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Kuipers S, Castelein S, Kronenberg L, Veer JV’, Boonstra N. The Development of an Oral Health Nursing Tool for Patients with a Psychotic Disorder: A Human-Centred Design with a Feasibility Test. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:492. [PMID: 38673403 PMCID: PMC11050105 DOI: 10.3390/ijerph21040492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Patients with psychotic disorders frequently report oral health problems, while mental health nurses (MHNs) seem not to be fully aware of these problems and the risk factors. Therefore, this study aimed to develop supportive tools for MHNs regarding oral health to increase sensitisation among MHNs and provide MHNs with the knowledge to recognise (potential) oral health problems in patients with a psychotic disorder. We used a human-centred design in which the user, MHNs and experts by experience were placed at the centre of the research process. Problems and needs in MHNs working with patients with a psychotic disorder were addressed. To identify key issues of problems as well as needs in terms of resources, we started with focus groups (n = 9). We analysed the data thematically based on the context of patients and MHNs in practice regarding oral health, preferred oral health tools focused on MHNs, and the intended outcomes of tools. A multi-criteria decision matrix was developed and analysed (n = 9) to identify the most optimal and viable solution based on established criteria and issues that are prevalent in the work of MHNs. The most promising result was the development of a brochure with an awareness screener. The brochure with the awareness screener was developed as a low-fidelity prototype for MHNs regarding oral health in patients with a psychotic disorder based on the latest scientific evidence. After testing it, the feasibility was tested through semi-structured interviews (n = 19). MHNs and experts by experience were satisfied with the tool and provided recommendations for adjustments to the content. Significant augmentations to the brochure included a clinical lesson and a toothbrush with toothpaste for patients. We can conclude that a brochure with an awareness screener is feasible for MHNs. Future steps aiming to further refine and optimise care processes for oral health tools in MHNs should take refining eligibility criteria for psychiatric populations and the language level of the target group of a tool into account.
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Affiliation(s)
- Sonja Kuipers
- Research Group Healthcare & Innovation in Psychiatry, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands;
- Department of Experimental Psychopathology and Clinical Psychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands;
| | - Stynke Castelein
- Department of Experimental Psychopathology and Clinical Psychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands;
- Lentis Research, Lentis Psychiatric Institute, Hereweg 80, 9725 AG Groningen, The Netherlands
| | - Linda Kronenberg
- Dimence Mental Health Care, Burgemeester Roelenweg 9, 8021 EV Zwolle, The Netherlands;
| | - Job van ’t Veer
- Research Group Digital Innovation in Care and Welfare, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands;
| | - Nynke Boonstra
- Research Group Healthcare & Innovation in Psychiatry, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands;
- KieN Early Intervention Service, Oosterkade 72, 8911 KJ Leeuwarden, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Soares GH, Bado FMR, Lopes AG, Biazevic MGH, Michel-Crosato E, Mialhe FL. Structure and replicability of oral health-related quality of life networks across patients with schizophrenia and the general community. Community Dent Oral Epidemiol 2023; 51:1216-1224. [PMID: 37166109 DOI: 10.1111/cdoe.12865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/31/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Schizophrenia is a disabling mental disorder associated with severe social dysfunction. Individuals with long-term mental conditions have poorer Oral Health-Related Quality of Life (OHRQoL) compared to the general population, but little is known about the measurement properties of OHRQoL instruments in this group of patients. This study aimed to examine the replicability of OHRQoL networks across samples of the general community (GC) and patients with schizophrenia (PWS). METHODS Data were obtained from 603 community-dwelling participants and 627 patients with schizophrenia. OHRQoL was measured using the short form of the Oral Health Impact Profile (OHIP-14) questionnaire. A regularized partial correlation network was estimated for each sample. The number of dimensions and structural stability were assessed using Exploratory Graph Analysis. Global strength, edge weights and centrality estimates were compared. Network replicability was examined fitting the PWS data to the GC network structure. RESULTS A single OHIP-14 dimension was identified in the GC sample, whereas three dimensions were detected in the PWS sample. Structural consistency was perfect in the network of GC participants (1), and considerably low in at least two dimensions of the PWS network (0.28; 0.65; 0.16). A moderate correlation for node strength estimates was observed (τ: 0.43; 95% CI: 0.13, 0.72), although edge weights were not correlated (τ: 0.025; 95% CI: -0.11, 0.16). The fit of the PWS data to the GC network structure was deemed unacceptable. CONCLUSION Network models of OHRQoL did not replicate across samples of the general community and outpatients with schizophrenia. Prudent use of OHIP-14 to compare measures of OHRQoL between groups with significant cognitive impartment and the general population is recommended.
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Affiliation(s)
- Gustavo Hermes Soares
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, Australia
| | | | | | | | | | - Fabio Luiz Mialhe
- Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Kuipers S, Castelein S, Kronenberg L, Veer JV’, Boonstra N. A Human-Centered Design Approach to Develop Oral Health Nursing Interventions in Patients with a Psychotic Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3475. [PMID: 36834171 PMCID: PMC9960686 DOI: 10.3390/ijerph20043475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
In mental health, oral health is often given little attention. Mental health nurses (MHNs) are professionally the appropriate target group to support maintaining and increasing oral health. We aimed to develop and validate personas that reflect the attitudes and needs of MHNs regarding oral health in patients with a psychotic disorder. We used a human-centered design with contextual interviews (n = 10) to address the key issues of the problems and needs of MHNs working with patients with a psychotic disorder. We analyzed the data thematically and reflected on insights into unique personas, which were then validated by conducting semi-structured interviews (n = 19) and member checking. Four personas were found based on attitudes and perspectives, barriers, needs, suggestions for interventions, and site conditions regarding practicing oral care in this patient group. Our findings were as follows: the attitudes and perspectives differed from not feeling any responsibility to a holistic obligation, including oral health; suggestions for interventions for MHNs ranged from interventions focusing on improving skills and knowledge to using practical tools; most MHNs recognized themselves within a persona that had a holistic obligation that included oral health; in addition, the MHNs indicated that they considered the issue of oral health in this patient group important, but, in practice, took little responsibility for that role. These findings suggest that a toolkit with interventions for MHNs that are tailored to the personas that emerged from our research should be developed by MHNs in co-creation with designers. The differences between the perceived role and MHNs' practice in oral health highlighted the need for role clarification and professional leadership of MHNs regarding oral health, which should be considered when developing interventions.
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Affiliation(s)
- Sonja Kuipers
- Research Group Healthcare & Innovation in Psychiatry, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands
- Department of Experimental Psychopathology and Clinical Psychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Stynke Castelein
- Department of Experimental Psychopathology and Clinical Psychology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
- Lentis Research, Lentis Psychiatric Institute, Hereweg 80, 9725 AG Groningen, The Netherlands
| | - Linda Kronenberg
- Dimence Mental Health Care, Burgemeester Roelenweg 9, 8021 EV Zwolle, The Netherlands
| | - Job van ’t Veer
- Research Group Digital Innovation in Care and Welfare, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands
| | - Nynke Boonstra
- Research Group Healthcare & Innovation in Psychiatry, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands
- KieN Early Intervention Service, Oosterkade 72, 8911 KJ Leeuwarden, The Netherlands
- UMC Utrecht Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Kuipers S, Castelein S, Barf H, Kronenberg L, Boonstra N. Risk factors and oral health-related quality of life: A case-control comparison between patients after a first-episode psychosis and people from general population. J Psychiatr Ment Health Nurs 2022; 29:430-441. [PMID: 35034403 PMCID: PMC9304272 DOI: 10.1111/jpm.12820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/01/2021] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Oral health consists of more than having good teeth; it is an important factor in general health and well-being. Despite its importance, oral health care is still largely overlooked in mental health nursing. There is no research available about oral health risk factors and OHRQoL in patients diagnosed with a psychotic disorder with a psychotic disorder (first-episode). WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study provides insight into the severity of the problem. It demonstrates the differences in risk factors and OHRQoL between patients diagnosed with a psychotic disorder (first-episode) and the general population. A negative impact on OHRQoL is more prevalent in patients diagnosed with a psychotic disorder (first-episode) (14.8%) compared to the general population (1.8%). Patients diagnosed with a psychotic disorder (first-episode) have a considerable increase in odds for low OHRQoL compared to the general population, as demonstrated by the odds ratio of 9.45, which supports the importance of preventive oral health interventions in this group. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings highlight the need for oral health interventions in patients diagnosed with a psychotic disorder (first-episode). Mental health nurses, as one of the main health professionals supporting the health of patients diagnosed with a mental health disorder, can support oral health (e.g. assess oral health in somatic screening, motivate patients, provide oral health education to increase awareness of risk factors, integration of oral healthcare services) all in order to improve the OHRQoL. ABSTRACT: Introduction No research is available about the oral health risk factors and oral health-related quality of life (OHRQoL) in patients diagnosed with a psychotic disorder. Aim To compare oral health risk factors and OHRQoL in patients diagnosed with a psychotic disorder (first-episode) to people with no history of psychotic disorder. Method A case-control comparison (1:2) multivariable linear regression analysis and an estimation of prevalence of impact on OHRQoL. Results Patients diagnosed with a psychotic disorder (first-episode) have lower OHRQoL with more associated risk factors. Of the patients diagnosed with a psychotic disorder (first-episode), 14.8% reported a negative impact on OHRQoL, higher than the prevalence of 1.8% found in people from the general population. Discussion The high prevalence rate of a negative impact on OHRQoL in patients diagnosed with a psychotic disorder (first-episode) shows the importance of acting at an early stage to prevent a worse outcome. Implications for practice The findings highlight the need for oral health interventions in patients diagnosed with a psychotic disorder (first-episode). Mental health nurses, as one of the main health professionals supporting the health of patients diagnosed with a mental health disorder, can support oral health (e.g. assess oral health in somatic screening) in order to improve the OHRQoL.
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Affiliation(s)
- Sonja Kuipers
- NHL Stenden University of Applied Sciences Leeuwarden, The Netherlands.,University of Groningen, Groningen, The Netherlands
| | - Stynke Castelein
- University of Groningen, Groningen, The Netherlands.,Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Hans Barf
- NHL Stenden University of Applied Sciences Leeuwarden, The Netherlands
| | | | - Nynke Boonstra
- NHL Stenden University of Applied Sciences Leeuwarden, The Netherlands.,KieN Early Intervention Service, Leeuwarden, The Netherlands
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Zechner M, Singhal V, Murphy A, Karyczak S. Exploring Dental Students’ Perceptions of Mental Illness to Address Unmet Needs: A Preliminary Study. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2112240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
There is little information about dental students’ perceptions about providing care to people with serious mental illnesses (SMI), despite the significant oral health challenges of this population. Objective: This brief report aims to explore gaps in dental students’ knowledge and skills for providing oral health care to people with SMI, along with their attitudes about working with this underserved population.
Methods:
Post-graduate dental students in the United States at a large northeastern university were asked to provide feedback and responses to 5 open-ended questions prior to an educational module about working with people with SMI, and 22 anonymous responses were received. Qualitative content analysis was used to code responses using independent coding and consensus meetings.
Results:
Dental students expressed concerns about working with this population and felt unprepared to provide services to them. Seven themes were identified and coded into three primary categories: Knowledge, Skills and Attitudes. Codes representing dental student knowledge gaps included mental health literacy and professional role clarification. Skill deficits were coded as an adaptation of dental care practices, communication skills, crisis management, and management of care. Attitudes were coded as beliefs about people with SMI.
Conclusion:
Additional attention to mental illness in dental education could assist future professionals in their skills and knowledge to address the extensive unmet oral health needs of people with SMI.
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Valdes-Stauber J, Hummel K. The relationship between dental anxiety and other kinds of anxiety: a naturalistic, cross-sectional and comparative study. BMC Psychol 2021; 9:184. [PMID: 34819158 PMCID: PMC8611955 DOI: 10.1186/s40359-021-00684-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Dental anxiety is of public health importance because it leads to postponed dental treatment, which comes with health complications. The present study investigated whether there is a correlation between the degree of dental anxiety and other kinds of anxiety and whether there are prognostic factors for the different kinds of anxiety. METHOD In the sample (N = 156) from a dental practice in a large German city, 62% of patients received a check-examination and 38% received dental surgery. The target variables were recorded with validated questionnaires: dental anxiety (IDAF-4c+), subclinical anxiety (SubA), anxiety of negative evaluation (SANB-5), current general anxiety (STAI state), loneliness (LS-S) and self-efficacy (GSW-6). The applied statistics were: t-tests for 31 variables, correlation matrix and multivariate and bivariate regression analyses. RESULTS The dental surgery patients displayed more dental anxiety and more dental interventions than the check-examination group. The main result was a positive correlation of all kinds of anxiety with each other, a positive correlation of loneliness and neuroticism with all forms of anxiety and a negative correlation between all forms of anxiety and self-efficacy. Especially dental anxiety is positively associated with other kinds of anxiety. In multivariate regression models only neuroticism is associated with dental anxiety, but feelings of loneliness are positively associated with with the other kinds of anxiety assessed in this study. The higher the self-efficacy, the lower the level of general anxiety. CONCLUSIONS In dentistry, anxiety from negative experiences with buccal interventions should be distinguished from anxiety caused by personality traits. Self-efficacy tends to protect against anxiety, while loneliness and neuroticism are direct or indirect risk factors for anxiety in this urban dentistry sample. Dental anxiety seems to be independent from biographical strains but not from neuroticism. In practice, more attention must be paid to anxiety control, self-management and efforts to improve the confidence of patients with emotional lability, less self-confidence and propensity to shame.
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Affiliation(s)
- Juan Valdes-Stauber
- Department of Psychiatry and Psychotherapy I, University of Ulm, Ulm, Germany.
| | - Kevin Hummel
- Department of Psychiatry and Psychotherapy I, University of Ulm, Ulm, Germany
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Kuipers S, Boonstra N, Kronenberg L, Keuning-Plantinga A, Castelein S. Oral Health Interventions in Patients with a Mental Health Disorder: A Scoping Review with Critical Appraisal of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158113. [PMID: 34360406 PMCID: PMC8346069 DOI: 10.3390/ijerph18158113] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 12/21/2022]
Abstract
Poor oral health affects quality of life and daily functioning in the general population and especially in patients with mental health disorders. Due to the high burden of oral health-related quality of life in patients with a mental health disorder, it is important for nurses to know how they can intervene in an early phase. The aim of this systematic scoping review was to identify and appraise oral health interventions in patients with a mental health disorder. A systematic scoping review with a critical appraisal of the literature was conducted using the Joanna Briggs Institute (JBI) methodology for scoping reviews and their checklists. MEDLINE, CINAHL, PsycINFO and reference lists were searched from their inception until December 2020. Results: Eleven quantitative studies were included in the review: four randomized controlled trials, six quasi-experimental studies and one cohort study. Studies focused on interventions for patients (n = 8) or focused on patients together with their professionals (n = 3). Four types of oral health interventions in mental health were found: (I) educational interventions; (II) physical interventions; (III) interventions combining behavioural and educational elements and (IV) interventions combining educational and physical elements. All studies (n = 11) had an evaluation period ≤12 months. Nine studies showed an effect on the short term (≤12 months) with regard to oral health knowledge, oral health behaviour, or physical oral health outcomes (e.g., plaque index). Two studies showed no effects on any outcome. Overall, the methodological insufficient to good. Conclusion: Four types of interventions with positive effects (≤12 months) on oral health knowledge, oral health behaviour, and physical oral health outcomes in different diagnostic patient groups were found. Due to the heterogeneity in both interventions, diagnostic groups and outcomes, one golden standard oral health intervention cannot be advised yet, although the methodological quality of studies seems sufficient. Developing an integrated oral health toolkit might be of great importance in mental health considering its potential effect on oral health-related quality of life.
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Affiliation(s)
- Sonja Kuipers
- Research Group Healthcare & Innovation in Psychiatry, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands; (N.B.); (A.K.-P.)
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands;
- Correspondence: ; Tel.: +31-652-690-627
| | - Nynke Boonstra
- Research Group Healthcare & Innovation in Psychiatry, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands; (N.B.); (A.K.-P.)
- KieN VIP, Oosterkade 72, 8911 KJ Leeuwarden, The Netherlands
| | - Linda Kronenberg
- Dimence Mental Health Care, Burgemeester Roelenweg 9, 8021 EV Zwolle, The Netherlands;
| | - Annette Keuning-Plantinga
- Research Group Healthcare & Innovation in Psychiatry, Department of Healthcare, NHL Stenden University of Applied Sciences, Rengerslaan 8-10, 8900 CG Leeuwarden, The Netherlands; (N.B.); (A.K.-P.)
- Health Sciences-Nursing Science & Education, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Stynke Castelein
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands;
- Lentis Research, Lentis Psychiatric Institute, Hereweg 80, 9725 AG Groningen, The Netherlands
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Lopes AG, Ju X, Jamieson L, Mialhe FL. Oral health-related quality of life among Brazilian adults with mental disorders. Eur J Oral Sci 2021; 129:e12774. [PMID: 33786899 DOI: 10.1111/eos.12774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/05/2021] [Accepted: 01/19/2021] [Indexed: 01/10/2023]
Abstract
The aim of this study was to investigate associations of sociodemographic, lifestyle, medical conditions, and caries experience with oral health-related quality of life (OHRQoL) in a large sample of adults with mental disorders. A sample of 753 adults diagnosed with schizophrenia or depression, who were users of 10 public mental health outpatient clinics located in the city of São Paulo, Brazil, participated in the study. Participants provided data on sociodemographic characteristics, psychiatric diagnosis, medication use, and health behaviors. Oral examinations to evaluate dental caries (using the decayed, missing, and filled teeth ([DMFT] index) and dental plaque (using the Silness-Löe plaque index) were conducted. Oral health-related quality of life was evaluated using the 14-item Oral Health Impact Profile (OHIP-14) questionnaire. Log-Poisson regression was used to evaluate associations between the outcome and independent variables. The prevalence of one or more OHIP-14 impacts occurring fairly often/often was 72.3%. Physical pain was the OHIP domain with the highest prevalence, followed by psychological discomfort. Multivariable analysis showed that higher prevalence of the reponses 'fairly often/often' in the OHIP-14 was associated with being female, aged 35 to 54 years, having a low family income, a diagnosis of depression, a smoking habit, and fewer than 20 teeth. Adults with mental disorders had a high prevalence of impacts on their OHRQoL, which were associated with caries experience, sociodemographic characteristics, type of psychiatric diagnosis, and behavioral risk indicators.
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Affiliation(s)
| | - Xiangqun Ju
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, SA, Australia
| | - Lisa Jamieson
- Australian Research Centre for Population Oral Health, Adelaide Dental School, University of Adelaide, SA, Australia
| | - Fábio Luiz Mialhe
- Department of Health Sciences and Pediatric Dentistry, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
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Wright WG, Averett PE, Benjamin J, Nowlin JP, Lee JGL, Anand V. Barriers to and Facilitators of Oral Health Among Persons Living With Mental Illness: A Qualitative Study. Psychiatr Serv 2021; 72:156-162. [PMID: 33234051 DOI: 10.1176/appi.ps.201900535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Persons with mental illness have poorer oral health and are less likely to receive oral health care than those in the general population. A comprehensive understanding of barriers to and facilitators of accessing oral health care from a multidisciplinary perspective is lacking. The authors of this qualitative study sought to explore barriers and facilitators in addressing the oral health needs of individuals with mental illness from the perspectives of patients, psychiatrists, and dentists. METHODS A thematic content analysis approach was used to triangulate the perspectives of the three groups. Face-to-face semistructured interviews were conducted in 2018-2019 with patients with mental illness (N=20), psychiatrists (N=20), and dentists (N=25) at an academic medical campus in rural eastern North Carolina. Participants were recruited until thematic saturation for each group was reached. RESULTS Reported barriers to oral health care were categorized under emerging themes: access to dental care, fear of dental care, characteristics of mental illness, lack of oral health screening by psychiatrists, lack of education and training, stigma of mental illness, and lack of communication. Facilitators of oral health care were linked to the reported need for education and training, financial support, dentists' chairside manner, community support, and interprofessional communication. CONCLUSIONS The findings highlight health system gaps between oral health and mental health. The barriers and facilitators identified can help inform the development of interventions to improve oral health of patients with mental illness. Interventions should include interdisciplinary education and training, improved communication, and strategies to reduce financial barriers and anxiety in dental practice.
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Affiliation(s)
- Wanda G Wright
- Department of Foundational Sciences and Division of Dental Public Health, School of Dental Medicine, East Carolina University (ECU), Greenville, North Carolina (Wright, Nowlin); School of Social Work (Averett) and Department of Health Education and Promotion (Lee), College of Health and Human Performance, ECU, Greenville; Department of Psychiatry and Behavioral Medicine (Benjamin, Anand) and Center for Health Disparities (Lee), Brody School of Medicine, ECU, Greenville
| | - Paige E Averett
- Department of Foundational Sciences and Division of Dental Public Health, School of Dental Medicine, East Carolina University (ECU), Greenville, North Carolina (Wright, Nowlin); School of Social Work (Averett) and Department of Health Education and Promotion (Lee), College of Health and Human Performance, ECU, Greenville; Department of Psychiatry and Behavioral Medicine (Benjamin, Anand) and Center for Health Disparities (Lee), Brody School of Medicine, ECU, Greenville
| | - Janet Benjamin
- Department of Foundational Sciences and Division of Dental Public Health, School of Dental Medicine, East Carolina University (ECU), Greenville, North Carolina (Wright, Nowlin); School of Social Work (Averett) and Department of Health Education and Promotion (Lee), College of Health and Human Performance, ECU, Greenville; Department of Psychiatry and Behavioral Medicine (Benjamin, Anand) and Center for Health Disparities (Lee), Brody School of Medicine, ECU, Greenville
| | - Jonathan P Nowlin
- Department of Foundational Sciences and Division of Dental Public Health, School of Dental Medicine, East Carolina University (ECU), Greenville, North Carolina (Wright, Nowlin); School of Social Work (Averett) and Department of Health Education and Promotion (Lee), College of Health and Human Performance, ECU, Greenville; Department of Psychiatry and Behavioral Medicine (Benjamin, Anand) and Center for Health Disparities (Lee), Brody School of Medicine, ECU, Greenville
| | - Joseph G L Lee
- Department of Foundational Sciences and Division of Dental Public Health, School of Dental Medicine, East Carolina University (ECU), Greenville, North Carolina (Wright, Nowlin); School of Social Work (Averett) and Department of Health Education and Promotion (Lee), College of Health and Human Performance, ECU, Greenville; Department of Psychiatry and Behavioral Medicine (Benjamin, Anand) and Center for Health Disparities (Lee), Brody School of Medicine, ECU, Greenville
| | - Vivek Anand
- Department of Foundational Sciences and Division of Dental Public Health, School of Dental Medicine, East Carolina University (ECU), Greenville, North Carolina (Wright, Nowlin); School of Social Work (Averett) and Department of Health Education and Promotion (Lee), College of Health and Human Performance, ECU, Greenville; Department of Psychiatry and Behavioral Medicine (Benjamin, Anand) and Center for Health Disparities (Lee), Brody School of Medicine, ECU, Greenville
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10
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Reliability of Screening Methods to Diagnose Oral Dryness and Evaluate Saliva Secretion. Dent J (Basel) 2020; 8:dj8030102. [PMID: 32887247 PMCID: PMC7558334 DOI: 10.3390/dj8030102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022] Open
Abstract
In this study, we evaluated the reliability and reproducibility of widely implemented salivary flow rate and oral dryness tests. In experiment 1, twenty young and healthy Japanese participants volunteered to participate. For each participant, the oral moisture (OM) level, unstimulated whole saliva volume (U-WSV), and stimulated whole saliva volume (S-WSV) were measured at the same time on two separate days. In experiment 2, twenty-seven patients who were over 65 years of age volunteered to participate. The OM level and U-WSV were measured at the same time on two separate days. In Experiment 1, the intra-class correlation coefficients (ICCs) corresponding to the S-WSV, U-WSV, and OM level were 0.23, 0.28, and 0.16, respectively, for the young participants. In Experiment 2, the ICCs corresponding to the U-WSV/spitting and OM level were 0.83 and 0.12, respectively, for the older participants. The results of Bland–Altman analysis confirmed the absence of systematic error, with the exception of the OM level results in Experiment 2, which indicated systematic bias. In conclusion, we believe that there is currently no consistent and reliable screening test for assessing salivary flow rate and oral dryness, although the spitting test was determined to be highly reliable.
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