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Prevention Science

, Volume 16, Issue 1, pp 1–10 | Cite as

Evaluating the Implementation Fidelity of a Multicomponent Intervention for Oral Health Promotion in Preschool Children

  • S. Van den Branden
  • S. Van den Broucke
  • R. Leroy
  • D. Declerck
  • K. Hoppenbrouwers
Article

Abstract

This study evaluates the process of implementation of a longitudinal intervention program to promote oral health in preschool children in Flanders, Belgium. As the program was implemented in an existing preventive health care organization, the study also evaluates this setting as the context for implementation. Qualitative and quantitative methods were used to evaluate implementation fidelity, based on Carroll's theoretical framework of implementation fidelity (Carroll et al., Implementation Science 2:40, 2007). Questionnaire data from participants and health workers were analyzed, and document analyses were performed to compare registrations of the actions with the planning manual. Results were mixed. Whereas more than 88 % of all parents attended all home visits, only 57 % received at least 9 of the 11 planned consultations. Fifty-two percent of the families received all supporting materials, and on average, 73 % of all attending families received all information at a contact as described in the manual. Moderating factors such as the adequate use of facilitators and high participant responsiveness had a positive impact on implementation fidelity, whereas the quality of delivery differed to a great extent between the nurses who were involved during the entire intervention period and those who gave only a few sessions. Implementing an intervention in an existing well-baby program has many advantages, although lack of time presents a challenge to implementation fidelity. The results of this process evaluation allow a better understanding of the contribution of implementation fidelity to the effectiveness of health promotion programs.

Keywords

Implementation fidelity Oral health promotion Preschool children Multicomponent intervention 

Notes

Acknowledgments

The following partners collaborated in the “Smile for Life” project: Dominique Declerck (project coordinator) and Roos Leroy (both from the Department of Oral Health Sciences, KU Leuven); Karel Hoppenbrouwers (Center of Youth Health Care, KU Leuven); Emmanuel Lesaffre (Erasmus University Rotterdam, the Netherlands); Stephan Van den Broucke (Department of Psychology, Université Catholique de Louvain); Luc Martens (Dental School, Ghent University); and Erwin Van Kerschaver and Martine Debyser (Child and Family). The study was supported financially by GABA Benelux and GABA International, a European-branded manufacturer of oral care products.

References

  1. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.CrossRefGoogle Scholar
  2. Breitenstein, S. M., Gross, D., Garvey, C. A., Hill, C., Fogg, L., & Resnick, B. (2010). Implementation fidelity in community-based interventions. Research in Nursing and Health, 33, 164–173.PubMedCentralPubMedGoogle Scholar
  3. Campbell, M., Fitzpatrick, R., Haines, A., Kinmonth, A. L., Sandercock, P., Spiegelhalter, D., & Tyrer, P. (2000). Framework for design and evaluation of complex interventions to improve health. British Medical Journal, 321, 694–696.PubMedCentralCrossRefPubMedGoogle Scholar
  4. Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2, 40.PubMedCentralCrossRefPubMedGoogle Scholar
  5. Dane, A. V., & Schneider, B. H. (1998). Program integrity in primary and early secondary prevention: Are implementation effects out of control? Clinical Psychological Review, 18, 23–45.CrossRefGoogle Scholar
  6. Davies, G. M., Duxbury, J. T., Boothman, N. J., Davies, R. M., & Blinkhorn, A. S. (2005). A staged intervention dental health promotion programme to reduce early childhood caries. Community Dental Health, 22, 118–122.PubMedGoogle Scholar
  7. Declerck, D., Leroy, R., Martens, L., Lesaffre, E., Garcia-Zattera, M. J., Van den Broucke, S., & Hoppenbrouwers, K. (2008). Factors associated with prevalence and severity of caries experience in preschool children. Community Dentistry and Oral Epidemiology, 36, 168–178.CrossRefPubMedGoogle Scholar
  8. Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41, 327–350.CrossRefPubMedGoogle Scholar
  9. Feldens, C. A., Vitolo, M. R., & Drachler, M. L. (2007). A randomized trial of the effectiveness of home visits in preventing early childhood caries. Community Dentistry and Oral Epidemiology, 35, 215–223.CrossRefPubMedGoogle Scholar
  10. Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network.Google Scholar
  11. Green, L. W., & Kreuter, M. W. (1999). Health promotion planning: An educational and ecological approach (3rd ed.). Mountainview: Mayfield.Google Scholar
  12. Harris, R., Nicoll, A. D., Adair, P. M., & Pine, C. M. (2004). Risk factors for dental caries in young children: A systematic review of the literature. Community Dental Health, 21, 71–85.PubMedGoogle Scholar
  13. Hasson, H. (2010). Systematic evaluation of implementation fidelity of complex interventions in health and social care. Implementation Science, 5, 67.PubMedCentralCrossRefPubMedGoogle Scholar
  14. Kowash, M. B., Pinfield, A., Smith, J., & Curzon, M. E. (2000). Effectiveness on oral health of a long-term health education programme for mothers with young children. British Dental Journal, 188, 201–205.PubMedGoogle Scholar
  15. Leroy, R., Bogaerts, K., Martens, L., & Declerck, D. (2011). Risk factors for caries incidence in a cohort of Flemish preschool children. Clinical Oral Investigations, 16, 805–812. doi: 10.1007/s00784-011-0579-y.CrossRefPubMedGoogle Scholar
  16. Locker, D. (2004). Oral health and quality of life. Oral Health & Preventive Dentistry, 2, 247–253.Google Scholar
  17. Malterud, K. (2001). Qualitative research: Standards, challenges, and guidelines. Lancet, 358, 483–488.CrossRefPubMedGoogle Scholar
  18. Michie, S., Johnston, M., Francis, J., Hardeman, W., & Eccles, M. (2008). From theory to intervention: Mapping theoretically derived behavioural determinants to behaviour change techniques. Applied Psychology: An International Review, 57, 660–680.CrossRefGoogle Scholar
  19. Mohebbi, S. Z., Virtanen, J. I., Murtomaa, H., Vahid-Golpayegani, M., & Vehkalahti, M. M. (2008). Mothers as facilitators of oral hygiene in early childhood. International Journal of Paediatric Dentistry, 18, 48–55.PubMedGoogle Scholar
  20. Oakley, A., Strange, V., Stephenson, J., Forrest, S., & Monteiro, H. (2004). Evaluating processes. Evaluation, 10, 440–462.CrossRefGoogle Scholar
  21. Plutzer, K., & Spencer, A. J. (2008). Efficacy of an oral health promotion intervention in the prevention of early childhood caries. Community Dentistry and Oral Epidemiology, 36, 335–346.CrossRefPubMedGoogle Scholar
  22. Scottish Intercollegiate Guidelines Network (SIGN). (2005). Prevention and management of dental decay in the pre-school child. A national clinical guideline. Retrieved from http://www.sign.ac.uk/guidelines/fulltext/83/index.html.
  23. Sheiham, A. (2006). Dental caries affects body weight, growth and quality of life in pre-school children. British Dental Journal, 201, 625–626.CrossRefPubMedGoogle Scholar
  24. Strippel, H. (2010). Effectiveness of structured comprehensive paediatric oral health education for parents of children less than two years of age in Germany. Community Dental Health, 27, 74–80.PubMedGoogle Scholar
  25. Tinanoff, N., & Reisine, S. (2009). Update on early childhood caries since the Surgeon General's Report. Academic Pediatrics, 9, 396–403.PubMedCentralCrossRefPubMedGoogle Scholar
  26. Vachirarojpisan, T., Shinada, K., & Kawaguchi, Y. (2005). The process and outcome of a programme for preventing early childhood caries in Thailand. Community Dental Health, 22, 253–259.PubMedGoogle Scholar
  27. Van den Branden, S., Van den Broucke, S., Leroy, R., Declerck, D., & Hoppenbrouwers, K. (2012). Effects of time and socio-economic status on the determinants of oral health-related behaviours of parents of preschool children. European Journal of Oral Sciences, 120, 153–160.CrossRefPubMedGoogle Scholar
  28. Van den Branden, S., Van den Broucke, S., Leroy, R., Declerck, D., & Hoppenbrouwers, K. (2013). Measuring determinants of oral health behaviour in parents of preschool children. Community Dental Health, 30, 19–25.PubMedGoogle Scholar

Copyright information

© Society for Prevention Research 2013

Authors and Affiliations

  • S. Van den Branden
    • 1
  • S. Van den Broucke
    • 2
    • 3
  • R. Leroy
    • 4
  • D. Declerck
    • 4
  • K. Hoppenbrouwers
    • 1
  1. 1.Youth Health CareKatholieke Universiteit LeuvenLeuvenBelgium
  2. 2.Psychological Sciences Research InstituteUniversité Catholique de LouvainLouvain-la-NeuveBelgium
  3. 3.Health PsychologyKatholieke Universiteit LeuvenLeuvenBelgium
  4. 4.Department of Oral Health SciencesKatholieke Universiteit LeuvenLeuvenBelgium

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