Using Normalisation Process Theory to investigate the implementation of school-based oral health promotion

Despite the considerable improvement in oral health of children in the UK over the last forty years, a significant burden of dental caries remains prevalent in some groups of children, indicating the need for more effective oral health promotion intervention (OHPI) strategies in this population.

To explore the implementation process of a community-based OHPI, in the North East of England, using Normalisation Process Theory (NPT) to provide insights on how effectiveness could be maximised.

Utilising a generic qualitative research approach, 19 participants were recruited into the study. In-depth interviews were conducted with relevant National Health Service (NHS) staff and primary school teachers while focus group discussions were conducted with reception teachers and teaching assistants. Analyses were conducted using thematic analysis with emergent themes mapped onto NPT constructs.

Participants highlighted the benefits of OHPI and the need for evidence in practice. However, implementation of 'best evidence' was hampered by lack of adequate synthesis of evidence from available clinical studies on effectiveness of OHPI as these generally have insufficient information on the dynamics of implementation and how effectiveness obtained in clinical studies could be achieved in 'real life'. This impacted on the decision-making process, levels of commitment, collaboration among OHP teams, resource allocation and evaluation of OHPI.

A large gap exists between available research evidence and translation of evidence in OHPI in community settings. Effectiveness of OHPI requires not only an awareness of evidence of clinical effectiveness but also synthesised information about change mechanisms and implementation protocols.