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van der Zande M, Exley C, Freeman R, Thetford C, Harris R. Is Dichotomization into Regular versus Irregular Dental Attenders Valid? A Qualitative Analysis. JDR Clin Trans Res 2023; 8:337-348. [PMID: 36032014 PMCID: PMC10504811 DOI: 10.1177/23800844221118515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS To discover whether dental visiting behavior can be understood as a dichotomy of planned versus problem based, or whether there were a range of different types of understanding and patient behavior, recognizable as patterns of dental visiting behavior. METHODS Secondary analysis drawing on 2 qualitative studies of patients' accounts of dental attendance and oral health, with 1) opportunistic interviews with people attending urgent dental care services (n = 43; including 19 with follow-up) and 2) home-based, in-depth interviews with people attending a dental practice with a mixture of improved or deteriorated/poor periodontal health (n = 25). RESULTS Four distinguishable patterns of dental visiting were identified in patients' accounts: Accepting and Active Monitoring, as well as Ambivalent and Active Problem-based dental visiting behavior. Individuals' patterns were relatively stable over time but could shift at turning points. Accepting Monitors were characterized as accepting dentists' recommendations and dental practice policies relating to oral health and visits, whereas Active Monitors were more independent in judging how often to attend for preventive appointments, while still valuing anticipatory care. Ambivalent Problem-based visitors placed a relatively low value on anticipatory care for oral health maintenance and drifted into lapsed attendance, in part because of service-related factors. This contrasted with Active Problem-based visitors, for whom using services only in an emergency was a conscious decision, with low value placed on anticipatory care. CONCLUSION This article demonstrates the dynamic nature of patterns of dental visiting where the dental system itself is partly instrumental in shaping patterns of utilization in an ecological way. Thus, service-related factors tend to combine with patients' behavior in expanding inequalities. This illuminates the reasons why risk-based recalls are challenging to implement as a dental policy. KNOWLEDGE TRANSFER STATEMENT The results of this analysis can be used by clinicians and policymakers to inform policy around supporting uptake of preventive health care visits, contributing in particular to understanding how risk-based preventive visiting policies may be better adapted to patients' understanding of the purpose of visits, taking into account that this is in part shaped by service-related factors in an ecological way, arising from patients' and dental teams' expectations.
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Affiliation(s)
- M.M. van der Zande
- Department of Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - C.E. Exley
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - R. Freeman
- School of Dentistry, University of Dundee, Dundee, UK
| | - C. Thetford
- School of Nursing, University of Central Lancashire, Preston, UK
| | - R.V. Harris
- Department of Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
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Smith CS. Applying a systems oriented ethical decision making framework to mitigating social and structural determinants of health. FRONTIERS IN ORAL HEALTH 2023; 4:1031574. [PMID: 37521174 PMCID: PMC10382250 DOI: 10.3389/froh.2023.1031574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 06/15/2023] [Indexed: 08/01/2023] Open
Abstract
Objectives Clinical ethical decision-making models are largely geared toward individual clinician choices and individual patient outcomes, not necessarily accounting for larger systemic issues that affect optimal patient outcomes. The purpose of this paper is to provide an ethical decision-making model, drawing upon systems orientation and ethical theory, specifically incorporating and aiding in the mitigation of social and structural determinants of health. Methods This paper presents a systems-oriented ethical decision-making framework derived from the analysis and critique of the Four-Box Method for Ethical Decision-Making by Jonsen, Siegler, and Winslade. Drawing upon both deontological and utilitarian ethical theory, the developed framework will assist providers, organizations, and health system leaders in navigating the increasingly complex ethical dimensions of care delivery for underserved patient populations, who are largely impacted by social and structural determinants of health. Results The needs of underserved patients are inextricably linked to various social and structural determinants of health that, if left unaddressed, result in even poorer health outcomes, exacerbating existing health disparities. A systems-oriented ethical decision-making framework, centered on obligation, duty, and a utilitarian view of the optimal good, will aid providers, organizations, health system leaders, and community stakeholders in navigating the increasingly complex ethical dimensions of care delivery for underserved patient populations. Conclusion Socioeconomic and political contexts have a significant impact on the way society is organized, how people are positioned in society, and how they will fare in terms of their health. Healthcare providers, including dentists, are largely unaware of and insensitive to the social issues that underlie the biological or psychological concerns that patients from socially disadvantaged backgrounds face. A systems-oriented ethical decision-making model will aid in mitigating social and structural determinants of health and the dental profession's obligations to the underserved.
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Affiliation(s)
- Carlos S. Smith
- Department of Dental Public Health and Policy, Virginia Commonwealth University School of Dentistry, Richmond, VA, United States
- Affiliate Faculty, Oral Health Equity Core, Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, VA, United States
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Pegon-Machat E, Jourdan D, Tubert-Jeannin S. [Oral health inequalities: Determinants of access to prevention and care in France]. SANTE PUBLIQUE 2018; 30:243-251. [PMID: 30148312 DOI: 10.3917/spub.182.0243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Oral diseases are unequally distributed according to a social gradient, which now constitutes a major public health problem. Acting against oral health inequalities requires a better understanding of the underlying mechanisms in order to identify the appropriate solutions to improve access to oral health promotion and dental care for deprived populations. METHODS A patient-centered model of health care access, describing the ideal interactions between individuals and the health care system was applied to the field of oral health in the French context. This model defines access to health care as the result of interactions between individuals and the health care system, in which health needs are perceived, health care is sought, health care structures are accessed and effectively used. Analysis is based on quantitative and qualitative bibliographic data acquired through an explanatory sociological approach. RESULTS Socially deprived populations face many barriers preventing their access to dental care: the need for dental care is not necessarily perceived, and, when perceived, dental care is not immediately sought, accessibility to dental care structures is difficult and dental attendance is erratic. CONCLUSION This review provides information to decision-makers in order to support regional health policies and to help implement public health strategies according to the principle of proportionate universalism. Two axes for action were identified, namely to integrate oral health promotion interventions within health promotion programmes and to gradually reorganize the dental care system to make it more accessible to everyone.
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Tubert-Jeannin S, Jourdan D. Renovating dental education: A public health issue. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2018; 22:e644-e647. [PMID: 29582568 DOI: 10.1111/eje.12347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 06/08/2023]
Affiliation(s)
- S Tubert-Jeannin
- Centre de Recherche en Odontologie Clinique, Dental School, CROC-EA4847, Université Clermont Auvergne, Clermont-Ferrand, France
| | - D Jourdan
- Laboratoire Activité, Connaissance, Transmission, Education, ACTE- EA4281, School of Education, Université Clermont Auvergne, Clermont-Ferrand, France
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Verheire F, De Visschere L, Fernandez C, Lambert M, Marks L. Accessibility to oral health care for people on social assistance: a survey of social service providers from Public Welfare Centers in Flanders. Int Dent J 2018; 68:393-404. [PMID: 29744868 DOI: 10.1111/idj.12395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES The goals of the present study were as follows: (i) to explore the characteristics of the Flemish Public Centers for Social Welfare (PCSW) concerning oral health care; (ii) to explore possible barriers experienced by people on social assistance and oral health-care providers; and (iii) to explore the accessibility of general and oral health care for people on social assistance. METHODS The data of this cross-sectional study were obtained by a survey of social service providers working in a PCSW. For this purpose, a new questionnaire was developed. The survey was validated by means of a pilot study. All 306 PCSWs in Flanders were invited to participate in this survey, of which 192 (62.7%) responded. RESULTS The findings demonstrate that for people on social assistance, financial limitations and low prioritisation of oral health are the main barriers to good oral health care. The study reveals that such individuals experience greater financial barriers and poorer access to a dentist than to a general medical practitioner. The study also reveals that dentists report financial concerns and administrative burdens as the main barriers in treating this subgroup. The responses of PCSWs demonstrate that local dentists are reluctant to treat this subgroup. CONCLUSION Additional efforts are needed to improve the accessibility of oral health care for people on social assistance. Recommended improvements at the organisational level could improve increased education to target the population on the importance of oral health care. Administrative burden and financial concerns of the providers also need to be addressed to decrease their reluctance to work with those on social assistance.
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Affiliation(s)
- Fee Verheire
- Center of Special Care in Dentistry, PaeCoMeDiS, Ghent University, Gent, Belgium
| | - Luc De Visschere
- Community Dentistry and Oral Public Health, PaeCoMeDiS, Ghent University, Gent, Belgium
| | - Carla Fernandez
- Center of Special Care in Dentistry, PaeCoMeDiS, Ghent University, Gent, Belgium
| | - Martijn Lambert
- Community Dentistry and Oral Public Health, PaeCoMeDiS, Ghent University, Gent, Belgium
| | - Luc Marks
- Center of Special Care in Dentistry, PaeCoMeDiS, Ghent University, Gent, Belgium
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Mago A, MacEntee MI, Brondani M, Frankish J. Anxiety and anger of homeless people coping with dental care. Community Dent Oral Epidemiol 2018; 46:225-230. [PMID: 29446849 DOI: 10.1111/cdoe.12363] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/04/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To reveal and describe from open-ended interviews how homeless people in Vancouver interpret, appraise and cope with dental care. METHODS Audio-recorded interviews with 25 homeless people (18 men and 7 women; age range: 25-64 years), purposefully selected for a range of experiences, were transcribed and analysed inductively. The process of interpretive description drawing from the Behavioral Model for Vulnerable Populations and Lazarus's Theory of Emotions identified how participants appraised and coped with dental care. RESULTS Four dominant themes emerged: barriers to care; service use; opinions on dental health; and improving dental services. Participants were anxious about the cost of dentistry and fearful of dentists. They got emergency dental care with difficulty, usually in hospital emergency departments although mostly they preferred self-treatment. They acknowledged the importance of dental health but felt stigmatized by their homelessness and visibly unhealthy mouths. They wanted accessible dental services with financial assistance from government, more widespread information about community dental clinics, and, notably among the Indigenous participants, less humiliating discrimination from dentists. CONCLUSIONS Homeless people have difficulty coping with dental care. They believe that dentistry is frightening, humiliating and expensive, and governments are neither sympathetic to their disability nor willing to provide helpful information about community dental clinics or sufficient dental benefits for their needs.
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Affiliation(s)
- Anjali Mago
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael I MacEntee
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Mario Brondani
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - James Frankish
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Dos Santos BF, Madathil S, Zuanon ACC, Bedos C, Nicolau B. Brazilian Dental Students' Attitudes About Provision of Care for Patients Living in Poverty. J Dent Educ 2017; 81:1309-1316. [PMID: 29093144 DOI: 10.21815/jde.017.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/06/2017] [Indexed: 11/20/2022]
Abstract
The aims of this study were to investigate dental students' attitudes toward people living in poverty and the extent to which their perceptions were associated with their willingness to treat those patients in their future practice. All 910 dental students enrolled in three Brazilian public universities in 2010 were invited to take part in a cross-sectional survey. A total of 766 students (83.7% response rate) completed the self-administered questionnaire on their perceptions of and attitudes about poverty and their intention to provide dental care to poor people. The responding students showed slightly positive attitudes about people living in poverty; however, a high percentage (35%) reported thinking they were different from the rest of the population. Nevertheless, most of these students expressed willingness to provide care to underserved populations in their future practice; this willingness was found to be associated with their beliefs about poverty (OR 1.65; 95% CI=1.41-1.94). Overall, the study found that these dental students had altruistic views toward people living in poverty. However, they seemed to lack a deep understanding of poverty that may prevent them from acting on their good intentions.
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Affiliation(s)
- Beatriz Ferraz Dos Santos
- Dr. Ferraz dos Santos is Research Director, Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada; Dr. Madathil is a PhD candidate, Division of Oral Health and Society, Faculty of Dentistry, McGill University; Dr. Zuanon is Professor, Department of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, UNESP-Univ Estadual Paulista, Araraquara, São Paulo, Brazil; Dr. Bedos is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University; and Dr. Nicolau is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University.
| | - Sreenath Madathil
- Dr. Ferraz dos Santos is Research Director, Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada; Dr. Madathil is a PhD candidate, Division of Oral Health and Society, Faculty of Dentistry, McGill University; Dr. Zuanon is Professor, Department of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, UNESP-Univ Estadual Paulista, Araraquara, São Paulo, Brazil; Dr. Bedos is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University; and Dr. Nicolau is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University
| | - Angela Cristina Cilense Zuanon
- Dr. Ferraz dos Santos is Research Director, Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada; Dr. Madathil is a PhD candidate, Division of Oral Health and Society, Faculty of Dentistry, McGill University; Dr. Zuanon is Professor, Department of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, UNESP-Univ Estadual Paulista, Araraquara, São Paulo, Brazil; Dr. Bedos is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University; and Dr. Nicolau is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University
| | - Christophe Bedos
- Dr. Ferraz dos Santos is Research Director, Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada; Dr. Madathil is a PhD candidate, Division of Oral Health and Society, Faculty of Dentistry, McGill University; Dr. Zuanon is Professor, Department of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, UNESP-Univ Estadual Paulista, Araraquara, São Paulo, Brazil; Dr. Bedos is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University; and Dr. Nicolau is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University
| | - Belinda Nicolau
- Dr. Ferraz dos Santos is Research Director, Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada; Dr. Madathil is a PhD candidate, Division of Oral Health and Society, Faculty of Dentistry, McGill University; Dr. Zuanon is Professor, Department of Orthodontics and Pediatric Dentistry, Araraquara School of Dentistry, UNESP-Univ Estadual Paulista, Araraquara, São Paulo, Brazil; Dr. Bedos is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University; and Dr. Nicolau is Associate Professor, Division of Oral Health and Society, Faculty of Dentistry, McGill University
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The healthcare system and the provision of oral healthcare in EU Member States: France. Br Dent J 2017; 220:197-203. [PMID: 26917309 DOI: 10.1038/sj.bdj.2016.138] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2016] [Indexed: 11/08/2022]
Abstract
The French oral health system is based on the provision of dental treatment and is organised around a fee-per-item model. The system is funded by a complex mix of public and complementary health insurance schemes. The system is successful in that it provides access to affordable dental treatment to the majority of the French population. However, France had the highest health expenditure as a share of gross domestic product (GDP) of all European Union countries in 2008 and rising oral health inequalities may be exacerbated by the manner in which oral health care is provided and funded. In addition, there is no organised national strategy for the prevention of oral diseases or for oral health promotion.
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Wallace B, Browne AJ, Varcoe C, Ford-Gilboe M, Wathen N, Long PM, Parker J. Self-reported oral health among a community sample of people experiencing social and health inequities: cross-sectional findings from a study to enhance equity in primary healthcare settings. BMJ Open 2015; 5:e009519. [PMID: 26700285 PMCID: PMC4691735 DOI: 10.1136/bmjopen-2015-009519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/30/2015] [Accepted: 10/16/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To describe the self-reported oral health issues among a community sample of primary care clients experiencing socioeconomic disadvantages. METHODS As part of a larger mixed-methods, multiple case study evaluating an equity-oriented primary healthcare intervention, we examined the oral health of a sample of 567 people receiving care at four clinics that serve marginalised populations in two Canadian provinces. Data collected included self-rated oral health and experiences accessing and receiving healthcare, standard self-report measures of health and quality of life, and sociodemographic information. RESULTS The prevalence of self-rated poor oral health was high, with almost half (46.3%) of the participants reporting poor or fair oral health. Significant relationships were observed between poor oral health and vulnerabilities related to mental health, trauma and housing instability. Our findings suggest that the oral health of some Canadian populations may be dramatically worse than what is reported in existing population health surveys. CONCLUSIONS Our findings reinforce the importance of addressing oral health as part of health equity strategies. The health and oral health issues experienced by this client cohort highlight the need for interdisciplinary, team-based care that can address the intersections among people's health status, oral health and social issues.
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Affiliation(s)
- Bruce Wallace
- School of Social Work, University of Victoria, Victoria, British Columbia, Canada
| | - Annette J Browne
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen Varcoe
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Nadine Wathen
- Faculty of Information & Media Studies, Western University, London, Ontario, Canada
| | - Phoebe M Long
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanne Parker
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Lévesque MC, Levine A, Bedos C. Ideological roadblocks to humanizing dentistry, an evaluative case study of a continuing education course on social determinants of health. Int J Equity Health 2015; 14:41. [PMID: 25926031 PMCID: PMC4440283 DOI: 10.1186/s12939-015-0170-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 04/21/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Front line providers of care are frequently lacking in knowledge on and sensitivity to social and structural determinants of underprivileged patients' health. Developing and evaluating approaches to raising health professional awareness and capacity to respond to social determinants is a crucial step in addressing this issue. McGill University, in partnership with Université de Montréal, Québec dental regulatory authorities, and the Québec anti-poverty coalition, co-developed a continuing education (CE) intervention that aims to transfer knowledge and improve the practices of oral health professionals with people living on welfare. Through the use of original educational tools integrating patient narratives and a short film, the onsite course aims to elicit affective learning and critical reflection on practices, as well as provide staff coaching. METHODS A qualitative case study was conducted, in Montreal Canada, among members of a dental team who participated in this innovative CE course over a period of four months. Data collection consisted in a series of semi-structured individual interviews conducted with 15 members of the dental team throughout the training, digitally recorded group discussions linked to the CE activities, clinic administrative documents and researcher-trainer field notes and journal. In line with adult transformative learning theory, interpretive analysis aimed to reveal learning processes, perceived outcomes and collective perspectives that constrain individual and organizational change. RESULTS The findings presented in this article consist in four interactive themes, reflective of clinic culture and context, that act as barriers to humanizing patient care: 1) belief in the "ineluctable" commoditization of dentistry; 2) "equal treatment", a belief constraining concern for equity and the recognition of discriminatory practices; 3) a predominantly biomedical orientation to care; and 4) stereotypical categorization of publically insured patients into "deserving" vs. "non-deserving" poor. We discuss implications for oral health policy, orientations for dental education, as well as the role dental regulatory authorities should play in addressing discrimination and prejudice. CONCLUSION Humanizing care and developing oral health practitioners' capacity to respond to social determinants of health, are challenged by significant ideological roadblocks. These require multi-level and multi-sectorial action if gains in social equity in oral health are to be made.
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Affiliation(s)
- Martine C Lévesque
- École de santé publique de l'Université de Montréal, Faculté de médecine de l'Université de Montréal, Montréal, Canada.
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montréal, Canada.
| | - Alissa Levine
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montréal, Canada.
| | - Christophe Bedos
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montréal, Canada.
- Institut de recherche en santé publique de l'Université de Montréal (IRSPUM), Montréal, Canada.
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Reis CM, Rodriguez C, Macaulay AC, Bedos C. Dental Students’ Perceptions of and Attitudes About Poverty: A Canadian Participatory Case Study. J Dent Educ 2014. [DOI: 10.1002/j.0022-0337.2014.78.12.tb05838.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Clarice M.R. Reis
- Department of Community and Preventive Dentistry; Federal University of Minas Gerais; Minas Gerais; Brazil
| | - Charo Rodriguez
- Department of Family Medicine; McGill University; Montreal; Quebec Canada
| | - Ann C. Macaulay
- Department of Family Medicine; McGill University; Montreal; Quebec Canada
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Bedos C, Loignon C, Landry A, Richard L, Allison PJ. Providing care to people on social assistance: how dentists in Montreal, Canada, respond to organisational, biomedical, and financial challenges. BMC Health Serv Res 2014; 14:472. [PMID: 25301021 PMCID: PMC4283076 DOI: 10.1186/1472-6963-14-472] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 09/26/2014] [Indexed: 11/12/2022] Open
Abstract
Background Dentists report facing difficulties and experiencing frustrations with people on social assistance, one of the social groups with the most dental needs. Scientists ignore how they deal with these difficulties and whether they are able to overcome them. Our objective was to understand how dentists deal with critical issues encountered with people on social assistance. Methods We conducted in-depth, semi-structured interviews with 33 dentists practicing in Montreal, Canada. The interview guides included questions on dentists’ experiences with people on social assistance and potential strategies developed for this group of people. Analyses consisted of interview debriefing, transcript coding, and data interpretation. Results Dentists described strategies to resolve three critical issues: missed appointments (organisational issue); difficulty in performing non-covered treatments (biomedical issue); and low government fees (financial issue). With respect to missed appointments, dentists developed strategies to maximise attendance, such as motivating their patients, and to minimise the impact of non-attendance, like booking two people at the same time. With respect to biomedical and financial issues, dentists did not find any satisfactory solutions and considered that it was the government’s duty to resolve them. Overall, dentists seem reluctant to exclude people on social assistance but develop solutions that may discriminate against them. Conclusions The efforts and failures experienced by dentists with people on social assistance should encourage us to rethink how dental services are provided and financed.
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Affiliation(s)
- Christophe Bedos
- Division of Oral Health and Society, Faculty of Dentistry, McGill University, 2001 McGill college avenue, Montreal, Quebec H3A1G1, Canada.
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Guessous I, Theler JM, Durosier Izart C, Stringhini S, Bodenmann P, Gaspoz JM, Wolff H. Forgoing dental care for economic reasons in Switzerland: a six-year cross-sectional population-based study. BMC Oral Health 2014; 14:121. [PMID: 25270828 PMCID: PMC4190381 DOI: 10.1186/1472-6831-14-121] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/25/2014] [Indexed: 11/25/2022] Open
Abstract
Background While oral health is part of general health and well-being, oral health disparities nevertheless persist. Potential mechanisms include socioeconomic factors that may influence access to dental care in the absence of universal dental care insurance coverage. We investigated the evolution, prevalence and determinants (including socioeconomic) of forgoing of dental care for economic reasons in a Swiss region, over the course of six years. Methods Repeated population-based surveys (2007–2012) of a representative sample of the adult population of the Canton of Geneva, Switzerland. Forgone dental care, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods. Results A total of 4313 subjects were included, 10.6% (457/4313) of whom reported having forgone dental care for economic reasons in the previous 12 months. The crude percentage varied from 2.4% in the wealthiest group (monthly income ≥13,000CHF, 1CHF ≈ 1$) to 23.5% among participants with the lowest income (<3,000CHF). Since 2007/8, forgoing dental care remained stable overall, but in subjects with a monthly income of <3,000CHF, the adjusted percentage increased from 16.3% in 2007/8 to 20.6% in 2012 (P trend = 0.002). Forgoing dental care for economic reasons was independently associated with lower income, younger age, female gender, current smoking, having dependent children, divorced status and not living with a partner, not having a supplementary health insurance, and receipt of a health insurance premium cost-subsidy. Conclusions In a Swiss region without universal dental care insurance coverage, prevalence of forgoing dental care for economic reasons was high and highly dependent on income. Efforts should be made to prevent high-risk populations from forgoing dental care. Electronic supplementary material The online version of this article (doi:10.1186/1472-6831-14-121) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Idris Guessous
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Walker A, Probst JC, Martin AB, Bellinger JD, Merchant A. Analysis of hospital-based emergency department visits for dental caries in the United States in 2008. J Public Health Dent 2013; 74:188-94. [DOI: 10.1111/jphd.12045] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 10/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Andre Walker
- Institute for Partnerships to Eliminate Health Disparities; Arnold School of Public Health; University of South Carolina; Columbia SC USA
| | - Janice C. Probst
- Department of Health Services Policy and Management; Arnold School of Public Health; University of South Carolina; Columbia SC USA
- South Carolina Rural Health Research Center; Columbia SC USA
| | - Amy B. Martin
- Department of Health Services Policy and Management; Arnold School of Public Health; University of South Carolina; Columbia SC USA
- South Carolina Rural Health Research Center; Columbia SC USA
| | - Jessica D. Bellinger
- Department of Health Services Policy and Management; Arnold School of Public Health; University of South Carolina; Columbia SC USA
- South Carolina Rural Health Research Center; Columbia SC USA
| | - Anwar Merchant
- Department of Epidemiology and Biostatistics; Arnold School of Public Health; University of South Carolina; Columbia SC USA
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16
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Health insurance, socio-economic position and racial disparities in preventive dental visits in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:178-91. [PMID: 23282482 PMCID: PMC3564136 DOI: 10.3390/ijerph10010178] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 12/25/2012] [Accepted: 12/25/2012] [Indexed: 11/17/2022]
Abstract
This study sought to determine the contributions of socio-economic position and health insurance enrollment in explaining racial disparities in preventive dental visits (PDVs) among South Africans. Data on the dentate adult population participating in the last South African Demographic and Health Survey conducted during 2003–2004 (n = 6,312) was used. Main outcome measure: Reporting making routine yearly PDVs as a preventive measure. Education, material wealth index and nutritional status indicated socio-economic position. Multi-level logistic regression analysis was conducted to determine the predictors of PDVs. A variant of Blinder-Oaxaca decomposition analysis was also conducted. Health insurance coverage was most common among Whites (70%) and least common among black Africans (10.1%) in South Africa. Similarly, a yearly PDV was most frequently reported by Whites (27.8%) and least frequently reported among black Africans (3.1%). Lower education and lower material wealth were associated with lower odds of making PDVs. There was significant interaction between location (urban/rural) and education (p = 0.010). The racial and socio-economic differences in PDVs observed in urban areas were not observed in rural areas. In the general dentate population, having health insurance significantly increased the odds of making PDVs (OR = 4.32; 3.04–6.14) and accounted for 40.3% of the White/non-White gap in the probability of making PDVs. Overall, socio-economic position and health insurance enrollments together accounted for 55.9% (95% CI = 44.9–67.8) of the White/non-White gap in PDVs. Interventions directed at improving both socio-economic position and insurance coverage of non-White South Africans are likely to significantly reduce racial disparities in PDVs.
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17
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Wallace BB, MacEntee MI, Harrison R, Hole R, Mitton C. Community dental clinics: providers' perspectives. Community Dent Oral Epidemiol 2012; 41:193-203. [DOI: 10.1111/cdoe.12012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 09/06/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Bruce B. Wallace
- Faculty of Dentistry; University of British Columbia; Vancouver; BC; Canada
| | | | - Rosamund Harrison
- Faculty of Dentistry; University of British Columbia; Vancouver; BC; Canada
| | - Rachelle Hole
- School of Social Work; University of British Columbia - Okanagan; Kelowna, BC; Canada
| | - Craig Mitton
- Centre for Clinical Epidemiology and Evaluation; Vancouver Coastal Health; Research Institute School of Population and Public Health; University of British Columbia; Vancouver; BC; Canada
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18
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Wallace BB, Macentee MI. Access to dental care for low-income adults: perceptions of affordability, availability and acceptability. J Community Health 2012; 37:32-9. [PMID: 21590434 DOI: 10.1007/s10900-011-9412-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The objective of this study was to explore access to dental care for low-income communities from the perspectives of low-income people, dentists and related health and social service-providers. The case study included 60 interviews involving, low-income adults (N = 41), dentists (N = 6) and health and social service-providers (N = 13). The analysis explores perceptions of need, evidence of unmet needs, and three dimensions of access--affordability, availability and acceptability. The study describes the sometimes poor fit between private dental practice and the public oral health needs of low-income individuals. Dentists and low-income patients alike explained how the current model of private dental practice and fee-for-service payments do not work well because of patients' concerns about the cost of dentistry, dentists' reluctance to treat this population, and the cultural incompatibility of most private practices to the needs of low-income communities. There is a poor fit between private practice dentistry, public dental benefits and the oral health needs of low-income communities, and other responses are needed to address the multiple dimensions of access to dentistry, including community dental clinics sensitive to the special needs of low-income people.
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Affiliation(s)
- Bruce B Wallace
- Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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