The Scenario:
A community health center developed an intervention to improve oral health of children in lower income communities. The intervention consisted of a mobile dental unit staffed by dental hygienists sent to elementary schools. After obtaining parental consent, children received cleanings and oral exams. When hygienists identified children needing additional care the parents were given a referral for follow-up with a dentist.
To pilot the intervention, they began with a mobile dental unit going to one school. Of all children eligible, 85% of parents gave consent for the children to receive cleaning and screening. Of families given referrals for additional care, a follow-up survey one week after the event showed 75% had made an appointment with a dental clinic.
This pilot was considered effective, so the community health center scaled up. They deployed mobile units to 20 additional schools.
In some schools, similar proportions of parents gave consent for care and made follow-up appointments. In others, the rates of parental consent or follow-up on referrals were much lower.
I would use implementation science to increase intervention uptake. I would focus on increasing comfort and trust from parents and children towards the mobile dental units and follow-up appointments from physicians and dentists (Guest & Namey, 2015). Implementation science focuses on the gap between what we know works within efficiency trials and how the intervention will play out successfully in the real world. The goal being to close this know-do gap. When looking at implementation science the aspects of focus for determining how to cover the know-do gap include how evidence base is determined, context, health equity, policy implementation, and audience/ stakeholder perspectives (Brownson et al., 2022). One point in the implementation science cycle I would focus on, on behalf of this scenario, would be audience/stakeholder perspectives (Garner et al., 1998). One audience of concern being the parents. The parents must give consent to the researchers on behalf of their children. Many adults and children have a history with colonialism. Thus, parents and even children may be adverse and less trustworthy to specific faces and individuals driving the mobile dental units or conducting dental surgery on their children. Engagement and partnerships with volunteers, scientists, and dental hygienist who speak the same language and look similar to the populations of the community receiving the dental care, would be ideal. This would increase trust within more skeptical parents in these communities with low consent percentages. I feel that the quantitative data is ample, but digging deeper to understand the reasons behind why parents do not consent to the mobile dental unfits and follow-up appointments, would be wise. A survey questionnaire focusing on this topic in the communities refusing to partake would help researchers know what areas to be modified, to ensure the intervention of mobile dental units and follow-up appointments are effective.