Table 2 Initial programme theories

Institution logic

1. IF the culture within an NHS practice (context) promotes prevention (mechanism) THEN they are more likely to employ staff with the appropriate skills and knowledge and adopt IPP (outcome)

2. IF the culture within an NHS practice (context) was not clear on the messages within IPP (mechanism) THEN the programme would not be delivered consistently (outcome)

3. IF the 'buy-in' to IPP wasn't consistent (mechanism) across the NHS practice (context) THEN the programme would not be adopted uniformly (outcome)

4. IF the practice principal (practice owner) (context) did not 'own' the programme (mechanism) THEN IPP would not be delivered across the practice (outcome)

Clinical leadership

1. IF clinicians (context) are empowered to take on leadership roles (mechanism) THEN they can play a more significant role in how programmes like IPP are developed and delivered (outcome)

2. IF a programme like IPP is developed in partnership (mechanism) with key stakeholders (context) THEN IPP will be better designed and shaped for use in the NHS practice (outcome)

3. IF clinicians (context) adopt leadership roles (mechanism):

THEN they can become empowered to shape change to improve local oral health through IPP (outcome)

THEN they can facilitate the implementation of IPP among their peers (peer-to-peer influence) (outcome)

Financial incentives in the NHS dental contract

1. IF NHS practices (context) are provided with financial incentives (or reduction in activity targets) (mechanism):

THEN they are more likely to adopt and engage with IPP (outcome)

THEN they are more likely to change working practices to facilitate the implement IPP (outcome)

2. IF NHS practices (context) are offered a reduction in their ACV or activity targets (mechanism):

THEN it can release sufficient resources to deliver IPP (outcome)

Behaviour change

1. IF NHS practices (context) adopt the evidence-based prevention in IPP (mechanism):

THEN young children and their families/carers are more likely to adopt healthy behaviours (outcome)

THEN young children and their careers are more likely to attend more regularly (outcome)

THEN young children are more likely to improve their oral health (outcome)

'Skill mix'

1. IF NHS practices (context) adopt greater levels of 'skill mix' (mechanism):

THEN the practice is more likely to promote IPP (outcome)

THEN they are more likely to meet future population need (oral health) via programmes like IPP (outcome)

THEN it can free dentists to undertake more complex cases (pursuant to their training) (outcome)