Enabling Service Users with Severe Mental Illness to Learn about and Engage (SMILE) with Good Oral Health: Co-production, Feasibility and Acceptability of a Systems intervention

Background Oral diseases can greatly impact general health and quality of life, affecting people's self-esteem and social interactions.

People living with severe mental illness (SMI) face severe oral health inequality due to challenges related to mental illness and a lack of support from health service providers.

Until now, oral health has not been a priority for people with SMI.To incorporate oral health in the routine care plans of people with SMI, we need interventions that address specific barriers and challenges this group faces. Such interventions will promote preventive aspects and create a supportive environment for good oral health.

Aim To co-produce a feasible and acceptable intervention that has the potential to improve oral health outcomes. Objectives 1.

Co-produce an intervention with people with SMI, service providers and related stakeholders to improve oral health and support access to dental services 2.

Co-produce training materials and service-level plans to integrate and deliver the intervention in routine mental health care settings. 3. Test the feasibility and acceptability of the new oral health intervention. 4.

Capture the experiences of service users with SMI who participate and of the professionals who delivered and supported the intervention We have started the co-production process of such an intervention which addresses the limitations of previous interventions.

In 17 in-depth interviews with service users, carers and service providers, and 11 stakeholder consultations, we identified the barriers, facilitators and potential key ingredients for a fit-for-purpose intervention.

This project will build on our preliminary work to finalise the co-production of this intervention and test its feasibility and acceptability as part of routine care planning.

The project will have two phases: Phase 1 (months 1-12) will be the co-production of the intervention materials with stakeholders (service users, carers, mental health and dental health professionals) through a series of workshops.

Phase 2 (months 13-24) Acceptability and feasibility testing will involve 30 service users with SMI from two sites who will be invited to use the intervention and report their experiences and related outcomes.

Potential measures of its effectiveness include increased awareness related to preventing dental diseases, increased regular tooth brushing, and at service level, increased support to maintain dental hygiene and access dental services. We will also collect measures that allow us to assess the health economic impact of the intervention.

Patient and Public Involvement (PPI) will be embedded at each stage of the project and will include people with SMI, their carers, and health professionals. The PPI group has also contributed to developing this proposal. We will take several steps to ensure representatives of underserved communities in the study.

Dissemination, and Impact: dissemination activities will include press releases, newsletters, info-graphics, publishing in journals, presenting at conferences etc. In the future, we plan to test the effectiveness and cost-effectiveness of that intervention in a larger study.

The project can potentially improve oral health outcomes and quality of life for people with SMI and reduce the burden on dentists and health services by reducing dental disease burden through prevention and early treatment.