hygiene, and lack of regular professional dental care. People with lived experience and those that support them have told us that there is significant stigma attached to having or having had a substance problem and this stigma is increased significantly by having poor oral health.

Research questions

1. What are the oral health experiences of people with a history of drug and alcohol use?
2. What content should resources aimed at improving the oral health of people with a history of drug and alcohol use contain?
3. How useful do end users find the resources produced?

Aim

To improve the oral health of people with experience of drug use, using an innovative co-design and co-production approach to create oral health improvement interventions.

Objectives

1. Explore the oral health experiences of people with a history of alcohol and drug use;
2. Explore what content they would like in an oral health resource;
3. Explore what comic format the resource would take;
4. Co-design with people with a history of alcohol and drug use, three comic books with oral health messages;
5. Co-produce with people with a history of alcohol and drug use, three comic books as a means of delivering oral health promotion messages to people.
6. Use the comic books and the Smile4life training package for the addiction worker training programme to enable addiction workers to be advocates for oral health in the social care settings they will work in.

Method

Co-design is a priority in this project. Workshops with a purposive sample recruited from the SDF peer researcher program explored the oral health experiences of service users. This included a ‘comic script jam’ facilitated by the research team. Content analysis informed the content of the oral health resources including the comics and the content of the training programme for the addiction trainee workers. The comic books will be distributed through NHS services, the Scottish Drugs Forum and other service providers to be used as an adjunct to wider oral health improvement work whilst the training resource will be delivered during induction of trainees.

Results

Three comics have been produced. Evaluation of the comics has included semi structured interviews with people with lived experience of drugs. The training resource has been evaluated using pre and post intervention questionnaires informed by the Theoretical Domains Framework.

Conclusion

This project is a key example of bringing together skills and resource to advance public health and create resources tailored through co-design for at risk groups. The methods used to develop the intervention are innovative and long term evaluation of the impact will be required. This project marks the start of our research in this area and we are keen to expand further including understanding more about oral disease prevalence and the accessibility/acceptability of current oral health care provision for this group.

Awards

• Faculty of Public Health in Scotland Conference 2019:  Prize Winner for ‘The poster that describes a piece of work that successfully involves several organisations’.
• British Association for the Study of Community Dentistry 2020: 2nd Place BASCD Borrow Foundation Early Careers Poster Prize.

Collaborating School

School of Humanities: Professor Chris Murray