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Mitchell G, Stark P, Wilson CB, Tsakos G, Brocklehurst P, Lappin C, Quinn B, Holland N, McKenna G. 'Whose role is it anyway?' Experiences of community nurses in the delivery and support of oral health care for older people living at home: a grounded theory study. BMC Nurs 2023; 22:359. [PMID: 37798687 PMCID: PMC10557176 DOI: 10.1186/s12912-023-01533-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 09/25/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Older people who receive care at home are likely to require support with oral health care. Community nurses, who are also referred to as district or home care nurses, have an important role with this population. This is because they are the healthcare professionals who are most likely to encounter this population, who may also not be receiving regular dental care or oral health promotion. However, few studies have explored community nursing experiences in the delivery and support of oral healthcare for older people living at home. METHODS A grounded theory approach was used to explore experiences of community nurses in the delivery and support of oral health care for older people living at home. Fifteen practising community nurses from the United Kingdom participated in one-to-one semi-structed interviews from May 2021 to December 2021. These interviews were audio-recorded, transcribed verbatim and analysed using constant comparative analysis. Ethical approval was obtained for this study prior to data collection. RESULTS Four categories emerged from the data to support development of the core phenomena. These four categories were: (1) Education, in relation to what community nurses knew about oral health, (2) Practice, with regards to how community nurses delivered oral health care to older people in their own home, (3) Confidence, with consideration to the extent to which this supported or impeded community nurses in providing oral healthcare to older people and (4) Motivation, in terms of the extent to which community nurses thought they could or should influence future practice improvement in the area. The core category was (C) Uncertainty as it was both present and central across all four categories and related to community nursing understanding about their specific role, and the role of other professionals, with reference to oral health of their patients. CONCLUSIONS This study reveals community nurses' uncertainty in providing oral healthcare to older adults at home. Emphasising comprehensive and continuous oral health education can boost nurses' confidence in patient support. Interprofessional collaboration and clear role definitions with oral health professionals are crucial for improving oral health outcomes in this vulnerable population.
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Grants
- SB/A/101010662/495750 Burdett Trust for Nursing
- SB/A/101010662/495750 Burdett Trust for Nursing
- SB/A/101010662/495750 Burdett Trust for Nursing
- SB/A/101010662/495750 Burdett Trust for Nursing
- SB/A/101010662/495750 Burdett Trust for Nursing
- SB/A/101010662/495750 Burdett Trust for Nursing
- SB/A/101010662/495750 Burdett Trust for Nursing
- SB/A/101010662/495750 Burdett Trust for Nursing
- SB/A/101010662/495750 Burdett Trust for Nursing
- COM/5611/20 HSC R&D Division, Belfast, Northern Ireland
- COM/5611/20 HSC R&D Division, Belfast, Northern Ireland
- COM/5611/20 HSC R&D Division, Belfast, Northern Ireland
- COM/5611/20 HSC R&D Division, Belfast, Northern Ireland
- COM/5611/20 HSC R&D Division, Belfast, Northern Ireland
- COM/5611/20 HSC R&D Division, Belfast, Northern Ireland
- COM/5611/20 HSC R&D Division, Belfast, Northern Ireland
- COM/5611/20 HSC R&D Division, Belfast, Northern Ireland
- COM/5611/20 HSC R&D Division, Belfast, Northern Ireland
- HSC R&D Division, Belfast, Northern Ireland
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Affiliation(s)
- Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland.
| | - Patrick Stark
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Caroline Lappin
- Department of Health, Castle Buildings, Stormont, Belfast, Northern Ireland
| | - Barry Quinn
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Nicola Holland
- Department of Health, Castle Buildings, Stormont, Belfast, Northern Ireland
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
| | - Gerry McKenna
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland
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Moloi H, Daniels K, Brooke-Sumner C, Cooper S, Odendaal WA, Thorne M, Akama E, Leon N. Healthcare workers' perceptions and experiences of primary healthcare integration: a scoping review of qualitative evidence. Cochrane Database Syst Rev 2023; 7:CD013603. [PMID: 37466272 PMCID: PMC10355136 DOI: 10.1002/14651858.cd013603.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
BACKGROUND Primary healthcare (PHC) integration has been promoted globally as a tool for health sector reform and universal health coverage (UHC), especially in low-resource settings. However, for a range of reasons, implementation and impact remain variable. PHC integration, at its simplest, can be considered a way of delivering PHC services together that sometimes have been delivered as a series of separate or 'vertical' health programmes. Healthcare workers are known to shape the success of implementing reform interventions. Understanding healthcare worker perceptions and experiences of PHC integration can therefore provide insights into the role healthcare workers play in shaping implementation efforts and the impact of PHC integration. However, the heterogeneity of the evidence base complicates our understanding of their role in shaping the implementation, delivery, and impact of PHC integration, and the role of contextual factors influencing their responses. OBJECTIVES To map the qualitative literature on healthcare workers' perceptions and experiences of PHC integration to characterise the evidence base, with a view to better inform future syntheses on the topic. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 28 July 2020. We did not search for grey literature due to the many published records identified. SELECTION CRITERIA We included studies with qualitative and mixed methods designs that reported on healthcare worker perceptions and experiences of PHC integration from any country. We excluded settings other than PHC and community-based health care, participants other than healthcare workers, and interventions broader than healthcare services. We used translation support from colleagues and Google Translate software to screen non-English records. Where translation was not feasible we categorised these records as studies awaiting classification. DATA COLLECTION AND ANALYSIS For data extraction, we used a customised data extraction form containing items developed using inductive and deductive approaches. We performed independent extraction in duplicate for a sample on 10% of studies allowed for sufficient agreement to be reached between review authors. We analysed extracted data quantitatively by counting the number of studies per indicator and converting these into proportions with additional qualitative descriptive information. Indicators included descriptions of study methods, country setting, intervention type, scope and strategies, implementing healthcare workers, and client target population. MAIN RESULTS The review included 184 studies for analysis based on 191 included papers. Most studies were published in the last 12 years, with a sharp increase in the last five years. Studies mostly employed methods with cross-sectional qualitative design (mainly interviews and focus group discussions), and few used longitudinal or ethnographic (or both) designs. Studies covered 37 countries, with close to an even split in the proportions of high-income countries (HICs) and low- and middle-income countries (LMICs). There were gaps in the geographical spread for both HICs and LMICs and some countries were more dominant, such as the USA for HICs, South Africa for middle-income countries, and Uganda for low-income countries. Methods were mainly cross-sectional observational studies with few longitudinal studies. A minority of studies used an analytical conceptual model to guide the design, implementation, and evaluation of the integration study. The main finding was the various levels of diversity found in the evidence base on PHC integration studies that examined healthcare workers' perceptions and experiences. The review identified six different configurations of health service streams that were being integrated and these were categorised as: mental and behavioural health; HIV, tuberculosis (TB) and sexual reproductive health; maternal, women, and child health; non-communicable diseases; and two broader categories, namely general PHC services, and allied and specialised services. Within the health streams, the review mapped the scope of the interventions as full or partial integration. The review mapped the use of three different integration strategies and categorised these as horizontal integration, service expansion, and service linkage strategies. The wide range of healthcare workers who participated in the implementation of integration interventions was mapped and these included policymakers, senior managers, middle and frontline managers, clinicians, allied healthcare professionals, lay healthcare workers, and health system support staff. We mapped the range of client target populations. AUTHORS' CONCLUSIONS This scoping review provides a systematic, descriptive overview of the heterogeneity in qualitative literature on healthcare workers' perceptions and experience of PHC integration, pointing to diversity with regard to country settings; study types; client populations; healthcare worker populations; and intervention focus, scope, and strategies. It would be important for researchers and decision-makers to understand how the diversity in PHC integration intervention design, implementation, and context may influence how healthcare workers shape PHC integration impact. The classification of studies on the various dimensions (e.g. integration focus, scope, strategy, and type of healthcare workers and client populations) can help researchers to navigate the way the literature varies and for specifying potential questions for future qualitative evidence syntheses.
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Affiliation(s)
- Hlengiwe Moloi
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Carrie Brooke-Sumner
- Alcohol Tobacco and Other Drug Research Unit, The South African Medical Research Council, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Social & Behavioural Sciences Division, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Willem A Odendaal
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | | | - Eliud Akama
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
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Moloi H, Daniels K, Brooke-Sumner C, Cooper S, Odendaal WA, Thorne M, Akama E, Leon N. Healthcare workers' perceptions and experiences of primary healthcare integration: a scoping review of qualitative evidence. Cochrane Database Syst Rev 2023; 7:CD013603. [PMID: 37434293 PMCID: PMC10335778 DOI: 10.1002/14651858.cd013603.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
BACKGROUND Primary healthcare (PHC) integration has been promoted globally as a tool for health sector reform and universal health coverage (UHC), especially in low-resource settings. However, for a range of reasons, implementation and impact remain variable. PHC integration, at its simplest, can be considered a way of delivering PHC services together that sometimes have been delivered as a series of separate or 'vertical' health programmes. Healthcare workers are known to shape the success of implementing reform interventions. Understanding healthcare worker perceptions and experiences of PHC integration can therefore provide insights into the role healthcare workers play in shaping implementation efforts and the impact of PHC integration. However, the heterogeneity of the evidence base complicates our understanding of their role in shaping the implementation, delivery, and impact of PHC integration, and the role of contextual factors influencing their responses. OBJECTIVES To map the qualitative literature on healthcare workers' perceptions and experiences of PHC integration to characterise the evidence base, with a view to better inform future syntheses on the topic. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 28 July 2020. We did not search for grey literature due to the many published records identified. SELECTION CRITERIA We included studies with qualitative and mixed methods designs that reported on healthcare worker perceptions and experiences of PHC integration from any country. We excluded settings other than PHC and community-based health care, participants other than healthcare workers, and interventions broader than healthcare services. We used translation support from colleagues and Google Translate software to screen non-English records. Where translation was not feasible we categorised these records as studies awaiting classification. DATA COLLECTION AND ANALYSIS For data extraction, we used a customised data extraction form containing items developed using inductive and deductive approaches. We performed independent extraction in duplicate for a sample on 10% of studies allowed for sufficient agreement to be reached between review authors. We analysed extracted data quantitatively by counting the number of studies per indicator and converting these into proportions with additional qualitative descriptive information. Indicators included descriptions of study methods, country setting, intervention type, scope and strategies, implementing healthcare workers, and client target population. MAIN RESULTS The review included 184 studies for analysis based on 191 included papers. Most studies were published in the last 12 years, with a sharp increase in the last five years. Studies mostly employed methods with cross-sectional qualitative design (mainly interviews and focus group discussions), and few used longitudinal or ethnographic (or both) designs. Studies covered 37 countries, with close to an even split in the proportions of high-income countries (HICs) and low- and middle-income countries (LMICs). There were gaps in the geographical spread for both HICs and LMICs and some countries were more dominant, such as the USA for HICs, South Africa for middle-income countries, and Uganda for low-income countries. Methods were mainly cross-sectional observational studies with few longitudinal studies. A minority of studies used an analytical conceptual model to guide the design, implementation, and evaluation of the integration study. The main finding was the various levels of diversity found in the evidence base on PHC integration studies that examined healthcare workers' perceptions and experiences. The review identified six different configurations of health service streams that were being integrated and these were categorised as: mental and behavioural health; HIV, tuberculosis (TB) and sexual reproductive health; maternal, women, and child health; non-communicable diseases; and two broader categories, namely general PHC services, and allied and specialised services. Within the health streams, the review mapped the scope of the interventions as full or partial integration. The review mapped the use of three different integration strategies and categorised these as horizontal integration, service expansion, and service linkage strategies. The wide range of healthcare workers who participated in the implementation of integration interventions was mapped and these included policymakers, senior managers, middle and frontline managers, clinicians, allied healthcare professionals, lay healthcare workers, and health system support staff. We mapped the range of client target populations. AUTHORS' CONCLUSIONS This scoping review provides a systematic, descriptive overview of the heterogeneity in qualitative literature on healthcare workers' perceptions and experience of PHC integration, pointing to diversity with regard to country settings; study types; client populations; healthcare worker populations; and intervention focus, scope, and strategies. It would be important for researchers and decision-makers to understand how the diversity in PHC integration intervention design, implementation, and context may influence how healthcare workers shape PHC integration impact. The classification of studies on the various dimensions (e.g. integration focus, scope, strategy, and type of healthcare workers and client populations) can help researchers to navigate the way the literature varies and for specifying potential questions for future qualitative evidence syntheses.
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Affiliation(s)
- Hlengiwe Moloi
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Carrie Brooke-Sumner
- Alcohol Tobacco and Other Drug Research Unit, The South African Medical Research Council, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- Social & Behavioural Sciences Division, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Willem A Odendaal
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | | | - Eliud Akama
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Natalie Leon
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
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Stark P, McKenna G, Wilson CB, Tsakos G, Brocklehurst P, Lappin C, Quinn B, Holland N, Mitchell G. Evaluation of a co-designed educational e-resource about oral health for community nurses: study protocol. BMC Nurs 2023; 22:94. [PMID: 37013600 PMCID: PMC10071717 DOI: 10.1186/s12912-023-01268-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/24/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Oral health is a crucial aspect of health and wellbeing for older people. Poor oral health has been found to significantly increase the risk of chronic health conditions and poor quality of life for older people. Nurses practicing in the community are well-placed to provide oral health care to older people in their own homes, yet there has been little research in this field to develop accessible support for them to do so. Previous literature, reviewed in an earlier phase of this work, revealed that there has, historically, been a paucity of oral health care education for nurses and very few educational resources have been developed in this field. METHODS This study will evaluate an educational e-resource which has been co-designed by service users, carers and clinicians. In the first phase of research, evidence of promise will be evaluated by analysing quantitative data on community nurses' oral health attitudes and self-efficacy for oral health assessments of older people. In the second phase of research, facilitators and barriers to community nurses' provision of oral health care to older people and the acceptability of the educational e-resource will be evaluated. DISCUSSION This research will investigate the potential of an educational e-resource to improve community nurses' capabilities to deliver oral health care to older people in their own homes. This research will inform both future intervention design and understanding of community nurses' knowledge and attitudes about oral health care. Facilitators and barriers to provision of this care for older people will also be explored.
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Affiliation(s)
- Patrick Stark
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Gerry McKenna
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | | | - Georgios Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | | | - Caroline Lappin
- Department of Health, Castle Buildings, Stormont, Belfast, Northern Ireland
| | - Barry Quinn
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - Nicola Holland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
- Department of Health, Castle Buildings, Stormont, Belfast, Northern Ireland
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland.
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Cardenas K, Weilnau T, Aguilar C, Ali A, Eidelman A, Ponnala S, Russel T, Schwanderla J, Sievers K, Wu H, Silk H, Hunt LS, Barrow J, Riedy CA, Phillips RS. Partnering for Integrated Care: A Learning Collaborative for Primary Care and Oral Health Teams. Ann Fam Med 2023; 21:S22-S30. [PMID: 36849470 PMCID: PMC9970677 DOI: 10.1370/afm.2918] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/13/2022] [Accepted: 10/12/2022] [Indexed: 03/01/2023] Open
Abstract
PURPOSE The Teaming and Integrating for Smiles and Health (TISH) Learning Collaborative was developed to help health care organizations accelerate progress in integrating delivery of oral and primary care. By providing expert support and a structure for testing change, the project aimed to improve the early detection of hypertension in the dental setting and of gingivitis in the primary care setting, and to increase the rate of bidirectional referrals between oral and primary care partners. We report its outcomes. METHODS A total of 17 primary and oral health care teams were recruited to participate in biweekly virtual calls over 3 months. Participants tested changes to their models of care through Plan-Do-Study-Act cycles between calls. Sites tracked the percentages of patients screened and referred, completed the TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) and Interprofessional Assessment questionnaires, and provided qualitative feedback and updates in storyboard presentations. RESULTS On average, with implementation of the TISH Learning Collaborative, sites displayed a nonrandom improvement in the percentages of patients screened for hypertension, referred for hypertension, referred to primary care, and referred for gingivitis. Gingivitis screening and referral to oral health care were not markedly improved. Qualitative responses indicated that teams made progress in screening and referral workflows, improved communication between medical and dental partners, and furthered understanding of the connection between primary care and oral care among staff and patients. CONCLUSIONS The TISH project is evidence that a virtual Learning Collaborative is an accessible and productive avenue to improve interprofessional education, further primary care and oral partnerships, and achieve practical progress in integrated care.
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Affiliation(s)
- Kaitlyn Cardenas
- Harvard School of Dental Medicine, Boston, Massachusetts (K.C., H.W., J.B., C.A.R.)
| | - Taylor Weilnau
- Harvard Medical School, Boston, Massachusetts (T.W., L.S.H., R.S.P.)
| | | | - Amal Ali
- The National Health Professions Commission Somaliland, Goljano Area, Somaliland (A.A.)
| | - Alec Eidelman
- Cambridge Health Alliance, Cambridge, Massachusetts (A.E.)
| | - Sridevi Ponnala
- Tiburcio Vasquez Health Center, San Leandro, California (S.P.)
| | - Tiffany Russel
- The Partners in Integrated Care (PIC) Place, Montrose, Colorado (T.R.)
| | | | - Karlynn Sievers
- St Mary's Medical Center Family Medicine Residency Program, Grand Junction, Colorado (K.S.)
| | - Hongsheng Wu
- Harvard School of Dental Medicine, Boston, Massachusetts (K.C., H.W., J.B., C.A.R.)
| | - Hugh Silk
- University of Massachusetts Medical School, Worcester, Massachusetts (H.S.)
| | | | - Jane Barrow
- Harvard School of Dental Medicine, Boston, Massachusetts (K.C., H.W., J.B., C.A.R.)
| | - Christine A Riedy
- Harvard School of Dental Medicine, Boston, Massachusetts (K.C., H.W., J.B., C.A.R.)
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Khan AJ, Md Sabri BA, Ahmad MS. Factors affecting provision of oral health care for people with special health care needs: A systematic review. Saudi Dent J 2022; 34:527-537. [PMID: 36267535 PMCID: PMC9577340 DOI: 10.1016/j.sdentj.2022.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background Special health care needs (SHCNs) individuals experience higher levels of dental problems including accessing oral health (OH) facilities. Improving standard of OH care in SHCNs requires identifying barriers and enablers. The aim of this study was to perform a systematic review of prior researches to identify OH care barriers and enablers for SHCN individuals. Methods Electronic searching was conducted systematically in PubMed and Cochrane databases. The PICOS parameters were formulated for the inclusion of studies, and the PRISMA method was used to select the articles. Two reviewers independently screened the articles for eligibility and to minimise the risk of bias in the studies and also searched the contents of key articles, quality of methodology, outcomes and reference lists of all the studies included. Results A total of 1316 (PubMed 956, Cochrane 360) studies were found initially and after title and abstract screening and also removal of duplication, reviewers selected 53 papers from PubMED and 19 articles from Cochrane to go through full articles and led to the final confirmation of 21 studies. Common challenges included lack of OH knowledge and awareness, difficulty in accessing treatment, transportation problem, treatment cost, and lack of inter-professional collaboration for specialized services. Potential solutions included OHE training and services for patients and caregivers, easy access to dental services, specialized dental practitioners and use of a combination of expertise to meet the demands of SHCN individuals. Conclusion This brief analysis will establish dental obstacles to the provision of information to policymakers for SHCN population at organizational, individuals and policy levels. It will help in effective planning for providing and improving OH care quality in caregivers.
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Affiliation(s)
- Afsary Jahan Khan
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM), 47000 Sungai Buloh, Selangor, Malaysia
| | - Budi Aslinie Md Sabri
- Centre of Population Oral Health and, Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), 47000 Sungai Buloh, Selangor, Malaysia
| | - Mas Suryalis Ahmad
- Centre of Comprehensive Care Studies, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), 47000 Sungai Buloh, Selangor, Malaysia
- Corresponding author at: Centre of Comprehensive Care Studies, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), 47000 Sungai Buloh, Selangor, Malaysia.
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Felgner S, Dreger M, Henschke C. Reasons for (not) choosing dental treatments—A qualitative study based on patients’ perspective. PLoS One 2022; 17:e0267656. [PMID: 35613130 PMCID: PMC9132305 DOI: 10.1371/journal.pone.0267656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 04/12/2022] [Indexed: 11/19/2022] Open
Abstract
Oral health is increasingly seen as a public health challenge due to the remarkable prevalence of oral diseases worldwide, the impact on general health, and health consequences that can arise for individuals. Compared to other health services, oral health services are usually not fully covered by statutory health insurance, which is seen as one reason in decision-making on dental treatments. Nevertheless, patients’ reasons for treatment decisions are not well understood although they can provide valuable insights. The objective of this study was to identify reasons of choice for dental treatments and to explore patients’ view on cost coverage in Germany. We conducted four focus group interviews with a total of 27 participants. The interviews were audiotaped and transcribed verbatim. Data was analyzed performing conventional content analysis. As part of a qualitative analysis, subcategories and categories were formed from identified reasons using an inductive approach. Our study supports and expands research in exploring patients’ decision-making on dental treatments. It highlights a variety of 53 reasons of choice for dental treatments from patients’ perspective, split in two categories “health care service”, and “dentist & dental office”. First category includes reasons regarding dental care performance (subcategories: “preconditions”, “treatment”, “costs”, and “outcomes”). Second category demonstrates reasons regarding dentists, office structures and processes (subcategories: "professional skills", "social skills", "office staff & equipment", and "office processes”). Reasons named “most important” by the participants are out-of-pocket payments, dentists’ training, and a relationship of trust between patient and dentist. Although the participants use incentive measures to lower financial burden, several perceived challenges exist. Identified reasons for choosing dental treatments provide a basis for further studies to quantify the relevance of these reasons from patients’ perspective. Based on this, the various reasons identified can be considered in future policies to improve patients’ utilization behavior, which can range from improved information sources to increased incentive measures.
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Affiliation(s)
- Susanne Felgner
- Department of Health Care Management, Berlin Centre of Health Economics Research Technische Universität Berlin, Berlin, Germany
- * E-mail:
| | - Marie Dreger
- Department of Health Care Management, Berlin Centre of Health Economics Research Technische Universität Berlin, Berlin, Germany
| | - Cornelia Henschke
- Department of Health Care Management, Berlin Centre of Health Economics Research Technische Universität Berlin, Berlin, Germany
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Kyoon-Achan G, Schroth RJ, DeMaré D, Sturym M, Edwards JM, Sanguins J, Campbell R, Chartrand F, Bertone M, Moffatt MEK. First Nations and Metis peoples' access and equity challenges with early childhood oral health: a qualitative study. Int J Equity Health 2021; 20:134. [PMID: 34098968 PMCID: PMC8183050 DOI: 10.1186/s12939-021-01476-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background Inequities in early childhood oral health are evident amongst Indigenous peoples and communities in Manitoba, Canada. Early childhood caries (ECC) is decay in primary dentition in children under 6 years of age. A severe form of the disease occurs at a higher rate in Indigenous populations compared to the general population. ECC has been strongly associated with social determinants of health. Methods Focus groups and sharing circles were conducted with four First Nations and Metis communities in urban and rural communities in Manitoba. There were eight groups in total of purposively sampled participants (n = 59). A grounded theory approach guided thematic analysis of audio recorded and transcribed data. Results Indigenous participants experienced challenges similar to those found in the general population, such as encouraging and motivating parents and caregivers to establish regular oral hygiene routines for their children. However other challenges reported, disproportionately affect Indigenous communities. These include poor access to dental care, specifically no dental offices within 1 h driving radius and not having transportation to get there. Not having evidence-based oral health information to support good oral hygiene practices, preventing parents from making the best choices of oral hygiene products and oral health behaviours for their children. Poverty and food insecurity resulting in poor nutritional choices and leading to ECC. For example, feeding children sugary foods and beverages because those are more readily avialble than healthy options. Confusing or difficult encounters with dental professionals, highlighted as a factor that can erode trust, reduce compliance and impact continued attendance at dental offices. Conclusion Closing existing early childhood oral health gaps for First Nations and Metis peoples and communities requires equity-oriented healthcare approaches to address specific problems and challenges faced by these populations. Family, community and systemic level interventions that directly implement community recommendations are needed.
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Affiliation(s)
- Grace Kyoon-Achan
- Department of Preventive Dental Science, Dr. Gerald Niznick College Of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada. .,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada. .,Ongomiizwin Research - Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada. .,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Robert J Schroth
- Department of Preventive Dental Science, Dr. Gerald Niznick College Of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada. .,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada. .,Ongomiizwin Research - Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada. .,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. .,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Daniella DeMaré
- Department of Preventive Dental Science, Dr. Gerald Niznick College Of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Melina Sturym
- Department of Preventive Dental Science, Dr. Gerald Niznick College Of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | | | - Julianne Sanguins
- Health & Wellness Department, Manitoba Metis Federation, 150 Henry Avenue, Winnipeg, MB, R3B 0J7, Canada
| | - Rhonda Campbell
- First Nations Health and Social Secretariat of Manitoba, 600-275 Portage Ave, Winnipeg, MB, R3B 2B3, Canada
| | - Frances Chartrand
- Health & Wellness Department, Manitoba Metis Federation, 150 Henry Avenue, Winnipeg, MB, R3B 0J7, Canada
| | - Mary Bertone
- Department of Preventive Dental Science, Dr. Gerald Niznick College Of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada
| | - Michael E K Moffatt
- Department of Preventive Dental Science, Dr. Gerald Niznick College Of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, R3E 3P4, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Niesten D, Gerritsen AE, Leve V. Barriers and Facilitators to integrate Oral Health care for Older Adults in General (Basic) Care in East Netherlands. Part 2 Functional Integration. Gerodontology 2021; 38:289-299. [PMID: 33386759 PMCID: PMC8451897 DOI: 10.1111/ger.12525] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/05/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE to synthesise a framework of barriers and facilitators in the functional integration of oral health care (OHC) into general health care for frail older adults at macro (system), meso (organisation and interprofessional integration) and micro (clinical practice) levels. BACKGROUND Identification of these barriers and facilitators is expected to promote better and more appropriate care. METHODS For this qualitative study, comprising 41 participants, representatives of 10 different groups of (professional) care providers, and OHC receivers (home-dwelling and nursing-home patients) were interviewed. Transcripts of the in-depth, topic-guided interviews were thematically analysed. In a subsequent workshop with 52 stakeholders, results and interpretations were discussed and refined. RESULTS Two themes were identified: (1) compartmentalised care systems and (2) poor interprofessional and communication infrastructure. Barriers related to (1) included lack of integrative policies and compartmentalised healthcare education (macro level); poor embedding of OHC in care procedures, instruments and guidelines (meso level); and poor interprofessional skills (micro level). Barriers related to (2) included poor financial incentives for collaborative practices (macro level) and badly connected ICT systems (meso level). Identified facilitators included integration of an OHC professional into care teams, and interdisciplinary consultations (meso level); and integration of OHC in individual care plans (micro level). CONCLUSION In The Netherlands, OHC for older people is at best poorly integrated into general care practices. Barriers and facilitators are interconnected across macro-, meso- and micro levels and between normative and functional domains and are mainly related to compartmentalisation at all levels and to poor interprofessional and communication infrastructure.
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Affiliation(s)
- D Niesten
- College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A E Gerritsen
- College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - V Leve
- Institut für Allgemeinmedizin, Heinrich-Heine-Universität Düsseldorf, Medizinische Fakultät, Germany
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