A Link Work Intervention to Facilitate Dental Visiting in People With Severe Mental Illness: A Two-Arm, Multi-Site, Assessor Blind, Randomised Feasibility Trial With Dental Record Linkage

Abstract

Objectives: People with severe mental illness experience poor oral health, compared to the general population. They experience inequity in accessing dental services. This randomised controlled trial evaluated the acceptability and feasibility of a link work intervention to support people with severe mental illness to access a routine dental appointment. Methods: This was a feasibility randomised controlled trial across three sites with 1:1 allocation to Treatment as usual (TAU) or TAU plus a link work intervention (ISRCTN13650779). Participants were adults accessing mental health services who had not attended a routine dental appointment in the past 3 years. The intervention comprised up to six sessions with a link worker. Participants completed self-report assessments and an optional dental examination at baseline and after nine months. Dental visiting data were obtained through self-report and the NHS Business Services Authority (BSA). Results: One hundred and sixty-one participants were referred into the trial, resulting in 79 out of the target 84 randomisations (94.0%) over 7 months. There were high levels of engagement with the intervention. Dental visiting data were available for 84.8% of participants (95% CI: 75.3%, 91.1%). Uptake of the optional dental examination within the research assessment battery was low (follow-up: 12.7%; 95% CI: 7.0%, 21.8%). There were no serious adverse events attributable to the intervention or trial procedures. There were substantially higher rates of dental attendance after nine months in the link work intervention arm, compared to TAU, in both the self-report (91.7% vs. 26.7%) and NHS BSA (55.3% vs. 12.1%) data. There was also a signal of improved self-reported oral health-related quality of life favouring the link work intervention arm. Conclusions: The trial procedures and link work intervention were found to be feasible, acceptable and safe. The intervention showed promise in terms of clinical outcomes. The effectiveness of the intervention requires evaluation in a larger trial. Trial Registration: NCT05545228.