Uncertainties around COVID-19 from the perspectives of oral health care workers during the first wave of SARS-CoV-2 infections in British Columbia, Canada

Deployment of dentists in COVID-19 case investigation and contact tracing: An example from Turkey

Aim

In Turkey, dentists working in public dental care centers were deployed in COVID-19 case investigation and contact tracing (CICT) teams during the pandemic. This study aims to explore the experiences of the dentists assigned to teams undertaking COVID-19 CICT practices to determine how healthcare workers should be supported when working in pandemic response and other crises.

Material and method

The sample of this qualitative, phenomenological study consisted of thirty four public dentists assigned to COVID-19 CICT practices in four metropolitan areas of Turkey. Data were collected through semi-structured in-depth interviews that were conducted online in August and September 2020. The data were analyzed using thematic content analysis.

Results

Six themes were revealed: preparation for CICT, basic requirements, work relations, working conditions, being a dentist assigned to CICT and COVID-19 pandemic management. The dentists complained that they were not appropriately assigned to CICT, as they lacked the preparations and sufficient training. They had to acquire personal protective equipment and other basic needs at their own expense. The working conditions were severe, and they had negative relations at work. The State and the Ministry of Health were criticized for inadequate implementation of institutional measures for COVID-19 pandemic management.

Conclusions

The study showed that dentists were motivated to participate in the management of pandemics and similar crisis situations, but in a negative work environment - where they were deployed without adequate training, preparation, and ensuring their basic needs and requirements were met - they lost this motivation, and experienced stress and feelings of inadequacy.

Canadian dental hygienists' experiences and perceptions of regulatory guidelines during the COVID-19 pandemic: a qualitative descriptive analysis

BACKGROUND

In Spring of 2020, due to the COVID-19 pandemic, Canadian provincial dental hygiene regulatory bodies implemented new practice guidelines. Reports of stress, anxiety and conflict experienced by dental hygienists have been linked to miscommunication between oral health regulators at this time. Limited data exists on the perceptions and experiences of dental hygienists navigating new guidelines for dental hygiene care during the pandemic. Therefore, the objective of our study was to explore via descriptive thematic analysis how dental hygienists experienced and perceived: i) dental hygiene practice during the COVID-19 pandemic, and ii) their regulatory body's COVID-19 guidelines.

METHODS

Participants were identified through provincial dental hygiene licensing bodies. Online bi-monthly questionnaires were administered to participants (n = 876) from December 2021 to January 2022. Two open-ended questions were asked in the questionnaire. A qualitative descriptive thematic analysis was applied to these two questions.

RESULTS

Major themes at baseline relayed challenges related to workplace compliance, patient treatment and communication of practice protocols. Across responses, hygienists confirmed conflicting messaging from regulators and guideline interpretations as stressors impacting their professional practice and satisfaction within the profession. Participant responses at endpoint cited increased satisfaction with regulatory guidelines as the pandemic evolved, yet inconsistencies in regulators' messaging was noted as a prevailing issue.

CONCLUSION

Inconsistent guideline messaging reflects an increased need for collaboration amongst oral health care regulators to streamline protocols for practice and reduce interprofessional conflict in pandemic circumstances. A national unified approach is warranted in establishing guidelines for dental hygiene practice in Canada.

Knowledge, Anxiety, and practice during the COVID-19 crisis among HCWs in Saudi Arabia

BACKGROUND

The rapid and widespread of COVID-19 has caused distress and havoc among people in all walks of life. Such impact has been more pronounced among HCWs. We sought to examine how health care workers (HCWs) knowledge about COVID-19 and perceived anxiety can influence preventive practices.

MATERIALS AND METHODS

In this cross-sectional study a multiple regression analysis was applied to examine the relationship between knowledge, anxiety, and preventive practices among 267 participants work in different settings in a variety of health care organizations in different regions in Saudi Arabia. To estimate potential associations, a multiple regression analysis was applied. Standardized beta-coefficients and their 95% confidence intervals were estimated to examine the outcome variable and the predictors' associations.

RESULTS

Our findings shows that HCWs had high levels of knowledge about COVID-19, perceived anxiety, and preventive practices. In examining the relation between HCWs characteristics and their knowledge about COVID-19, older HCWs have been shown to have higher knowledge compared to younger HCWs. Finally, the model to estimate the impact of knowledge about COVID-19 and perceived anxiety on preventive practice showed that both have a significant impact.

CONCLUSIONS

HCWs tendency to adhere to preventive practices is related to their levels of knowledge and perceived anxiety. Such a relationship can inform administrators and policymakers in the health care field to design health promotion campaigns to ensure all HCWs are aware of the nature of communicable diseases and the risk they might entail.

Dental safety net providers' experiences with service delivery during the first year of COVID-19 should inform dental pandemic preparedness

BACKGROUND

COVID-19 disrupted oral health care delivery and revealed gaps in dental public health emergency preparedness and response (PHEPR). Emerging dental PHEPR frameworks can be strengthened by means of understanding the experiences of the discipline's frontline workers-dental safety net providers-during the initial phase of the COVID-19 pandemic.

METHODS

Experienced qualitative researchers interviewed dental safety net directors and clinicians (n = 21) in 6 states to understand their experiences delivering care from March 2020 through February 2021. Interview transcriptions were analyzed using iterative codes to identify major and minor themes. Conventional qualitative validity checks were used continuously to ensure impartiality and rigor.

RESULTS

Three major themes were identified: unpredictability caused concerns among staff members and patients, while also deepening fulfilling collaborations; care delivery was guided by means of various resources that balanced safety, flexibility, and respect for autonomy; and pandemic-driven changes to oral health care delivery are timely, long-lasting, and can be somewhat fraught.

CONCLUSIONS

The human, material, and policy resources that providers used to control infections, serve vulnerable patients, maintain clinic solvency, and address provider burnout during the first year of the COVID-19 pandemic can improve dental PHEPR.

PRACTICAL IMPLICATIONS

Dental PHEPR should address concerns beyond infection control within and between practice models, governmental agencies, and professional organizations. Examples of such concerns include, but are not limited to, guideline synchronization, materials exigencies, task shifting, and provider resilience.

Developing an integrated multilevel model of uncertainty in health care: a qualitative systematic review and thematic synthesis

Introduction

Uncertainty is an inevitable part of healthcare and a source of confusion and challenge to decision-making. Several taxonomies of uncertainty have been developed, but mainly focus on decisions in clinical settings. Our goal was to develop a holistic model of uncertainty that can be applied to both clinical as well as public and global health scenarios.

Methods

We searched Medline, Embase, CINAHL, Scopus and Google scholar in March 2021 for literature reviews, qualitative studies and case studies related to classifications or models of uncertainty in healthcare. Empirical articles were assessed for study limitations using the Critical Appraisal Skills Programme (CASP) checklist. We synthesised the literature using a thematic analysis and developed a dynamic multilevel model of uncertainty. We sought patient input to assess relatability of the model and applied it to two case examples.

Results

We screened 4125 studies and included 15 empirical studies, 13 literature reviews and 5 case studies. We identified 77 codes and organised these into 26 descriptive and 11 analytical themes of uncertainty. The themes identified are global, public health, healthcare system, clinical, ethical, relational, personal, knowledge exchange, epistemic, aleatoric and parameter uncertainty. The themes were included in a model, which captures the macro, meso and microlevels and the inter-relatedness of uncertainty. We successfully piloted the model on one public health example and an environmental topic. The main limitations are that the research input into our model predominantly came from North America and Europe, and that we have not yet tested the model in a real-life setting.

Conclusion

We developed a model that can comprehensively capture uncertainty in public and global health scenarios. It builds on models that focus solely on clinical settings by including social and political contexts and emphasising the dynamic interplay between different areas of uncertainty.

The impact of COVID-19 on the dental hygienists: A cross-sectional study in the Lombardy first-wave outbreak

The impact of COVID-19 on socio-economical activities has changed everyday life. Dental hygienists, who perform aerosol generating procedures, have been strongly affected by changes in routine procedures. This cross-sectional study aimed at carrying out an online survey among dental hygienists in Lombardy. The survey was implemented after the first-wave lockdown focusing on the level of knowledge on COVID-19 and Sars-CoV-2, the virus-related changes in their attitude and working routine, and the socio-economic effects. In this report, we included 313 questionnaires of respondents (259 Females, and 54 Males; age = 33 ± 9 years). A significant percentage of respondents acknowledged the use of “word of mouth” among colleagues (n = 114, 36%) and social networks (n = 113, 36%) to be up to date on COVID-19. About half of respondents correctly identified the main COVID-19 symptoms/signs, just 13% (n = 41) identified the routes of transmission. Three quarters of respondents (n = 234, 75%) were afraid of being infected during the clinical practice, and about half of them would be afraid to treat patients having symptoms attributable to COVID-19. Twenty-one percent (n = 67) of participants also thought about changing job. Air-polishing was identified as the highest risk procedure, and 82% (n = 256) reported that they eliminated its use. Most claimed they never had a swab or a serological test, with two respondents positive to molecular test (0.6%), and 12 positives to serological test (3.8%). More than half of the participants (65%; n = 202) complained the dental hygienist is not protected, despite a loss of earnings due to lockdown between 2,000 and 10,000 euros. This study demonstrated that dental hygienists were emotionally and economically affected by the pandemic, significantly changing their work routine. Anti-epidemic protocols are pivotal to react promptly and to contain the virus in the dental setting.