Prevent, Promote, Promulgate: A Realist Synthesis of Oral Health Outreach from Optics to Outcomes, Across Children, Communities, and the Special Care Continuum

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Background/Objectives: Dental caries is the most prevalent chronic disease of childhood, and untreated caries in the primary dentition affects an estimated 514 million children worldwide. Children are the principal target of oral health outreach through school dental screening, community camps, and charitable events for children with special healthcare needs, yet these programmes are evaluated largely by what is most visible: the number of children examined and the photographs disseminated. This measurement substitution dissociates activity from impact, so that children are screened but not treated, counted but not cared for. The objective was to determine what works, for whom, in what contexts, and through what mechanisms in converting children’s oral health screening contacts into sustained care, with primary applicability to low- and middle-income, community-outreach-oriented health systems and, in particular, to India and South Asia, while the configurational logic is offered as transferable rather than universal. Methods: A realist synthesis was conducted and reported in accordance with the RAMESES publication standards. An initial programme theory was developed and refined through purposive iterative searching, appraisal of relevance and rigour, and the extraction of Context, Mechanism, and Outcome (CMO) configurations across the diverse literature. Searching ran from initiation to theoretical saturation; complete strategies, dates, and a document-selection flow diagram are provided. Results: Eight configurations were derived, six enabling and two antagonistic, organised around three thematic constellations, Prevent, Promote, and Promulgate, and navigated by a compass of competency-based education. Thirty-six documents were retained as the principal contributors to the final synthesis. The refined theory holds that the intervention is not the camp but the configuration of conditions that allows it to convert into care for the child. Conclusions: Children’s oral health outreach should be evaluated as a multi-level health-systems configuration rather than a discrete event; competency-based education is the generative lever that reorients practice from optics to outcomes. The eight configurations are theoretical propositions that require prospective empirical testing through realist evaluation before they are treated as confirmed causal claims.