Access to oral health care services among adults with learning disabilities: a scoping review

Access to dental care among individuals with intellectual and developmental disabilities in India: A scoping review

INTRODUCTION

Individuals with intellectual and developmental disabilities (IDDs) face numerous challenges in accessing dental care. Despite difficulties, more evidence exploring difficulties among this cohort in India is needed. This study aims to conduct a scoping review of articles published in India exploring access to dental care among individuals with IDD.

METHOD

We followed the Arksey O'Malley framework for scoping reviews and the PRISMA guidelines for reporting studies. Findings were analyzed based on Levesque's framework for access.

RESULTS

Seventeen articles were collated from five databases. The perceived need for dental care was low, and dental visits were mainly need-based and infrequent. Knowledge regarding dental care did not translate to dental visits. Patient-related barriers were cost, transportation difficulties, fear, lack of dentist skills, patient behavior, and cooperation. From the providers' perspective, most dentists were willing to treat but noted infrastructural and knowledge-based limitations.

CONCLUSION

Access to dental care was limited due to infrastructure constraints and a lack of dentist training. Caregivers and individuals with IDD did not prioritize dental health, faced communication barriers, and were afraid of dental procedures. It is important to improve preventive dental care and raise awareness among caregivers of individuals with IDD in India. Training dentists and incorporating special care dentistry into the standard dental curriculum will improve access.

Oral and dental health utilization determinants in special health care needs: a systematic review of reviews

BACKGROUND

Oral health is essential for overall well-being and can significantly improve quality of life. However, people with special health care needs (SHCN) often face challenges in accessing dental services. This study aimed to systematically review all available evidence on the oral and dental service utilization determinants among these individuals. Based on the findings, we also explore strategies to increase their access to dental care.

METHOD

This study is a systematic review of reviews based on the PRISMA 2020. Six databases were systematically searched including PubMed, Web of Science, Scopus, Embase, ProQuest, and Cochrane Library. Related keywords were applied up to 30 October 2023. This study includes all systematic, scoping, and rapid reviews written in English that examine the factors affecting dental service use among SHCNs. Microsoft Power BI was used for descriptive quantitative analysis, and MAXQDA version 10 was applied for qualitative thematic analysis.

RESULTS

The number of 2238 articles were retrieved based on the search strategy. After excluding duplications and appraising the eligibility, 7 articles were included. An examination of these 7 articles shows that they were all carried out from 2016 to 2022. Of these, 42% were systematic reviews, 42% used a scoping method, and one study (14%) was a rapid review. According to the thematic analysis, there were five main themes concerning determinants of oral and dental utilization of SHCN: "Financial considerations," "Patient-Provider Relationship," "Accessibility and Availability of Services," "Patient Factors," and "Quality of Care." Additionally, regarding strategies for improving utilization, three main themes emerged: "Education and Training," "Service Improvement," and "Policy Solutions.

CONCLUSION

This study delves into the intricate challenges SHCNs face in accessing dental services, highlighting the imperative for comprehensive interventions addressing supply and demand. Supply-oriented measures encompass dentist education, implementing financial policies for affordable services, and integrating dental care into primary healthcare systems. On the demand side, strategies revolve around empowering patients and caregivers and enhancing cultural inclusivity. Despite sustained efforts, current utilization rates fall short of optimal levels. Thus, effective strategic planning by policymakers and healthcare leaders is paramount to bolster dental service utilization among SHCNs, thereby enhancing their overall well-being.

Investigating the access barriers to oral and dental health services for children from the perspective of parents attending the health centers of Kerman

Background

Oral health plays a key role in people's overall health. Dental caries is the most important problem in children's oral health. Despite significant advances made in the area of oral health around the world, there is inequality in access to oral health within Iran and abroad, and this is considered a public health challenge. This study was conducted to investigate the access barriers to children's oral health services from the perspective of parents attending the health centers of Kerman, Iran.

Materials and Methods

The present descriptive-analytical study was carried out, as a cross-sectional survey, on 410 parents of children living in Kerman, Iran. The data were collected by access barriers questionnaire, and then were analyzed by SPSS software using descriptive statistical methods and the multiple linear regression test. Confidence interval (CI) in this study was 95% (95% CI).

Results

The most common access barrier to children's oral health was the high treatment cost. The access barriers to children's oral health services were significantly associated with parental education (P = 0.00), maternal employment (P = 0.04), supplementary insurance (P = 0.00), and family income (P = 0.01). Parental satisfaction was also significantly correlated to the child's sex (P = 0.04), supplementary insurance (P = 0.04), and number of filled teeth (P = 0.04). The mean score of parental satisfaction was 1.83 ± 0.34; within the range of 1-3 from satisfied to dissatisfied.

Conclusion

The cost of dental treatment services high and there are many barriers to accessing children's oral health.

Impact of the special care dentistry education on Malaysian students' attitudes, self-efficacy and intention to treat people with learning disability

INTRODUCTION

Special Care Dentistry (SCD) education has been introduced in Malaysia, but there are limited number of studies about its impact to students. Thus, this study aimed to explore the level of students' readiness to treat people with learning disability (PWLD) based on their attitudes, self-efficacy and intention to treat.

METHODS

A questionnaire was developed based on the Dental Student Attitude to the Handicapped Scale, Scale of Attitudes to the Disabled Persons and Health Action Process Approach. The self-administered, validated questionnaire was tested for reliability (Cronbach's alpha = .71-.81), before being distributed to clinical dental students of both genders from two universities (University A, n = 176 and University B, n = 175). Quantitative data were analysed via t test and ANOVA (p < .05) using the SPSS software.

RESULTS

There was no significant difference in mean total attitude score between the universities, although dental students from University A, who mostly reported having received hands-on clinical experience in SCD and exposure to Disability Equality Training (DET), showed significantly higher individual mean attitude score for 5 (out of 24) attitudinal items. The mean total self-efficacy score and individual mean self-efficacy score for 1 (out of 5) self-efficacy items were also significantly higher amongst University A dental students. The intention to treat PWLD was not significantly influenced by university, gender or year of study.

CONCLUSION

Incorporation of SCD education in the undergraduate curriculum, with hands-on clinical experience and exposure to DET, is recommended to equip students to be efficient oral healthcare providers for PWLD.

The impact of COVID-19 on access to dental care for people with disabilities: a global survey during the COVID-19 first wave lockdown

BACKGROUND

It is unclear what immediate impact the COVID-19 pandemic has had on delivery of oral healthcare to people with disabilities worldwide.

AIM

To report the international impact of COVID-19 lockdown on oral healthcare provision for people with disabilities before, during and after the first lockdown (March to July 2020).

MATERIAL AND METHODS

Cross-sectional online self-administered survey of dentists who treat people with disabilities completed 10th to 31st of July 2020. Responses allowed comparison from before, during and immediately after the first wave lockdowns of the COVID-19 pandemic. Data were analysed using McNemar's test to compare reported practice before to during lockdown, and before to after lockdown.

RESULTS

Four-hundred-thirty-six respondents from across global regions reported a significant reduction from before to during and from before to after lockdown regarding: the proportion of dentists treating people with all types of disability (p <0.001) and the number of patients with disabilities seen per week (p<0.0001). The proportion reporting no availability of any pharmacological supports rose from 22% pre-lockdown to 61% during lockdown (p < 0.001) and a persistent 44% after lockdown (p < 0.001). An increase in teledentistry was observed.

CONCLUSIONS

During the first COVID-19 lockdown, there was a significant negative impact on the delivery of dental care to people with disabilities. Oral healthcare access was significantly restricted for people with disabilities with access to sedation and general anaesthesia particularly affected. There is now an increased need to ensure that no-one is left behind in new and existing services as they emerge post-pandemic.

Barriers in access to healthcare for women with disabilities: a systematic review in qualitative studies

Background

Studies show that different socio-economic and structural factors can limit access to healthcare for women with disabilities. The aim of the current study was to review barriers in access to healthcare services for women with disabilities (WWD) internationally.

Methods

We conducted a systematic review of relevant qualitative articles in PubMed, Web of Science and Scopus databases from January 2009 to December 2017. The search strategy was based on two main topics: (1) access to healthcare; and (2) disability. In this review, women (older than 18) with different kinds of disabilities (physical, sensory and intellectual disabilities) were included. Studies were excluded if they were not peer-reviewed, and had a focus on men with disabilities.

Results

Twenty four articles met the inclusion criteria for the final review. In each study, participants noted various barriers to accessing healthcare. Findings revealed that WWD faced different sociocultural (erroneous assumptions, negative attitudes, being ignored, being judged, violence, abuse, insult, impoliteness, and low health literacy), financial (poverty, unemployment, high transportation costs) and structural (lack of insurance coverage, inaccessible equipment and transportation facilities, lack of knowledge, lack of information, lack of transparency, and communicative problems) factors which impacted their access healthcare.

Conclusions

Healthcare systems need to train the healthcare workforce to respect WWD, pay attention to their preferences and choices, provide non-discriminatory and respectful treatment, and address stigmatizing attitudinal towards WWD. In addition, families and communities need to participate in advocacy efforts to promote WWD’s access to health care.

The Knowledge, Attitude and Practices of the Caregivers about Oral Health Care, at Centers for Intellectually Disabled, in Southern Region of Saudi Arabia

Oral health is perhaps the most neglected aspect of healthcare for persons living in rehabilitation centers, compared to the general population. The caregivers play a vital role in administering daily oral care to residents in rehabilitation centers: The aim of the present questionnaire-based study was to evaluate the caregivers’ knowledge, attitude and practices towards oral healthcare at centers for the intellectually disabled in the Southern region of Saudi Arabia (SA). The present study was designed as a cross-sectional one-point time survey. The samples were selected by using a non-probability convenience sampling method. The self-administered closed-ended questionnaire comprised of 22 items divided into four sections, which was designed to elicit the demographic information, awareness of oral care, attitude towards oral health and practice of the oral healthcare regime among the participants. Of the164 participants, 53.0% and 47.0% were male and female, respectively. Most of the participants—54.9%—were between 30–39 years of age. Participants were almost equally distributed between educational groups, and about 87% had more than 2 years of experience. A brief overview showed a fair level of knowledge and attitude among 61.6% and 58.5% of respondents, respectively. Participants with an education level above that of high school showed good knowledge and attitude scores (p < 0.05), whereas females showed better attitude scores compared to the males (p < 0.05). Respondents mentioned the difficulties they faced while treating the subjects. The special healthcare workers generally had acceptable oral health knowledge and practices. Caregivers who had lower education levels should be advised for training programs that addressed the importance of oral health services.

Factors affecting access to primary health care services for persons with disabilities in rural areas: a "best-fit" framework synthesis

Background

Access to primary health care (PHC) is a fundamental human right and central in the performance of health care systems, however persons with disabilities (PWDs) generally experience greater barriers in accessing PHC than the general population. These problems are further exacerbated for those with disabilities in rural areas. Understanding PHC access for PWDs is particularly important as such knowledge can inform policies, clinical practice and future research in rural settings.

Methods

We conducted a synthesis of published literature to explore the factors affecting access to PHC for PWDs in rural areas globally. Using an adapted keyword search string we searched five databases (CINAHL, EMBASE, Global Health, Medline and Web of Science), key journals and the reference lists of included articles. We imported the articles into NVivo and conducted deductive (framework) analysis by charting the data into a rural PHC access framework. We subsequently conducted inductive (thematic) analysis.

Results

We identified 36 studies that met our inclusion criteria. A majority (n = 26) of the studies were conducted in low-and middle-income countries. We found that PWDs were unable to access PHC due to obstacles including the interplay of four major factors; availability, acceptability, geography and affordability. In particular, limited availability of health care facilities and services and perceived low quality of care meant that those in need of health care services frequently had to travel for care. The barrier of geographic distance was worsened by transportation problems. We also observed that where health services were available most people could not afford the cost.

Conclusion

Our synthesis noted that modifying the access framework to incorporate relationships among the barriers might help better conceptualize PHC access challenges and opportunities in rural settings. We also made recommendations for policy development, practice consideration and future research that could lead to more equitable access to health care. Importantly, there is the need for health policies that aim address rural health problems to consider all the dimensions and their interactions. In terms of practice, the review also highlights the need to provide in-service training to health care providers on how to enhance their communication skills with PWDs. Future research should focus on exploring access in geographical contexts with different health care systems, the perspectives of health care providers and how PWDs respond to access problems in rural settings.

Electronic supplementary material

The online version of this article (10.1186/s41256-018-0091-x) contains supplementary material, which is available to authorized users.

Factors Affecting Access to Oral Health Care among Adults in Abha City, Saudi Arabia

AIMS AND OBJECTIVES

To investigate the self-reported access problems to dental care among adults in Abha city, KSA.

MATERIALS AND METHODS

A cross-sectional descriptive survey was carried out among adults in Abha city, Saudi Arabia. A structured, close-ended, self-administered questionnaire elicited the access and utilization of dental care among a sample of adults. Data were collected and analyzed using SPSS version 21.0 statistical software. The descriptive statistics and logistic regression analysis were performed to predict the variables associated with access and utilization of dental care.

RESULTS

A total of 499 adults (male = 270, female = 229) participated in the study. More than half (289, 57.9%) of the participants utilized dental services and emergency services (283, 56.7%) were the most common reason to visit dentist. For most of the participants (281, 57.1%), the last dental visit was less than 1 year. Majority (409, 82%) of the participants self-funded for their treatment in private dental clinics (382, 76.6%). More than half (258, 51.7%) of the participants received restorative treatment during their last visit to dentist. Cost (39.1%) and lack of time (28.7%) were the main barriers to accessing dental care. Education and income were all involved in predicting nonutilization of dental services among the study participants.

CONCLUSION

Access to and utilization of dental care are the multidimensional concepts influenced by many factors. Cost and lack of time were the predominant barriers to utilization of dental services. Access to dental care is a multidimensional issue with education and income, were considered as the significant predictors of nonutilization of dental services. Similarly, income and transportation problems significantly predicted the use of private dental services. Marital status, transportation problem, health problems, and difficulty in movement were all concerned with multiple barriers to accessing dental services among the study participants.

Oral health knowledge and attitude among caregivers of special needs patients at a Comprehensive Rehabilitation Centre: an analytical study

Aim

To evaluate knowledge and attitude of caregivers/healthcare workers regarding oral health of special need patients, at a comprehensive rehabilitation centre.

Material and methods

A validated self-administered structured questionnaire was used in an interview style among 120 caregivers at a comprehensive rehabilitation centre. The first part of questionnaire collected demographic information (age, gender, experience, literacy). The other part of the questionnaire was related to the knowledge and attitude of caregivers regarding importance of oral health including oral hygiene practices, cause of tooth decay, significance of fluoride, common oral problems and need for oral health education. Comparison between oral health knowledge and oral health attitude of caregivers was done using one-sample t Test. The level of significance was set as p=0.005*.

Results

Adequate oral health knowledge was found to be among 59.2% and favourable attitude of caregivers towards oral health care was found among 48.3%. The results indicate that though majority among caregivers had adequate knowledge but their attitude towards oral health was inadequate.

Conclusion

Caregivers showed a deficiency in the proper oral health attitude. To improve oral health attitudes of caregivers, dental education plus training programs should be given high priority.