Table 4 Recommendations based on our programme theories

Programme theory 1: subsidising the TADA service means oral health becomes a public project and dental avoidance behaviours become a public health concern. This consequently improves patient access and service uptake

We recommend that policy makers consider public-subsidised anxiety treatment and dental services for patients with a history of torture or abuse or with dental phobia to promote successful service uptake and potentially impact these patients’ quality of life.

Programme theory 2:

catering to a heterogeneous patient group means adapting and tailoring the service to regional resources and patient requirements

We recommend a hybrid bottom-up and top-down approach when designing dental services that address both the psychological and dental needs of vulnerable patients. A hybrid approach would allow the TADA team to interpret national guidelines, often set to meet a larger population, to match their local context. Allowing for this flexibility, means that service deliverers would be in a better position to use their professional discretion. National guidelines should be seen as service enablers rather than service constraints.

Programme theory 3:

a national service, operated by individual satellites, leads to a lack of communication, nationally and regionally, and isolation of each service from others.

We recommend an increase of opportunities for regional TADA teams to meet. These events could range from annual service conferences, that encourage the exchange of local solutions, to interactive digital platforms on which cases could be easily shared and discussed. The latter is a timely option given the current COVID-19 pandemic.

Programme theory 4:

lack of recruitment of torture survivors to the TADA service is explained by challenges that patients experience because of the migration process and poor dissemination practices

We recommend that service developers develop specific recruitment strategies for torture survivors, perhaps collaborating with institutions that process migrants and asylum seekers at their point of entry into Norway. These collaborations should seek to relieve first the administrative pressures currently placed on migrants and, secondly, clearly include their dental health needs in the entry process. Upon uptake, service deliverers, working in services such as TADA should be particularly cogent of the specific needs of torture survivors and their associated psychological and dental needs/treatment.