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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179–211.
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.
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.
Carroll, C., Patterson, M., Wood, S., Booth, A., Rick, J., & Balain, S. (2007). A conceptual framework for implementation fidelity. Implementation Science, 2, 40.
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.
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.
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.
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.
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.
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.
Green, L. W., & Kreuter, M. W. (1999). Health promotion planning: An educational and ecological approach (3rd ed.). Mountainview: Mayfield.
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.
Hasson, H. (2010). Systematic evaluation of implementation fidelity of complex interventions in health and social care. Implementation Science, 5, 67.
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.
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.
Locker, D. (2004). Oral health and quality of life. Oral Health & Preventive Dentistry, 2, 247–253.
Malterud, K. (2001). Qualitative research: Standards, challenges, and guidelines. Lancet, 358, 483–488.
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.
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.
Oakley, A., Strange, V., Stephenson, J., Forrest, S., & Monteiro, H. (2004). Evaluating processes. Evaluation, 10, 440–462.
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.
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.
Sheiham, A. (2006). Dental caries affects body weight, growth and quality of life in pre-school children. British Dental Journal, 201, 625–626.
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.
Tinanoff, N., & Reisine, S. (2009). Update on early childhood caries since the Surgeon General's Report. Academic Pediatrics, 9, 396–403.
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.
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.
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.
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Van den Branden, S., Van den Broucke, S., Leroy, R. et al. Evaluating the Implementation Fidelity of a Multicomponent Intervention for Oral Health Promotion in Preschool Children. Prev Sci 16, 1–10 (2015). https://doi.org/10.1007/s11121-013-0425-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-013-0425-3