Effectiveness of an Oral Health Education Program for Obstetrician/Gynecologist Residents at Tufts Medical Center

Why Aren't Antenatal Care Providers Adopting Oral Health Guidelines? A Qualitative Exploration

OBJECTIVE

The current Australian Pregnancy Care guidelines recommend that antenatal care providers discuss oral health, provide advice and refer women to dental professionals as needed. However, the delivery of oral health recommendations in antenatal settings appears substandard. This study aimed to identify the barriers and enablers influencing antenatal care providers' adoption of the oral health guidelines.

METHODS

A qualitative study was conducted using semi-structured interviews with a purposive sample of antenatal care providers in Tasmania, Australia. Data analysis followed a thematic coding method using the Capability, Opportunity, Motivation - Behaviour (COM-B) model and Theoretical Domains Framework to identify implementation barriers and enablers and to inform recommendations.

RESULTS

Twenty-five antenatal care providers participated (midwives n = 14, general practitioners n = 10 and obstetrician-gynaecologist n = 1). Thirty-two explanatory themes were identified and mapped directly to six COM-B constructs and 11 Theoretical Domains Framework domains. Eight main themes were identified as both impeding and enabling when viewed in different contexts: (1) perceived patient knowledge and awareness; (2) professional oral health knowledge, training and skills; (3) awareness of the guidelines on oral health; (4) patient education and professional resources; (5) interprofessional collaboration and support; (6) streamlined referral processes and access to dental services; (7) perceived outcomes of oral health interventions; and (8) perceived professional responsibility related to oral health.

CONCLUSIONS

Key strategies include improvements to the promotion and dissemination of relevant guidelines, professional education and training, and development and adoption of oral health-centred models of care to support interprofessional collaboration. Future research should focus on developing brief and sustainable interventions that address antenatal care providers' practice behaviours.

Factors Influencing the Provision of Oral Health Care Practices by Antenatal Care Providers: A Systematic Review

Background: Antenatal care (ANC) providers are recommended to promote oral health care during pregnancy through the provision of oral health care practices, but studies have indicated that providers remain unclear and inconstant in adopting these practices into routine care. Therefore, the objectives were to undertake a systematic review of the current oral health care practices of ANC providers and identify factors (barriers and facilitators) that influence the provision of ANC providers' oral health care practices. Methods: Qualitative and quantitative studies were systematically searched within four databases (database inception, October 2020). Studies were selected if they were published in English and conducted in developed countries. Thematic analysis was employed where reported barriers and facilitators from the included studies were grouped by themes and were inductively categorized within a multilevel framework. Reported current oral health care practices were deductively categorized according to a predetermined "assess," "advise," and "refer" framework. Summative frequencies of oral health care practices, if reported, were also extracted. Results: A total of 3519 ANC providers were included across 26 studies. Rates of reported current oral health care practices among ANC providers varied considerably. The most reported barriers related to providers' limited oral health care knowledge, concerns with dental costs, and absence of organizational referral processes. The most reported facilitators related to providers' level of oral health care knowledge, patient prompt, and access to informational and educational resources. Conclusions: Further efforts are needed to address the range of barriers identified in this review and support ANC providers' clinical practice behaviors. This includes improved interprofessional education, training opportunities, and integrated health care models.