Phase 1: Qualitative work and intervention development

To understand why people put off going to the dentist, we spent around 160 hours watching what happens when people visited the Liverpool Dental Hospital and NHS dental practices in Merseyside with a dental problem.

We also spoke to 97 people who had dental issues, some just once, others over days or even weeks. We wanted to hear their stories and learn what made it hard for them to go to the dentist. We also asked what might help them to feel more comfortable about returning to the dentist for routine care or check-ups.

Using what we learned, we created materials which talk about the common reasons people avoid the dentist and share what has helped others get back into regular care. Before finalising them, we showed the materials to local people, who helped us shape them into something truly useful. You can see the materials in the RETURN Intervention Materials tab.

Phase 2: Feasibility study

After developing the RETURN materials, we needed to test whether dental nurses could be trained to give them to patients during urgent dental visits. To do this, we ran a small feasibility study.

Our goal was to recruit 60 people from three dental centres in Merseyside over three months. The first centre (a dental practice) started recruitment in January 2020 and successfully enrolled 20 people. The other two centres opened later, but recruitment was cut short in March 2020 due to the COVID-19 pandemic.

How It Worked

Patients visiting for urgent dental care were invited to take part in the study and given information about it. Those who agreed were randomly assigned to one of two groups. Half received the RETURN materials alongside their usual urgent care appointment and the other half had their usual urgent care appointment only.

We followed up with patients four months later by phone, email, or post (whichever they preferred) to see if they had since visited a dentist for routine care. We also collected NHS data to test whether this would be feasible to do for the final phase of the project.

What We Learned

• We successfully recruited 28 people in a short time, meeting our feasibility study goals.
• We were able to collect enough NHS data in relation to the patients in the study.
• We observed how dental nurses delivered the materials and asked patients for feedback and based on this, we refined the intervention materials and study procedures.
• We made improvements to the intervention materials using input from community engagement activities, a stakeholder event which took place in February 2020, and discussions with policy makers and dental teams.

The updated RETURN materials were ready for the next phase of the project – The Randomised Controlled Trial.

Phase 3: Randomised Controlled Trial

In August 2021, we recruited our first patient to the randomised controlled trial. Over the next 13 months, we recruited a total of 1,179 patients from 14 different locations, including:

• Liverpool Dental Hospital
• Dental practices providing urgent care appointments during usual working hours
• A dental practice providing urgent care appointments outside of usual working hours

To ensure patients received the right support, we trained 14 dental nurses to deliver the RETURN materials during urgent care appointments. As in the feasibility study, patients were randomly assigned to one of two groups where half received the intervention materials and half received dental care as would usually be provided.

This allowed us to compare whether those who received the intervention materials were more likely to attend routine dental care after their urgent visit.

Trial Follow-Up

We aimed to stay in touch with all participants for 18 months, contacting them at 6 months, 12 months, and 18 months. To stay in touch with as many people as possible for as long as possible, we used a variety of methods: telephone, email or post, depending on what the patient preferred. The overall response rates of patient at the different timepoints were:

• 6 months: 72%
• 12 months: 67%
• 18 months: 59%

Everyone who took part, both those who received the intervention and those who had usual care, were shown a video explaining the follow-up process. You can watch this below:

Exploring Patient Experiences

As part of Phase 3, we conducted an embedded qualitative study to explore in more depth how and why the intervention worked. We spoke to around 50 participants throughout their 18-month involvement in the trial, gathering insights into their experiences over time.

This qualitative research helped us understand:

• Which parts of the intervention were most effective
• For whom it worked best
• How the intervention influenced long-term dental visiting habits

---

Information For Trial Participants

Further information about how we collect your data and which organisations see it

Before you agreed to take part in this trial, you will have been told that we will be using routine dental visiting information about you that is either collected by the NHS Business Services Authority or by the Liverpool Dental Hospital. Below we set out what is going to happen to your data.

NHS Business Services Authority
This is an organisation that routinely gathers information about your dental attendances direct from the dental practice(s) you attend. Information they gather includes things like:

• What treatment you received
• Whether this was urgent or routine treatment
• When and which dental practice you attended

We want to know if you’ve been back to the dentist, and what treatment you’ve received (if any) during your time in the study (18 months).

We (The University of Liverpool) request this information from the NHS Business Services Authority 12 and 18 months after you agreed to take part in the study. To do this, we securely supply your name, your date of birth and your postcode. The NHS Business Services Authority then securely send to us information about any dental visits that you may have had during your time in the study.

We will then take out any of your personal identifiable information from this information before sending this securely to the University of Leeds, who will also be helping with the research report.

Information about your dental visits are not kept by the NHS Business Services Authority if you attend the Liverpool Dental Hospital at any time during the study, and so we will collect this information directly from them by looking at your dental notes. This information will be stored securely by the University of Liverpool, and this will also be sent securely to the University of Leeds so they can help us with the research report at the end of the study.

You do not have to do anything to take part in this part of the study. If you do not wish to take part in this part of the study, you can let us know.