Selected areas of work

Evaluation and research is currently underway in all of the key domains underpinning Childsmile's evaluation strategy (see the Evaluation Matrix). A brief summary of selected studies is outlined below.

Component: Record Linkage Outcomes Evaluation
Key evaluation domains: Service Impact, Service Delivery (Quality) and Health and Behavioural Outcomes.
Investigators: Central Evaluation and Research Team (CERT), Health Infomatic Centre (HIC) and NHS National Services Scotland Information Services Division (ISD).

Summary: The development of IT systems to ensure efficient collection and use of comparable routine monitoring data across multiple agencies throughout Scotland. These data will be used to explore delivery / engagement in the Childsmile programme and its impact on: oral health outcomes; dental services; health service outcomes; and general health outcomes. This component will also involve linkage of Childsmile data (through the Communuty Health Index (CHI) number) with national data sets and the use of the Scottish Index of Multiple Deprivation (SIMD) to examine delivery and outcomes for different socio-economic groups.

Component: Process Evaluation
Key evaluation domains: This work contributes to multiple domains and is central to the theory-based approach underpinning the wider evaluation strategy.
Investigators: CERT and Childsmile Regional Research Teams.

Summary: Qualitative approach (complementary to quantitative monitoring) to document and describe ongoing development and implementation of the programme, and in particular to explore regional variations in delivery and how contextual factors interact with outcomes. This research also aims to capture unintended consequences and utilises stakeholder experience and learning to review Childsmile implementational theory.

Component: Oral Health Related Quality of Life
Key evaluation domains: Health Outcomes.
Investigators: CERT, NHS Greater Glasgow and Clyde and University College London.

Summary: Research is being undertaken to develop and validate an instrument to measure the quality of life of five-year-old school children.

It is anticipated that the instrument will be used to collect data to examine the intermediate and longer term outcomes of the Childsmile programme.

Component: Application of Fluoride Varnish: A national survey of General Dental Practitioners (GDPs) in Scotland.
Key evaluation domains: Service Impact, Service Delivery, Professional Participation.
Investigators: CERT.

Summary: The survey is designed to measure the level of fluoride varnish delivery by GDPs in Scotland and the key behavioural domains likely to predict subsequent delivery of fluoride varnish before and after a change to the Statement of Dental Remuneration (SDR) implemented at the start of October, 2011.

Component: The Behavioural Profiling of Dental Nurses in Applying Fluoride Varnish Engaging Dental Nurses in Nursery and Practice Settings (BEHAVE project).
Key evaluation domains: Training and Workforce Development and Service Delivery (Quality).
Investigators: University of St Andrews.

Summary: Examination of video evidence of dental nurse-child interactions to uncover nurse behaviours that contribute to successful fluoride varnish application and to determine the benefit of designing additional training sessions to improve the process of varnish application.

Component: – Developing an Inventory to Assess Parental Concerns and Enable Child Dental Registration (The DAPER study).
Key evaluation domains: Family Participation.
Investigators: Dental Health Services Research Unit, University of Dundee.

Summary: A three stage study that involves: a qualitative exploration to identify main parental concerns around dental registration and attendance for preventive care; the development and subsequent validation of a questionnaire to assess parental concerns; and a field trial utilising this questionnaire to identify parents with concerns and assess if additional Dental Health Support Workers (DHSWs) support can assist access of children to preventive dental care.

Component: The Childsmile Nursery Fluoride Varnish Trial
Key evaluation domains: Health Outcomes
Investigators: CERT, University of Glasgow

The reference links in the text below are for external websites.

Summary: The Childsmile Nursery Fluoride Varnish programme is implementing guidance set out by the Scottish Dental Clinical Effectiveness Programme (SDCEP) on the prevention and management of dental caries in children (external website), which recommends fluoride varnish application as a key component of clinical prevention in pre-school children. A recent trial in school children in North West England (external website) found that there was limited evidence of effectiveness of fluoride varnish in a public health programme. However, there are several key differences between this trial and the Childsmile Nursery programme that warrant further investigation. Firstly, the North West England trial was undertaken in older children (aged 7-8 years old), while the Childsmile Nursery programme focuses on 3 and 4 year olds; secondly the small amount of varnish used in the North West England trial applied only to permanent molars may have been insufficient to provide effective dental caries prevention. Thirdly, the Childsmile Programme also includes supervised nursery toothbrushing which needs to be considered. Finally the Childsmile programme focuses on children from more deprived areas who have a greater risk of developing dental caries. .

It is therefore important that a randomised clinical trial of the effectiveness and efficiency of fluoride varnish in the Childsmile Nursery Programme is undertaken. This is planned to commence in 2012. It is widely recognised that there is a need for further evidence in this area as stated in the Cochrane review (external website) which only included a small number of studies in this younger age group. And in addition to our trial there are two other clinical trials underway in the UK – one in Northern Ireland in a dental practice setting and another in Wales assessing Fluoride varnish versus pit and fissure sealants.