How do we improve support for oral health, substance use, smoking and diet for people facing severe and multiple disadvantage?
Study Title: Factors affecting implementation of interventions for oral health, substance use, smoking and diet for people with severe and multiple disadvantage
Quick-read summary
People experiencing homelessness, substance use and repeat offending (known as people with severe and multiple disadvantage) often face challenges with their dental health. These issues are closely linked with the use of cigarettes, alcohol, and other drugs, and poor or unhealthy diet.
A better understanding of how the health support can be improved for people experiencing severe and multiple disadvantage can encourage positive health outcomes.
This can reduce health inequalities and reduce the burden on health systems and social care in the long-term.
This study involved speaking to people living with severe and multiple disadvantage and people involved in providing health and social care services, to understand how delivery and longevity of services for oral health and associated health behaviours can be improved.
The study found that the health support for oral health and related health behaviours depended on factors ranging from the relationships at individual level, to how the health services were organised – as well as the wider availability and policy for health support.
These factors closely interacted with the lived vulnerabilities of a people experiencing severe and multiple disadvantage.
Why is this important?
People experiencing severe and multiple disadvantage are caught in a never ending cycle of inter-connected challenges. Improving the way services are delivered to them can improve their health outcomes in the long-term and help break the cycle between poor health outcomes and homelessness. This study provides findings that can also be used to improve access to other support, such as those for infectious diseases such as hepatitis or AIDS as well as improving vaccine uptake.
Who is this evidence useful for?
Commissioners in health and social care sectors, local authorities, healthcare providers, voluntary organisations and policy makers
What is the issue?
- People experiencing homelessness face complex health conditions due to social and economic disadvantages. This means they often also experience challenges with drugs, alcohol, and repeat crimes, which together with homelessness creates a loop of disadvantage (known as severe and multiple disadvantage).
- Previous studies have found that people experiencing homelessness often suffer from poor dental health. This leads to difficulty in chewing, getting appropriate nutrition and also affects self-esteem in the long term.
- People with poor dental health may also show high levels of smoking, substance use and poor diet. In some cases, people with dental pain told us that they smoke or drink alcohol to help with the pain. Poor oral health, smoking, substance use, and poor diet create poor physical and mental health in this population.
- There is limited information available on how to improve the health support for oral health and related health behaviours for people experiencing severe and multiple disadvantage.
Research summary
We spoke with 28 people experiencing severe and multiple disadvantage from Newcastle upon Tyne and Gateshead in the North East of England.
We also spoke with 78 service providers, commissioners and policy makers from London, Plymouth, Newcastle upon Tyne, and Gateshead to understand their experiences and opinions on health support for oral health and related health behaviours.
What the research found
- Wider policies and practice such as earmarking more funding towards health support for vulnerable populations, and bringing together care and support for different health conditions can be helpful in improving delivery and sustainability of health support.
- Placing different services closer to one another to overcome barriers in access, offering training to services and healthcare providers to prevent stigma at the point of delivery, and including health promotion and prevention in strategies can be useful at an organisational level.
- A good relationships between a service provider and the person experiencing severe and multiple disadvantage were important in providing health support. These relationships can be improved by including a support worker as a point of contact and building motivation among service providers.
- The study identifies several gaps in research, such as around understanding how to improve diet in people living with severe and multiple disadvantage.
How were people/community groups/patients involved in this work?
We met with a group of 2-4 people with lived experience of severe and multiple disadvantage at different stages of the study to get their input on various aspects of study. Documents such as information sheets were designed with their collaboration and participant recruitment was aided by an animation designed with support from this group. They gave input on the language and content of the information sheet as well as the guides which were used to conduct conversation with the study participants.
What’s next?
The findings from this study are being used to collaborate with policy makers and people in practice to inform future plans for improving outcomes for oral health and related health behaviours in people living with severe and multiple disadvantage.
A visual representation of the findings from the overarching project has been developed with support from More than Minutes, along with a policy brief. These documents will be used to streamline the conversation.
Another paper from this study has been submitted for consideration for publication which looks at solutions to promote physical access to the services by people experiencing severe and multiple disadvantage.
Get in touch about this research
Neha Jain
Email: neha.jain@newcastle.ac.uk
Professor Sheena Ramsay
Email: sheena.ramsay@newcastle.ac.uk
Read the full research paper: Factors affecting implementation of interventions for oral health, substance use, smoking and diet for people with severe and multiple disadvantage: a community-based qualitative study in England | BMJ Public Health – May 2024
https://bmjpublichealth.bmj.com/content/2/1/e000626
How was this work funded?
This research is supported by the National Institute of Health and Care Research (NIHR) Policy Research Programme (NIHR200415). Emma Adams was supported by the NIHR School for Public Health Research (SPHR) pre-doctoral fellowship, Grant Reference Number PD-SPH-2015 and the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC) (NIHR200173).
Now, Emma (Doctoral Research Fellow, NU-010978) is funded by the NIHR for this research project.
Eileen Kaner is supported by an NIHR Senior Investigator award and directs the NIHR funded Applied Research Collaboration North East and North Cumbria. Sheena Ramsay, Eileen Kaner, Neha Jain, Emma Adams, Laura McGowan are members of the Centre for Translational Research in Public Health (www.fuse.ac.uk) and NIHR Applied Research Collaboration North East North Cumbria.