Community Readiness for Children's Oral Health Improvement Across Three Cities in England

Childhood caries is a widespread global public health issue, with its prevalence closely reflecting underlying health and social inequalities. Planning effective oral health programmes tailored to the needs of the community is of primary importance. The Community Readiness Model (CRM) provides a methodological approach to quantify the degree to which a community is willing to engage with programmes and thus inform adaptations to maximise engagement and impact. This study aimed to apply the CRM to explore the factors influencing community readiness to improve children's oral health.

A mixed-methods study was conducted using the CRM across three cities in England. Semi-structured interviews were undertaken with key community stakeholders (n = 27). Quantitative readiness scores were derived across six domains to classify each city within one of nine readiness stages and allow comparison between localities. Interview transcripts were analysed using framework analysis to contextualise quantitative findings.

Two cities achieved a mean score of five, corresponding to the "Preparation" stage of community readiness, while one city scored three, indicating "Vague awareness". Although oral health programmes were present in all the cities, differences in readiness were related to three key factors: (1) availability of resources and funding, (2) leadership and partnership working, and (3) community engagement. Participants highlighted perceived barriers relating to access to dental services, competing social priorities, and variability in community knowledge.

This study is the first to use the CRM to examine community readiness to address children's oral health and provides a valuable framework for understanding community readiness for oral health improvement that can help direct policymakers and community leaders to maximise the impact of oral health programmes. Findings demonstrated that while oral health need was evident, readiness to act varied across settings and was influenced by contextual and systemic factors. Strengthening availability of resources, communication, leadership, and community engagement is vital to enhance readiness and improve programme effectiveness.