Building capacity to promote oral health in an Australian community mental health setting
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2018
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Melbourne Authors
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Melbourne Dental School
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PhD thesis
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Open Access
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© 2018 Dr. Roisin Mary McGrath
Abstract
Half of all Australians will experience a common mental illness during their lifetime. There is strong evidence that people living with mental illness, particularly those living with severe mental illness, experience poor oral health outcomes and face significant challenges in accessing oral health care. Indeed, Australia’s National Oral Health Plan identifies people living with mental illness as a Priority Population with additional and/or specialised oral health needs. Despite this recognition, there is a distinct lack of oral health promotion programs targeting people living with mental illness.
The utilisation of non-dental professionals (e.g. aged care professionals, midwives, pharmacists etc.) in promoting oral health has demonstrated considerable success in a variety of settings. However, there is little evidence of this approach involving mental health professionals. Developing oral health promotion skills of mental health professionals may provide an appropriate approach to increase oral health advice and support for people living with mental illness. Therefore, the aim of this PhD project was to investigate how to build capacity to promote oral health in an Australian community mental health setting. All research activities were approved by the Human Research Ethics Committee at the Melbourne Dental School and by the Research and Evaluation Committee at Neami National.
A multi-stage sequential mixed methods participatory action research design was used in this project. It was guided by the ‘Framework for Building Capacity to Improve Health’, which is a well-recognised and widely used framework in Australia. Research was conducted within Neami National, one of Australia’s largest community mental health organisations. Stage One explored existing capacity to promote oral health within Neami National through an environmental scan of health promotion action, a post-training evaluation survey after face-to-face oral health training, and a cross-sectional web-based survey of Neami Community Rehabilitation and Support Workers measuring their oral health knowledge, attitudes and professional practices.
Stage Two focused on the design, development and implementation of professional development activities to increase capacity of Neami Community Rehabilitation and Support Workers to promote oral health for mental health consumers. This stage involved a multi-state quasi-experimental control group study design, which sought to compare the effectiveness of different training delivery modes (face-to-face, online, blended or none) as part of the ‘Smile for Health’ professional development program. Oral health ‘champions’ in each Neami site were utilised to support the implementation of oral health professional development within their team.
Stage Three included process, impact and outcome evaluation, which was used in determining which Smile for Health training delivery mode is most appropriate for use in a community mental health setting. Evaluation activities included a mixed-mode post-training evaluation survey, qualitative focus groups and semi-structured interviews, and a follow-up cross-sectional survey of Neami Community Rehabilitation and Support Workers to measure changes in oral health-related knowledge, attitudes and professional practices.
The results of this project demonstrated that any type of professional development can increase the provision of oral health support to mental health consumers. However, it is important to tailor professional development activities to be contextually appropriate. The utilisation of oral health champions was a key enabler in this project, as they had the skills and capacity to problem-solve any issues as they arose and ensured that oral health promotion remained on the agenda within individual teams. Oral health champions offer a sustainable solution to support the implementation of capacity building approaches to increase oral health promotion in community mental health settings.
People living with mental illness require specialised oral health promotion programs. This research provides evidence on how to increase capacity to promote oral health in a community mental health setting. Smile for Health offers a contextually appropriate oral health promotion approach for services providing support to people living with mental illness. It is recommended that Smile for Health be rolled out across all Neami sites and potentially implemented in other community mental health services.
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Keywords
oral health promotion, severe mental illness, capacity building, participatory action research, oral health champions