RETURN Feasibility
Research type
Research Study
Full title
InteRventions to rEduce inequaliTies in the Uptake of Routine deNtal care: The feasibility study
IRAS ID
265789
Contact name
Rebecca Harris
Contact email
Sponsor organisation
University of Liverpool
Duration of Study in the UK
0 years, 7 months, 1 days
Research summary
Summary of Research
People living in deprived areas often put off visiting a dentist until they have a problem. But leaving it this late often means that decay is too far gone to save the tooth, meaning extraction is necessary. This affects peoples’ dental health for the rest of their lives and can leave them embarrassed about their appearance (avoiding smiling etc.). Since over half of people with urgent dental problems receive antibiotics for infection, leaving dental visits until there is pain and infection adds to the problem of antibiotics being less effective against bacteria because they are used so widely.
By exploring barriers to dental visiting with both patients using urgent dental care services, and local members of the community, the RETURN programme (WP1, REC ref: 18/NE/0061) has developed the RETURN intervention to try and help patients to plan and keep appointments for dental check-ups.
The RETURN intervention includes booklets about common barriers to visiting the dentist, providing information and persuasive messages designed to get patients back into planned care, video clips that can be viewed online showing patient stories, as well as a goal setting booklet enabling patients to set their own goals about future dental visiting, addressing their barriers. The intervention pack will also contain other resources such as a credit card sized card that can be given to the patient’s employer, and relaxation exercises to use in the waiting room for anxious patients.
The results from this study will be used to determine whether the RETURN intervention is practical and should be studied with a larger number of patients over a longer period. The results from the larger study may result in the RETURN intervention being made available UK wide to increase the uptake in patients attending the dentist for regular visits.
Summary of Results
The RETURN (InteRventions to rEduce inequaliTies in the Uptake of Routine deNtal care) feasibility study was a randomised controlled open study to determine if the RETURN intervention for dental urgent care users could be successfully delivered in NHS dental practices and Dental Hospitals. The RETURN feasibility study was conducted to investigate whether a larger full trial would be possible within the urgent care dental setting.
The RETURN intervention is a brief personally-tailored psychological behaviour change intervention which uses personalised booklets and videos guided by a trained dental team member or research dental nurse, delivered in the urgent care dental setting. Patients who receive the intervention have a discussion with a dental nurse to identify their personal barrier(s) to attending the dentist which are then discussed within the context of the relevant intervention materials. Patients then make a goal and set an action plan designed to help them to attend for regular dental care in the future. The pack of materials and access to the videos are given to intervention patients to take home with them.
The feasibility study aimed to recruit 60 urgent dental care users at three different site types: the Liverpool Dental Hospital, an out-of-hours urgent care practice and an in-hours urgent care practice, all based in Merseyside / Cheshire. 50% of the patients received the intervention and 50% did not. Patients were then followed up by telephone, email or post four months later.
The main things we wanted to find out were;
• Would we be able to recruit the required number of patients to the research so that we could determine if our main trial target would be possible?
• Would we be able to collect, complete and valid (by the answering of 12 or more questions from the questionnaire) oral health and quality of life questionnaire data from patients who took part in the study?
• Could we match information we collected about patients recruited to the study with routinely held NHS data from the Business Services Authority? This would enable us to find out if patients had been back to the dentist for dental treatment by the time of follow-up. We explored this to determine if this was a viable option to use in the main trial
• Do dental teams follow intervention delivery protocols?The feasibility trial was conducted, but was halted by the impacts of COVID-19. Recruitment had commenced in all three sites, the In Hours, Out of Hours and Dental Hospital and 28 out of the planned 60 participants were recruited from the three sites. The in hours site had recruited all of their planned 20 patients. The conclusion was that we could run a full trial with some changes. The recommended changes we would look to make for the main trial were;
• The addition of collecting participant postcodes to increase the accuracy of BSA data
• Addition of a ‘Thank you’ animation for control group patients to improve retention in this group
• Training expanded for site teams to ensure better adherence to intervention delivery protocols
• Inclusion criteria changed. The feasibility study only asked patients if they had seen a dentist for a non-emergency appointment in the last two years – in which case, they would not be eligible to take part in the study. Due to COVID-19 it was likely many people who would have previously attended regular non-emergency appointments will not have been to their dentist for this length of time. If patients now confirm they have NOT visited a dentist for a non-emergency appointment in the last two years, they will also be asked to also confirm that they DO NOT have their own dentist who they visit for non-urgent care.REC name
London - Bromley Research Ethics Committee
REC reference
19/LO/1510
Date of REC Opinion
27 Nov 2019
REC opinion
Further Information Favourable Opinion