Barriers to prevention in oral health care for english NHS dental patients: a qualitative study of views from key stakeholders

BACKGROUND

Despite significant progress in the control of oral diseases since the discovery of fluoride in the 1940s, dental caries and periodontal diseases continue to affect a significant proportion of the population, particularly socially disadvantaged and lower socioeconomic groups. The National Health Service in England provides preventive advice and treatments as part of an oral health assessment, and evidence-based guidance recommends the use of fissure sealants and topical fluorides in addition to dietary and oral hygiene advice. Although oral health promotion and education have become expected parts of dental care, the need for restorative treatments remains relatively high. We aimed to explore how barriers to preventive advice and treatment for NHS patients may be hindering the provision of prevention in oral health to patients from the perspectives of multiple key stakeholders.

METHODS

Semi-structured interviews and focus groups were undertaken between March 2016-February 2017 with four groups of stakeholders: dentists, insurers, policy makers and patient participants. The interviews were analysed using deductive, reflexive thematic analysis.

RESULTS

Thirty-two stakeholders participated: 6 dentists, 5 insurers, 10 policy makers, and 11 patient participants. Four themes were developed: Perspectives on the clarity of oral health messaging and patient's knowledge, The variability of prioritising prevention, Influences of the dentist-patient relationship on effective communication and Motivation to enact positive oral health behaviours.

CONCLUSIONS

The findings from this research indicate that patients' knowledge of and priority placed on prevention is variable. Participants believed that more targeted education could be valuable in enhancing these. A patient's relationship with their dentist could also influence their level of knowledge through the information shared with them, their receptivity to the preventive messages and the value they place on it. However, even with knowledge, prioritising prevention and a good patient-dentist relationship, without motivation to engage in preventive behaviour the impact of these is reduced. Our findings are discussed in relation to the COM-B model of behaviour change.

Addressing gaps in transversal educational contents in undergraduate dental education. The audio-visual 'pill of knowledge' approach

INTRODUCTION

Training on impression disinfection is often limited to brief explanations in the clinic. This investigation assessed knowledge on this topic amongst clinical students in our university, produced a pill of knowledge to suit their needs, and evaluated its impact and acceptance.

MATERIAL AND METHODS

A pre-post study was designed to identify knowledge gaps using an anonymous, voluntary self-applied questionnaire before and after watching an audio-visual clip (pill of knowledge). All 136 students in the school were invited to enter the study (estimated sample size: 116).

RESULTS

Participants: 109 (26.6% in 3rd year; 37.6% in 4th year and 39.4% in 5th year). Participation dropped 10.29% (n = 95) in the post-intervention survey. Knowledge improvement was higher for those impression materials included in the pill. Most students (68.4%) reported to know more about impression disinfection after the pill and 70.5% felt more able to achieve correct disinfection. The pill was particularly well received (86.3%). All students would recommend it to their peers, and 93.5% are willing to receive pills on other topics.

DISCUSSION

Our results disclosed an important gap in knowledge, which can be filled by a single, brief and concise pill adapted to the intended audience. Once made readily available through digital repositories, it may help solve this problem, given the ubiquitous presence of mobile devices.

CONCLUSIONS

Our results found pills of knowledge as a useful approach to facilitating undergraduates' learning process. This method, using suitable information and communication technologies, has the potential to improve the performance on certain clinical tasks.

Primary care physicians and nurses: Targets for basic periodontal education

BACKGROUND

Early diagnosis may improve patients' quality of life and reduce the lifelong social and financial burden inherent to treatment. Growing evidence supports the importance of a healthy periodontium in systemic health. Diagnosis depends on the patient and the healthcare professional. As many patients seek physicians' advice first, this study aims at assessing periodontal knowledge in a general population and their primary care physicians and nurses.

METHODS

This is a cross-sectional study using an anonymous questionnaire applied to randomly selected laypersons (March to June 2016), and to physicians and nurses at their workplaces (October to December 2016) in Ourense, Spain. Sample size for the general population was determined by quota sampling.

RESULTS

A total of 1,469 people entered the study. All healthcare workers and 624 (47.1%) laypersons were familiar with periodontitis. Bacterial etiology of periodontitis was recognized by 25 (4%) laypersons, 23 (34.3%) physicians, and 11 (16.6%) nurses. The following periodontal problems were experienced: 1) gingival redness: laypersons 14.4%, physicians 16.4%, and nurses 21.2%; 2) gingival bleeding: laypersons 22.2%, physicians 50.7%, and nurses 50%; 3) tooth mobility: laypersons 34.9%, physicians 7.4%, and nurses 6%; and 4) bleeding while toothbrushing: laypersons 44.3%, physicians 8.9%, and nurses 15.1%. More than a third of laypersons (37%) think periodontitis is related to other health problems, together with 53% of physicians and 47% of nurses.

CONCLUSIONS

Our results show a low degree of periodontal knowledge both amongst the public and their primary care physicians and nurses and unveil unreliable targets (primary healthcare workers) for educational interventions to improve early diagnosis and treatment of periodontal disorders.

Evaluation of the Impact of a Mass Media Campaign on Periodontal Knowledge among Iranian Adults: A Three-Month Follow-Up

Objectives

This study aimed to evaluate the impact of a national media campaign to promote oral health and periodontal knowledge among adults after a three-month follow-up.

Methods

We conducted a population-based study of adults aged 18 to 50 years using a stratified multi-stage sampling method in Tehran, Iran in 2011. The campaign included an animation clip about periodontal health and disease telecast on national TV for ten consecutive days. We used an instrument to assess the effect of the campaign at baseline, immediately after the campaign and after a three-month follow-up. A total of 543 participants responded at baseline and immediately after the intervention, and 294 were interviewed at the three-month follow-up assessment (response rate: 54.1%). We assessed each participant’s periodontal knowledge score, calculated as a sum of correct answers, and the change in their score following the campaign. We then used a five-item questionnaire to evaluate the participants’ opinion of the success of the campaign. We used descriptive statistics and generalised estimating equations (GEE) analysis to conduct the statistical analysis.

Results

The mean score for knowledge improvement from baseline to immediate post-intervention evaluation was higher among those who saw the campaign (0.61) than among those who did not (0.29); the corresponding figures from immediate evaluation to three-month follow-up were -0.17 and 0.15, respectively. Adjusting for baseline values, the GEE analysis demonstrated that improvement in the mean score of post-campaign knowledge associated significantly with age, education and seeing the campaign. Significant interaction between the time since seeing the campaign and whether the participant saw it (p < 0.001) revealed that the mean difference in the knowledge score between the groups who did and did not see the campaign was 0.4 at the immediate evaluation and -0.04 at the three-month follow-up. The participants received the campaign well in terms of being appealing (91.4%), worth bearing in mind (83.4%) and containing valuable information (80.3%).

Conclusions

Our findings indicate that a population-based media campaign promoting oral health and periodontal knowledge among adults had a positive short-term impact, although the effect seemed to plateau after three months.

Assessment of periodontal knowledge following a mass media oral health promotion campaign: a population-based study

Background

Oral health promotion can be achieved through education using various approaches including mass media health education campaigns. Mass media campaigns might increase oral health knowledge and perhaps could lead to desired behaviour changes and prevention of oral diseases. The aim of this study was to assess the effect of a national television campaign on knowledge of periodontal health among Iranian adults.

Methods

We conducted a population-based survey among adults aged 18–50 using a stratified multistage sampling method in the 22 districts of Tehran, Iran, in 2011. All participants were interviewed at two points in time: baseline (before launching the campaign) and follow-up assessment (after the campaign was finished) by using a validated instrument. The campaign included an animation clip about periodontal health and disease that was telecasted for ten days from several national TV channels. The instrument included items related to aetiology and sign of gum disease. Periodontal knowledge score and its change were calculated for each participant and were evaluated using statistical analyses in order to examine the effect of the campaign.

Results

In all 791 individuals (mean age: 32.6 years) were interviewed at baseline. Of these, 543 individuals were followed one month after the campaign. However, only 163 out of 543 reported that they had seen the campaign. Thus, comparison was made between those who had seen the campaign and who did not. The knowledge scores improved significantly among those who saw the campaign compared to those who did not (the mean knowledge score improvement 0.61 ± 0.96 versus 0.29 ± 0.8 respectively, p < 0.001). The results obtained from multiple logistic regression analysis indicated that improvement in periodontal knowledge was significantly associated with exposure to the campaign (OR = 2.20, 95% CI = 1.37-3.54), female gender (OR = 1.59, 95% CI = 1.05-2.43), being in age group 25–34 (OR = 1.76, 95% CI = 1.00-3.08), having higher education (high school: OR = 2.34, 95% CI = 1.23-4.43; university: OR = 3.33, 95% CI = 1.66-6.64), and baseline knowledge (OR = 0.25, 95% CI = 0.17-0.36).

Conclusion

The study demonstrated a significant impact of the mass media campaign on Iranian adults’ knowledge regarding periodontal health and disease.