Development of an initial theory explaining the outcomes of a community oral health promotion program in school children in Peru

Résumé fourni par la source

Introduction: Crosssectorial collaboration, known to promote more sustainable change within communities, is being examined in an oral health promotion program (OHPP). In Peruvian Andean regions, an OHPP involving local people was advanced by the Ministry of Health, to reduce the incidence of cavities in schoolchildren. In some rural communities, however, these initiatives met limited success. This project aims to achieve a realist evaluation (RE) to understand underlying mechanisms and context, to understand the limited success of community OHPP for schoolchildren in Peruvian Andean rural communities. This presentation focuses on the first stage of an RE: developing an initial theory explaining some possible influences of context and mechanisms on outcomes. \nMethod: A logic model of the progam was established From various policies adopted and documents published on OHPP by the Peruvian government between 2007 and 2013. Then, the initial theory was developed following a literature review on deployment of community health promotion programs and the different elements of context and mechanisms explaining the programs outcomes. \nResults: In this initial theory, three elements of context that may influence the outcomes of a community OHPP have been identified: (1) previous experiences of collaboration of various actors; (2) human and material resources; and (3) physical and social environment. Two types of mechanisms could explain the outcome of community OHPP. First, situational mechanisms promote the development of crosssectorial collaboration among the various actors, and thus promote their common and individual involvement in the program interventions. Then, transformational mechanisms could explain the contribution of each stakeholder to the OHPP outcomes. Six situational mechanisms and four transformational mechanisms were identified in the initial theory. \nConclusion: Following this development process, we will validate and refine the initial theory during an RE with representatives of different local stakeholders from two Peruvian Andean rural communities. Then it will be possible to identify strategies to promote collaboration of all stakeholders involved in Peruvian OHPP, in order to maximize its effect on oral health of primary school children.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.