Evaluation of HMP Shotts Oral
Health Improvement Project
Celia Watt
Senior Health Promotion Officer
NHS Lanarkshire
Celia.Watt@lanarkshire.scot.nhs.uk
Background
• Severe tooth decay 4 times more likely in prison
population (Scottish Prisons Dental Health Survey,
2002).
• Dental Action Plan (2005) – development of oral
health care preventive programmes for adults in
most need such as … prisoners.
• NHSL – HMP Shotts collaborative 3 year pilot
(2008-2011).
• Aim to pilot a whole settings approach to oral health
improvement involving prisoners, their families and
staff at HMP Shotts.
Evaluation objectives
1. Identify change in oral-health related
knowledge, attitudes, behaviours.
2. Identify good practice within OHIP.
3. Explore challenges of working in prison
environment and that impact of the OHIP
on the prison environment, structures and
systems.
4. Make recommendations for future health
improvement involvement within prison
settings.
Evaluation Methods
• University of Dundee Dental Health
Services Research Unit.
• 107 self completion questionnaires
(intervention and control).
• Focus groups (20 prison staff and 14
prisoners).
• 8 SPS/NHSL one-to-one interviews.
• Nuffield Partnership Assessment Tool.
Study population
• Age 21-60 years (mean age 34).
• 2011 mean length of time in prison = 2 years, 3
months.
• Less than a quarter had all of their own teeth with no
teeth missing, while over 40% had some teeth missing.
• Pre prison - over a third of prisoners reported they only
attended the dentist when they were in pain or in an
emergency. Another third stated that they attended 6
monthly.
Prisoner Awareness/Participation
in OHIP
Prisoner Knowledge of Oral Health
Messages
Behaviours
• Some changes in behaviours were
apparent but were not reported at a
statistically significant level.
• Some strong qualitative evidence of
behaviour change noted:
– “there’s more guys buy fruit and veg in
here than ever before”.
– “Aye, just found out that you’re not
meant to use a hard toothbrush, meant
to soft…I got one fae [the HPO]”.
Evaluation objectives
1. Identify change in oral-health related
knowledge, attitudes, behaviours.
2. Identify good practice within
OHIP.
3. Explore challenges of working in prison
environment and that impact of the OHIP
on the prison environment, structures and
systems.
4. Make recommendations for future health
improvement involvement within prison
settings.
2. Good practice within OHIP
•
•
•
•
Evidence based approach
Whole settings approach
NICE guidelines – dental recall, PHG6
Partnership and joint agenda setting
Empowerment and support
• “she’s been up sitting in the visits, and having a
chat with them and showing them different bits and
pieces. Stuff that was more geared toward the kids
but allowed them [prisoners] to have an input in it.
The guys really enjoyed that”.
• “I think it’s a clever approach…whilst the father as
parent educator is involved in the process, he must
be observing some of this message themselves”.
• “His family is the most important thing in his life…I
think they see it as a chance to say [to kids] I am
telling you how to eat, how to look after your dental
hygiene”.
Partnership
Evaluation objectives
1. Identify change in oral-health related
knowledge, attitudes, behaviours.
2. Identify good practice within OHIP.
3. Explore challenges of working in
prison environment and that impact of
the OHIP on the prison environment,
structures and systems.
4. Make recommendations for future health
improvement involvement within prison
settings.
3. Challenges
• Nature of the prison population.
• Attitudes towards OH improvement and
health improvement generally – staff and
prisoners.
• General restrictions such as security
demands, resources made available to
the HPO within the prison.
3. Impact on environment,
structures and systems
• Catering – availability of healthier choices
• HWL – involvement of staff.
• Routine OHI involvement in events, visits,
induction.
• Availability of resources for OHI; toys,
books for visits; involvement in health
promotion events for staff, prisoners and
families.
• Development of good working partnership
between NHSL and HMPS.
Evaluation objectives
1. Identify change in oral-health related
knowledge, attitudes, behaviours.
2. Identify good practice within OHIP.
3. Explore challenges of working in prison
environment and that impact of the OHIP
on the prison environment, structures and
systems.
4. Make recommendations for future
health improvement involvement within
prison settings.
4. Future direction in HMP Shotts
• Build on recommendations plus content on
Better Health, Better Lives for Prisoners and
National Oral Health Improvement Strategy for
Priority Groups.
• Continue to focus on whole settings approach.
• Widen to encompass other related health topics
under Common Risk Factor Approach.
• Focus on changing behaviour rather than
information and knowledge.
• Link in with local and national parenting
strategies/campaigns.
Priority Action Areas
•
Build Health Public policy
– Health impact assessment
•
Create Supportive Environments for Health
– Prisoner involvement
– Staff training
– Population level intervention and programmes
– Secure commitment, leadership and partnership of senior prison staff
•
Strengthen Community
– Community level interventions and programmes
– Events
– Parenting
•
Develop Personal Skills
– Accessibility of resources and information
– Individual level interventions and programmes
– Families and children
•
Reorient Health Services
– Appropriate service models
– Partnership with new NHS salaried dental service provision
Acknowledgements
• University of Dundee Dental Health
Services Research Unit
– Tahira Akbar, Steve Turner, Markus
Themessl-Huber, Ruth Freeman.
• HMP Shotts - Staff and Prisoners