Implementation fidelity of school oral health programs at a District in South Africa

Abstract

Background It is important that components contributing to success of a program are well understood to ensure better outcomes and strengthen interventions. Hence the purpose of the study was to assess the level of fidelity achieved by school oral health programs in our study district and to determine elements of fidelity that predict the risk of dental decay. Methods A cross-sectional study design was utilised. A multistage sampling technique was employed to randomly select 10 schools, two grades in each school were selected and all pupils in the selected grades were included in an oral health examination. Ten oral hygienists were observed and interviewed as they carried out the activities of the program and records were reviewed. Data collection tools included an oral health examination form, and an implementation fidelity checklist. Results The average level of fidelity obtained was 40% and it was shown to be inversely correlated with levels of decay, as decay was predicted to decrease with increasing levels of fidelity. The fidelity elements that were found to directly predict the outcome of decay included duration (IRR, 0.49; p = 0.02) coverage (IRR, 0.54; p = 008), content (IRR, 1.36; p = 0.03) and age (IRR, 2.14; p = 0.00). Moderating factors of fidelity which indirectly influenced the outcome of decay included facilitation strategy, duration and age. These were predicted to reduce the risk of decay by 92%, 83% and 48% respectively. Conclusion The school oral health programs exhibited high levels of pupil coverage, however, the content of the programs offered was low (28%). Coverage was high in the context of lack of dental assistance and time. Multi-sectoral participation is therefore necessary to re-organise the program for improving implementation fidelity and bringing about quality implementation.

Dissemination and implementation research for oral and craniofacial health: Background, a review of literature and future directions

“…122 As predicted, facilitation strategies moderated the association between fidelity and the primary health outcome of interest, tooth decay. 122 In another of such studies, researchers used implementation strategies such as feedback, reminders and interactive meetings to support the implementation of a clinical practice guideline for the management of asymptomatic impacted third molars. 124 That two-arm cluster randomized controlled trial found that use of the implementation strategies resulted in increased knowledge on the topic among dentists as well as improved decision-making in simulated cases, but no change in clinical outcomes.…”

“…implementation strategies) such as technical support, support from local champions, and availability of necessary equipment 122 . As predicted, facilitation strategies moderated the association between fidelity and the primary health outcome of interest, tooth decay 122 . In another of such studies, researchers used implementation strategies such as feedback, reminders and interactive meetings to support the implementation of a clinical practice guideline for the management of asymptomatic impacted third molars 124 .…”

“…One example of such a study measured fidelity—an important implementation outcome—of school oral health programs, accounting for facilitation strategies (i.e. implementation strategies) such as technical support, support from local champions, and availability of necessary equipment 122 . As predicted, facilitation strategies moderated the association between fidelity and the primary health outcome of interest, tooth decay 122 .…”

A Review of the South African National Oral Health Policy

“…Other preventative services that should be implemented are unfortunately not defined, however, there are fissure sealants and brushing programmes being conducted throughout the country under the auspices of the department of oral health. [15][16] The curative services are defined with a focus on prioritisation of the list system. Levels of treatment are set within the scope of practice of oral health professionals and include education, preventive and curative services (management of pain and sepsis set as priority).…”

Cost-effectiveness of dental caries prevention strategies in South African schools

“…The National Department of Health’s policy aspiration is to improve oral health access, prevention and care and has put efforts into school-based oral health programs. Oral health personnel go into schools to provide oral health screenings, education and preventative care as mentioned above [ 44 , 45 ]. The benefits of such programs are to promote the adoption of lifestyles that promote good health, and enable learners and staff to take action for a healthier community and widen access to care [ 46 ].…”