Special Issue "Promoting Inclusion Oral-Health: Social Interventions to Reduce Oral Health Inequities"

A special issue of Dentistry Journal (ISSN 2304-6767).

Deadline for manuscript submissions: closed (30 November 2018)

Special Issue Editor

Guest Editor
Prof. Ruth E. Freeman

Dental Health Services Research Unit, Dundee Dental Hospital and School, University of Dundee, Dundee, UK
Website | E-Mail

Special Issue Information

Dear Colleagues,

The aim of this collection of papers is to provide the reader with a cogent understanding of the role of evidence in the development of social or community-based interventions to promote inclusion oral-health and reduce oral health, health, and psychosocial inequities. In addition, this material will include various methods used for their implementation and evaluation.

At the outset, the reader will be offered a working definition of inclusion oral-health, which will be modelled on the work of Luchenski et al. [1]. The interventions described are theoretically underpinned by a pluralistic definition of evidence-based practice [2] and the radical discourse of health promotion as postulated by Laverack and Labonte [3] and others [4,5]. This Special Issue will consist of eight papers, including an introduction. The first three papers will examine the various sources of evidence used to transform top-down into bottom-up community-based interventions for people experiencing homelessness; people in custody and for families residing in areas of high social deprivation. The final four papers will report on the implementation and evaluation of social or community-based interventions. This collection of research papers will highlight the importance of focusing on prevention and the adoption of a common risk factor agenda to tackle oral health, health and psychosocial inequities felt by those most excluded in our societies.

References:

  1. Luchenski S.; Psych, N.M.D.; Aldridge, R.W.; Hayward, A.; Story, A.; Perri, P.; Withers, J.; Clint, S.; Fitzpatrick, S.; Hewett, N. What works in inclusion health: Overview of effective interventions for marginalised and excluded populations. The Lancet. 2018, 391, 266–280. DOI:https://doi.org/10.1016/S0140-6736(17)31959-1
  2. Holmes D.; Murray, S.J.; Perron, A.; Rail, G. Deconstructing the evidence-based discourse in health sciences: Truth, power and fascism. Int. J. Evid. Based Health. 2006, 4, 180–186
  3. Laverack G.; Labonte R. A planning framework for community empowerment goals within health promotion. Health Policy Plan, 2000, 15, 255–256.
  4. Freeman R. Health promotion and the randomised controlled trial: a square peg in a round hole? BMC Oral Health 2009, doi:10.1186/1472-6831-9-1
  5. Freire P. Pedagogy of the Oppressed. The Continuum International Publishing Group Inc.: London, UK, 1996.

Prof. Ruth E. Freeman
Guest Editor

Manuscript Submission Information

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Published Papers (6 papers)

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Research

Open AccessArticle
Factors Associated with Accessing Prison Dental Services in Scotland: A Cross-Sectional Study
Dent. J. 2019, 7(1), 12; https://doi.org/10.3390/dj7010012
Received: 12 December 2018 / Revised: 26 January 2019 / Accepted: 29 January 2019 / Published: 1 February 2019
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Abstract
Background: Prisoners have poorer dental health than non-prison populations. It is known that the prison environment can promote health and thus, policies, including access to dental care, are in place to promote health during imprisonment. Aim: Our aim was to conduct an oral [...] Read more.
Background: Prisoners have poorer dental health than non-prison populations. It is known that the prison environment can promote health and thus, policies, including access to dental care, are in place to promote health during imprisonment. Aim: Our aim was to conduct an oral health and psychosocial needs survey to identify the factors associated with accessing prison dental services in Scotland. Methods: A convenience sample of offenders from a male maximum security prison, a women’s prison, and a young offenders’ institution was gathered. A questionnaire examined the demography, prison experience, dental anxiety, oral health-related quality of life, and reported attendance of dental services. A dental examination was conducted using the International Caries Detection and Assessment System to diagnose obvious decay. A hierarchical logistic regression analysis was performed. Results: 342 prisoners participated. When missing data were excluded, the final sample was 259. The regression analysis showed the following: Model 1 characterized the offenders by demography and prison experience, explaining 19% of the variance. Model 2 showed that an offender was 36% more likely to attend dental services for every unit change in the 5-point ranking scale of ‘feeling irritable with people because of teeth, mouth, or dentures’, explaining an additional 7% of the variance. Model 3 explained 35% of the variance, (i.e., an additional 9%) and was adopted as the final model to characterize offenders who access dental services when in prison. An offender who reported accessing prison dental services was 3.28 times more likely to be male. For each increase in the year of an offender’s age, the offender was 5% more likely to access prison dental services. An 11% greater chance of accessing prison dental services for every experience of remand was also found. An offender was 32% more likely to access prison dental services for each increased level of irritability, and there was a 2 times higher likelihood of emergency dental services’ attendance. There was a 19% lower chance of accessing prison dental services for each additional tooth affected by decay and a 13% greater chance of accessing prison dental services for each unit increase in missing teeth. Conclusions: In conclusion, this investigation identified factors associated with access to prison dental services in Scotland. The role of accessibility factors, such as the oral health impact of irritability, appeared to increase perceptions of dental need and promote dental services’ attendance. Full article
Open AccessArticle
Strengthening Social Interactions and Constructing New Oral Health and Health Knowledge: The Co-design, Implementation and Evaluation of A Pedagogical Workshop Program with and for Homeless Young People
Dent. J. 2019, 7(1), 11; https://doi.org/10.3390/dj7010011
Received: 9 October 2018 / Revised: 15 January 2019 / Accepted: 17 January 2019 / Published: 1 February 2019
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Abstract
Young homeless people make up nearly one-third of those experiencing homelessness. The need to provide an educative approach, to strengthen social interacting, and construct new knowledge to increase social inclusivity, is required. The aim of this qualitative exploration was to use critical consciousness [...] Read more.
Young homeless people make up nearly one-third of those experiencing homelessness. The need to provide an educative approach, to strengthen social interacting, and construct new knowledge to increase social inclusivity, is required. The aim of this qualitative exploration was to use critical consciousness as an educative tool, to co-design, implement, and evaluate a series of oral health and health pedagogical workshops to strengthen social engagement and to construct new health knowledge, with, and for, homeless young people and their service providers. An action research design permitted the simultaneous development, implementation, and evaluation of the pedagogical workshop program. A Non-Governmental Organization (NGO), providing supported accommodation for young homeless people, acted as the partner organization. Thirteen young people and five staff members from this NGO participated and co-designed eight workshops. Qualitative data collection included unstructured post-intervention interviews together with verbatim quotes from the group discussions during the workshops and from the post-workshop questionnaires. The qualitative analysis was informed by content analysis to permit the emergence of key themes from the data. The two themes were: 1. ‘trust building and collective engaging’ and 2. ‘constructing knowledge and developing skills’. Theme 1 highlighted engagement with the service provider, illustrating the transformation of the young people’s relationships, strengthening of their social interacting, and enabling their critical reflexive thinking on sensitive issues present in the homelessness trajectory. Theme 2 illustrated the young people’s ability to share, lend, and encode their new health information and convert it into an understandable and useable form. This new comprehension permitted their behavior change and social interaction. These findings provide an approach to increase young people’s knowledge, health literacy, and strengthen their social interacting to support community action. Full article
Open AccessArticle
Evaluating an Oral Health Education Intervention in Chinese Undocumented Migrant Mothers of Infants in Northern Ireland
Dent. J. 2019, 7(1), 8; https://doi.org/10.3390/dj7010008
Received: 19 November 2018 / Revised: 13 January 2019 / Accepted: 14 January 2019 / Published: 19 January 2019
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Abstract
Background: Poor oral health remains a significant dental public health challenge for ethnic minority and immigrant groups living in the UK. This study aimed to evaluate a culturally appropriate community-based home visiting oral health education intervention for Chinese, undocumented migrant mothers to promote [...] Read more.
Background: Poor oral health remains a significant dental public health challenge for ethnic minority and immigrant groups living in the UK. This study aimed to evaluate a culturally appropriate community-based home visiting oral health education intervention for Chinese, undocumented migrant mothers to promote their infants’ oral health, by focusing on their oral health related knowledge, attitudes, and behaviors. Methods: A convenience sample of 36 Chinese mothers with babies aged less than eight weeks were recruited in South-East region of Belfast. The local Chinese community was consulted to assist with the development of the intervention. The oral health education intervention was provided to 19 intervention group mothers through home visits and telephone calls during mothers’ first postpartum year. They were also provided with unlimited social support during the intervention period. Mothers’ oral health related knowledge, attitudes, and behaviors regarding baby toothbrushing and sugar snacking were measured at eight weeks, six months, and 12 months. Results: A higher proportion of Chinese intervention group mothers had improved knowledge about baby toothbrushing at 12 months compared with control group mothers (χ2 = 14.12: p = 0.004). Significantly, more intervention group mothers’ oral health related attitudes were enhanced regarding baby toothbrushing and sugar snacking compared with control group mothers. Conclusion: This community-based oral health education intervention has shown effects in mothers’ self-reported knowledge, attitudes, and behaviors in the intervention group when the community based and culturally appropriate home-visiting program improved the mothers’ oral health related knowledge, attitudes, and behaviors. Full article
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Open AccessArticle
Dental Attendance in Undocumented Immigrants before and after the Implementation of a Personal Assistance Program: A Cross-Sectional Observational Study
Dent. J. 2018, 6(4), 73; https://doi.org/10.3390/dj6040073
Received: 27 October 2018 / Revised: 30 November 2018 / Accepted: 11 December 2018 / Published: 14 December 2018
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Abstract
Undocumented immigrants are a high-risk social group with low access to care. The present study aims to increase awareness and dental attendance in this subgroup, assisted by community health workers (CHW). Starting from 2015, two trained dentists volunteered to perform free oral health [...] Read more.
Undocumented immigrants are a high-risk social group with low access to care. The present study aims to increase awareness and dental attendance in this subgroup, assisted by community health workers (CHW). Starting from 2015, two trained dentists volunteered to perform free oral health examinations and further dental care referral in a welfare organisation in Ghent, Belgium. In 2016 and 2017, a two-day oral health training was added, enabling social workers to operate as community oral health workers and to provide personal oral health advice and assistance. Over the three years, an oral health examination was performed on 204 clients from 1 to 69 years old, with a mean age of 36.7 (SD = 15.9), showing high levels of untreated caries (71.6%; n = 146) and a Dutch Periodontal Screening Index (DPSI) score of 3 or 4 in 62.2% of the sample (n = 97). Regarding dental attendance, the total number of missed appointments decreased significantly, with 40.9% in 2015, 11.9% in 2016 and 8.0% in 2017 (p < 0.001). Undocumented immigrants can be integrated into professional oral health care. Personal assistance by community health workers might be an effective method, although this requires further investigation. Full article
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Open AccessArticle
Implementing an Oral Health Intervention for People Experiencing Homelessness in Scotland: A Participant Observation Study
Dent. J. 2018, 6(4), 68; https://doi.org/10.3390/dj6040068
Received: 3 October 2018 / Revised: 4 November 2018 / Accepted: 19 November 2018 / Published: 1 December 2018
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Abstract
Smile4life is an intervention aimed at improving the oral health of people experiencing homelessness in Scotland. The purpose of this research was to determine how this intervention was being translated from guidance into action. Data concerning Smile4life working practices were collected in three [...] Read more.
Smile4life is an intervention aimed at improving the oral health of people experiencing homelessness in Scotland. The purpose of this research was to determine how this intervention was being translated from guidance into action. Data concerning Smile4life working practices were collected in three NHS Boards using participant observation. Fieldnotes taken during these observations were analysed using content analysis. This analysis revealed that there were working alliances between the oral health practitioner, the Third Sector staff, and the homeless service users, and that these alliances were affected by various barriers and enablers. The observation sessions also highlighted variations in working practices. Full article
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Open AccessArticle
Homeless in Scotland: An Oral Health and Psychosocial Needs Assessment
Dent. J. 2018, 6(4), 67; https://doi.org/10.3390/dj6040067
Received: 3 October 2018 / Revised: 13 November 2018 / Accepted: 13 November 2018 / Published: 1 December 2018
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Abstract
The aim of this research was to conduct an oral health and psychosocial needs assessment of a homeless population in Scotland to determine the levels of unmet need and provide recommendations for oral health improvement. A non-probability convenience sample of homeless people residing [...] Read more.
The aim of this research was to conduct an oral health and psychosocial needs assessment of a homeless population in Scotland to determine the levels of unmet need and provide recommendations for oral health improvement. A non-probability convenience sample of homeless people residing in seven Scottish Health Boards was collected. All consenting participants were asked to complete a questionnaire assessing their health and psychosocial needs, dental anxiety, and oral health-related quality of life. The participants’ oral health was examined by a trained and calibrated dentist and dental nurse. Eight hundred and fifty-three homeless people consented to take part. Participants had a mean D3cvMFT score of 16.9 (95% CI: 16.3, 17.6). Dental anxiety was high, with 20% scoring as dentally phobic. Respondents with higher dental anxiety were found to have significantly greater mean numbers of filled teeth than those with lower dental anxiety (t = −2.9, p < 0.05). Common oral health impacts were painful aching and discomfort while eating, experienced occasionally by 31% and 27% of the respondents, respectively. Fifty-eight percent of participants were found to have a depressive illness, and obvious decay experience was significantly higher among this section of participants (t = −4.3, p < 0.05). Homeless people in Scotland were found to be in need of a more accessible dental service than is currently available. An enhanced service should meet the oral health and psychosocial needs of this population to improve their oral health and quality of life. Full article
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