Implementing the Smile4life intervention for people experiencing homelessness: a path analytical evaluation

Area of Science:

• Public Health
• Health Services Research
• Behavioral Science

Background:

• Homeless individuals face significant oral health challenges, including decay and cancer.
• The Scottish Government initiated the Smile4life program to improve oral health for this population.
• This study examined the implementation of Smile4life and influencing work-related beliefs.

Purpose of the Study:

• To investigate implementation behaviors of the Smile4life program.
• To explore the role of work-related beliefs in program delivery.
• To identify factors influencing the successful rollout of oral health initiatives for the homeless.

Main Methods:

• Utilized non-probability and snowball sampling to recruit 100 practitioners.
• Employed the Behavior Change Wheel and Theoretical Domains Framework for evaluation.
• Administered a questionnaire assessing awareness, activities, beliefs, and ability to deliver, followed by psychometric analysis and path analysis.

Main Results:

• Implementation behavior was predicted by a linear model with good fit (R²=0.62).
• Positive beliefs and outcomes, along with the ability to deliver, were significantly associated with implementation behavior (p<0.05).
• The model demonstrated strong loadings for implementation behavior (0.87 and 0.56).

Conclusions:

• Work-related factors, specifically positive beliefs and perceived ability, are essential for Smile4life program implementation.
• Future efforts should focus on tailored training and accessible resources for homelessness sector professionals.
• Promoting effective implementation behaviors is key to the sustainability and success of the Smile4life program.