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Sodo PP, Malele-Kolisa Y, Moola A, Yengopal V, Nemutandani S, Jewett S. Exploring reasons why South African dental therapists are leaving their profession: A theory-informed qualitative study. PLoS One 2023; 18:e0293039. [PMID: 37883391 PMCID: PMC10602277 DOI: 10.1371/journal.pone.0293039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Dental therapy is a category of mid-level oral health professional that was introduced to address inequities in oral health service provision in South Africa within a constrained human resource for health context. However, low numbers of registered dental therapists and attrition threaten this strategy. AIM This study explored reasons for this attrition, building on the Hertzberg Two-Factor Theory. METHODS Through a qualitative exploratory study design, in-depth interviews were conducted with former dental therapists to explore their reasons for leaving the profession. They were recruited using snowball sampling. All interviews were audio recorded, transcribed verbatim, and coded in NVIVO12. A team of researchers applied thematic analysis to agree on themes and sub-themes, guided by Hertzberg's ideas of intrinsic and extrinsic factors. FINDINGS All 14 former dental therapists interviewed expressed their passion for the profession, even though their motivations to join the profession varied. Many of their reasons for leaving aligned with extrinsic and intrinsic factors defined in Hertzberg's Two-Factor Theory. However, they also spoke about a desire for a professional identity that was recognized and respected within the oral health profession, health system, and communities. This is a novel study contribution. CONCLUSION Dental therapist attrition in South Africa is mainly caused by job dissatisfaction and motivation issues resulting from health system level factors. While the Hertzberg Two-Factor Theory helped identify extrinsic and intrinsic factors at an individual level, we used the Human Resources for Health System Development Analytical Framework to identify solutions for dental therapist production, deployment, and retention. Addressing these issues will enhance retention and accessibility to oral health services in the country.
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Affiliation(s)
- Pumla Pamella Sodo
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Yolanda Malele-Kolisa
- School of Oral Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aneesa Moola
- School of Oral Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Veerasamy Yengopal
- Faculty of Dentistry, University of Western Cape, Cape Town, South Africa
| | - Simon Nemutandani
- Research and Innovation Directorate, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Sara Jewett
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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2
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Teledentistry as a novel pathway to improve dental health in school children: a research protocol for a randomised controlled trial. BMC Oral Health 2020; 20:11. [PMID: 31937284 PMCID: PMC6961289 DOI: 10.1186/s12903-019-0992-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background Despite great improvement in child oral health, some children subgroups still suffer from higher levels of dental caries. Geographic and socioeconomic barriers and the lack of access to dental care services are among common reasons for poor oral health in children. Historically in Australia, oral health therapists or dental therapists have been responsible for providing dental care for school children through the School Dental Services (SDS). The current SDS has been unable to provide sustainable dental care to all school children due to a reduction in workforce participation and limited resources. We propose a paradigm shift in the current service through the introduction of user-friendly technology to provide a foundation for sustainable dental care for school children. Methods/design We describe an ongoing parallel, two-armed, non-inferiority randomised controlled trial that compares routine and teledental pathway of dental care in children aged 4–15 years (n = 250). Participating schools in Western Australia will be randomly assigned to the control or teledental group, approximately three schools in each group with a maximum of 45 children in each school. All participants will first receive a standard dental examination to identify those who require urgent referrals and then their teeth will be photographed using a smartphone camera. At the baseline, children in the control group will receive screening results and advice on the pathway of dental care based on the visual dental screening while children in the teledental group will receive screening results based on the assessment of dental images. At 9 months follow-up, all participants will undergo a final visual dental screening. The primary outcomes include decay experience and proportion of children become caries active. The secondary outcomes include the diagnostic performance of photographic dental assessment and costs comparison of two pathways of dental care. Discussion The current project seeks to take advantage of mobile technology to acquire dental images from a child’s mouth at school settings and forwarding images electronically to an offsite dental practitioner to assess and prepare dental recommendations remotely. Such an approach will help to prioritise high-risk children and provide them with a quick treatment pathway and avoid unnecessary referrals or travel. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12619001233112. Registered 06 September 2019.
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Jean G, Kruger E, Tennant M. The distribution of allied dental practitioners in australia: socio-economics and rurality as a driver of better health service accessibility. Aust Dent J 2019; 64:153-160. [PMID: 30676647 DOI: 10.1111/adj.12679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Analysis of the distribution of allied dental practitioners relative to the socio-economic profile of the population, to develop a baseline of employment demographics at a time of proposed deregulation of practicing restrictions. METHODS A database of allied dental practitioners (ADP - oral health therapists, dental therapists and dental hygienists) was compiled from the public access register of the Australian Health Practitioner Regulation Agency. The principal practice locations limited to suburb and postcode were geocoded by latitude and longitude and superimposed on a map of the Australian landmass using QGIS software. Using Australian Bureau of Statistics data, the number of ADPs for each Statistical Area 2 (SA2) was counted and apportioned according to proportion of the population within each SA2 for each quintile of the Index of Relative Socio-economic Disadvantage (IRSD). The results were reported according to oral health therapists, dental therapists and dental hygienists per 100 000 population for each IRSD quintile, by state and territory, and the Australian Regional Index for Areas (ARIA+). RESULTS The ADP to population ratio was not consistent for each professional class between states and territories, IRSD quintiles and (ARIA+) regional areas. Across major cities, South Australia was the state with the highest ratio of oral health therapists (10.6-12.9) and dental hygienists (14.6-24.5) for all IRSD quintiles. Western Australia had the highest ratio of dental therapists (9.3-16.0), CONCLUSION: There is no consistent pattern of distribution of ADPs relative to the socio-economic profile of the population across states and territories, and regional (ARIA+) areas of Australia.
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Affiliation(s)
- G Jean
- International Research Collaborative - Oral Health and Equity, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - E Kruger
- International Research Collaborative - Oral Health and Equity, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - M Tennant
- International Research Collaborative - Oral Health and Equity, School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
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Estai M, Bunt S, Kanagasingam Y, Tennant M. Cost savings from a teledentistry model for school dental screening: an Australian health system perspective. AUST HEALTH REV 2018; 42:482-490. [DOI: 10.1071/ah16119] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 04/06/2017] [Indexed: 11/23/2022]
Abstract
Objective
The aim of the present study was to compare the costs of teledentistry and traditional dental screening approaches in Australian school children.
Methods
A cost-minimisation analysis was performed from the perspective of the oral health system, comparing the cost of dental screening in school children using a traditional visual examination approach with the cost of mid-level dental practitioners (MLDPs), such as dental therapists, screening the same cohort of children remotely using teledentistry. A model was developed to simulate the costs (over a 12-month period) of the two models of dental screening for all school children (2.7 million children) aged 5–14 years across all Australian states and territories. The fixed costs and the variable costs, including staff salary, travel and accommodation costs, and cost of supply were calculated. All costs are given in Australian dollars.
Results
The total estimated cost of the teledentistry model was $50 million. The fixed cost of teledentistry was $1 million and that of staff salaries (tele-assistants, charters and their supervisors, as well as information technology support was estimated to be $49 million. The estimated staff salary saved with the teledentistry model was $56 million, and the estimated travel allowance and supply expenses avoided were $16 million and $14 million respectively; an annual reduction of $85 million in total.
Conclusions
The present study shows that the teledentistry model of dental screening can minimise costs. The estimated savings were due primarily to the low salaries of dental therapists and the avoidance of travel and accommodation costs. Such savings could be redistributed to improve infrastructure and oral health services in rural or other underserved areas.
What is known about the topic?
Caries is a preventable disease, which, if it remains untreated, can cause significant morbidity requiring costly treatment. Regular dental screening and oral health education have the great potential to improve oral health and save significant resources. The use of role substitution, such as using MLDPs to provide oral care has been well acknowledged worldwide because of their ability to provide safe and effective care. The teledentistry approach for dental screening offers a comparable diagnostic performance to the traditional visual approach.
What does this paper add?
The results of the present study suggest that teledentistry is a practical and economically viable approach for mass dental screening not only for isolated communities, but also for underserved urban communities. The costs of the teledentistry model were substantially lower than the costs associated with a conventional, face-to-face approach to dental screening in both remote and urban areas. The primary driver of net savings is the low salary of MLDPs and avoidance of travel and overnight accommodation by MLDPs.
What are the implications for practitioners?
The use of lower-cost MLDPs and a teledentistry model for dental screening has the potential to save significant economic and human resources that can be redirected to improve infrastructure and oral care services in underserved regions. In the absence of evidence of the economic usefulness of teledentistry, studies such as the present one can increase the acceptance of this technology among dental care providers and guide future decisions on whether or not to implement teledentistry services.
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Estai M, Bunt SM, Kruger E, Tennant M. The use of mobile health applications in school dental screening. Aust Dent J 2017; 62:394-396. [DOI: 10.1111/adj.12527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M Estai
- International Research Collaborative, Oral Health, and Equity; School of Human Sciences; University of Western Australia; Crawley Western Australia Australia
| | - SM Bunt
- International Research Collaborative, Oral Health, and Equity; School of Human Sciences; University of Western Australia; Crawley Western Australia Australia
| | - E Kruger
- International Research Collaborative, Oral Health, and Equity; School of Human Sciences; University of Western Australia; Crawley Western Australia Australia
| | - M Tennant
- International Research Collaborative, Oral Health, and Equity; School of Human Sciences; University of Western Australia; Crawley Western Australia Australia
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Godwin D, Hoang H, Crocombe L. Views of Australian dental practitioners towards rural recruitment and retention: a descriptive study. BMC Oral Health 2016; 16:63. [PMID: 27251191 PMCID: PMC4888206 DOI: 10.1186/s12903-016-0221-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 05/24/2016] [Indexed: 11/17/2022] Open
Abstract
Background Despite an increase in the supply of dental practitioners in Australia in recent years, there remains an unequal distribution of dental practitioners with more dental practitioners working in city areas. This is in part due to difficulties in attracting and retaining dental practitioners to rural practice. The aim of this study was to investigate the attitudes of Australian dental practitioners towards what may attract them to rural areas and why they may remain in them. Method A descriptive study, utilising telephone, semi-structured interviews with dental practitioners across Australia. Dental practitioners were recruited through their professional associations. Data were analysed using content and thematic analysis. Results Fifty participants; 34 dentists, eight oral health therapists, and eight dental prosthetists working in rural and urban areas of Australia. Four main themes were identified: Business Case: concerns related to income and employment security, Differences in Clinical Practices: differences in clinical treatments and professional work, Community: fitting in and belonging in the area in which you live and work, and Individual Factors: local area provision for lifestyle choices and circumstances. The most influential of these themes were business case and individual factors. Smaller rural areas, due to low populations and being unable to provide individuals with their lifestyle needs were considered unappealing for dental practitioners to live. Previous experience of rural areas was highly influential. Conclusions The main factors influencing rural recruitment and retention were income sustainability and employment security, and individual factors. Dental practitioners felt that it was harder to earn a sustainable income and provide quality lifestyles for their family in rural areas. Previous experience of rural areas was influential towards long-term rural retention. These factors should be considered in order to develop effective strategies to address the unequal distribution of dental practitioners.
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Affiliation(s)
- Diana Godwin
- Centre for Rural Health, University of Tasmania, Hobart, Tasmania, Australia.
| | - Ha Hoang
- Centre for Rural Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Leonard Crocombe
- Centre for Rural Health, University of Tasmania, Hobart, Tasmania, Australia.,Australian Research Centre for Population Oral Health, School of Dentistry, University of Adelaide, Adelaide, Australia
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Estai M, Kruger E, Tennant M. Will producing more dentists solve all the workforce issues in rural and remote areas? Aust Dent J 2016; 61:262-3. [DOI: 10.1111/adj.12423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Mohamed Estai
- International Research Collaborative; Oral Health and Equity; Department of Anatomy, Physiology and Human Biology; The University of Western Australia; Western Australia Australia
| | - Estie Kruger
- International Research Collaborative; Oral Health and Equity; Department of Anatomy, Physiology and Human Biology; The University of Western Australia; Western Australia Australia
| | - Marc Tennant
- International Research Collaborative; Oral Health and Equity; Department of Anatomy, Physiology and Human Biology; The University of Western Australia; Western Australia Australia
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Estai M, Kruger E, Tennant M. Role of telemedicine and mid-level dental providers in expanding dental-care access: potential application in rural Australia. Int Dent J 2016; 66:195-200. [PMID: 26846683 DOI: 10.1111/idj.12217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Despite great progress in oral health over the past three decades, the rates of caries remain high in Australia, particularly among underserved populations. The reasons for poor oral health amongst underserved populations are multiple, but rests with socio-economic determinants of health. The present review considers international workforce models that have been created to enhance the recruitment and retention of dental providers in rural areas. Several strategies have been developed to address care access problems in rural areas, including the use of telemedicine and mid-level dental providers (MLDPs). Despite ongoing opposition from dentistry organisations, the Alaska and Minnesota workforce models have proven that developing and deploying dental therapists from rural communities has the potential to address the unmet needs of underserved populations. It is more efficient and cost-effective for MLDPs to perform triage and treat simple cases and for dentists to treat complicated cases. The use of MLDPs is intended to increase the capacity of the dental workforce in areas that are too isolated to entice dentists. Telemedicine has emerged as one solution to address limited access to health care, particularly in locations where there is a lack of providers. Telemedicine not only provides access to care, but also offers support, consultations and access to continuing education for practicing dental providers in rural areas. This strategy has the potential to free up resources to increase care access and reduce oral health disparities, thereby contributing to closing the rural-urban oral health gap.
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Affiliation(s)
- Mohamed Estai
- International Research Collaborative, Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, WA, Australia
| | - Estie Kruger
- International Research Collaborative, Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, WA, Australia
| | - Marc Tennant
- International Research Collaborative, Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Perth, WA, Australia
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Dyson K, Kruger E, Tennant M. A decade of experience evolving visiting dental services in partnership with rural remote Aboriginal communities. Aust Dent J 2014; 59:187-92. [DOI: 10.1111/adj.12162] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- K Dyson
- International Research Collaborative-Oral Health and Equity; The University of Western Australia
| | - E Kruger
- International Research Collaborative-Oral Health and Equity; The University of Western Australia
| | - M Tennant
- International Research Collaborative-Oral Health and Equity; The University of Western Australia
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Solowiej K, Upton P, Upton D. A scheme to support the recruitment and retention of allied health professionals to hard to fill posts in rural areas. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2010. [DOI: 10.12968/ijtr.2010.17.10.78813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kazia Solowiej
- Psychology, Institute of Health and Society, University of Worcester, Worcester, UK
| | - Penney Upton
- Psychology, Institute of Health and Society, University of Worcester, Worcester, UK
| | - Dominic Upton
- Psychological Sciences, Institute of Health and Society, University of Worcester, Worcester, UK
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Leach MJ, Segal L, May E. Lost opportunities with Australia's health workforce? Med J Aust 2010; 193:167-72. [DOI: 10.5694/j.1326-5377.2010.tb03838.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2009] [Accepted: 03/01/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Matthew J Leach
- Health Economics and Policy Group, School of Nursing and Midwifery, University of South Australia, Adelaide, SA
| | - Leonie Segal
- Health Economics and Policy Group, School of Nursing and Midwifery, University of South Australia, Adelaide, SA
| | - Esther May
- School of Health Sciences, University of South Australia, Adelaide, SA
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