Delivering Smile4life to Scottish Homeless Populations: Factors Affecting Practitioner Implementation

Objectives: To explore qualitatively how Smile4life, the Scottish oral health improvement programme for homeless people, is delivered by oral health practitioners in their health boards, using the COM-B model.
Methods: A purposive sample of oral health practitioners was collected from 3 Scottish NHS Boards. The participants were invited to speak about their thoughts, feelings and experiences of delivering Smile4life with homeless people in NHS Boards and NGOs. The focus groups were audio-recorded and transcribed. The data were analysed using content analysis, within a COM-B model framework.
Results: 11 practitioners took part in 3 separate focus groups. The data revealed that the practitioners had the capability, opportunity and motivation to deliver Smile4life. Their delivery, however, was dependent upon their relationship with NGO service providers and homeless service users. An important factor influencing the implementation emerged as the relationship between practitioners and NGO service providers and the capability of the practitioner to work within a multiagency context. Multiagency working affected their opportunity to deliver Smile4life. The practitioners, within this multiagency context, acted as ‘boundary spanners’ – operating across agencies to achieve their service goals and benefit service users. In doing so the practitioners spanned boundaries and worked together with their NGO service provider counterparts ensuring the delivery of Smile4life. Additional factors that affected motivation included: difficulties engaging with service providers, stigma around homelessness and dental anxiety of service users and providers.
Conclusions: This qualitative exploration, using the COM-B framework, revealed that the practitioners had the capability, opportunity and motivation to deliver Smile4life but this was affected, both positively and negatively, by multiagency working and additional factors that reduce practitioner motivation.