Improving oral health and related health behaviours (substance use, smoking, diet) in people with severe and multiple disadvantage: A systematic review of effectiveness and cost-effectiveness of interventions.

Autor: McGowan LJ; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom., John DA; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom., Kenny RPW; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom., Joyes EC; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom., Adams EA; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom., Shabaninejad H; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom., Richmond C; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom., Beyer FR; Evidence Synthesis Group and Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom., Landes D; NHS England & Improvement, Newcastle Upon Tyne, United Kingdom., Watt RG; Department of Epidemiology and Public Health, University College London, London, United Kingdom., Sniehotta FF; NIHR Policy Research Unit Behavioural Science, Newcastle University, Newcastle Upon Tyne, United Kingdom.; Department of Public Health, Social and Preventive Medicine, Centre for Preventive Medicine and Digital Health (CPD), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany., Paisi M; Faculty of Medicine and Dentistry, Peninsula Dental School, University of Plymouth, Plymouth, United Kingdom., Bambra C; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom., Craig D; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom., Kaner E; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom., Ramsay SE; Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Apr 18; Vol. 19 (4), pp. e0298885. Date of Electronic Publication: 2024 Apr 18 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0298885
Abstrakt: Background: People experiencing homelessness co-occurring with substance use or offending ('severe and multiple disadvantage' SMD) often have high levels of poor oral health and related health behaviours (particularly, substance use, smoking, poor diet). This systematic review aimed to assess the effectiveness and cost-effectiveness of interventions in adults experiencing SMD to improve oral health and related health behaviours.
Methods and Findings: From inception to February 2023, five bibliographic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus) and grey literature were searched. Two researchers independently screened the search results. Randomized controlled trials (RCTs), comparative studies and economic evaluations were included that reported outcomes on oral health and the related health behaviours. Risk of bias was assessed and results narratively synthesized. Meta-analyses were performed where appropriate. This review was registered with PROSPERO (reg. no: CRD42020202416). Thirty-eight studies were included (published between 1991 and 2023) with 34 studies reporting about effectiveness. Most studies reported on substance use (n = 30). Interventions with a combination of housing support with substance use and mental health support such as contingent work therapy appeared to show some reduction in substance use in SMD groups. However, meta-analyses showed no statistically significant results. Most studies had short periods of follow-up and high attrition rates. Only one study reported on oral health; none reported on diet. Three RCTs reported on smoking, of which one comprising nicotine replacement with contingency management showed improved smoking abstinence at 4 weeks compared to control. Five studies with economic evaluations provided some evidence that interventions such as Housing First and enhanced support could be cost-effective in reducing substance use.
Conclusion: This review found that services such as housing combined with other healthcare services could be effective in improving health behaviours, particularly substance use, among SMD groups. Gaps in evidence also remain on oral health improvement, smoking, and diet. High quality studies on effectiveness with adequate power and retention are needed to address these significant health challenges in SMD populations.
Competing Interests: The authors have declared that no competing interests exist.
(Copyright: © 2024 McGowan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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