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Leggett H, Vinall-Collier K, Csikar J, Owen J, Edwebi S, Douglas GVA. A scoping review of dental practitioners' perspectives on perceived barriers and facilitators to preventive oral health care in general dental practice. BMC Oral Health 2024; 24:249. [PMID: 38368349 PMCID: PMC10874524 DOI: 10.1186/s12903-024-04022-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/13/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Oral health has an important role in the general health and well-being of individuals. Dental teams are ideally placed to support patients in preventing ill-health. Understanding the barriers and facilitators to the adoption, promotion and facilitation of preventive advice and treatment is key to improving oral health services. The Theoretical Domains Framework (TDF) is a useful psychological framework to help identify individual, interpersonal and environmental issues which could be impacting clinicians' ability to provide preventive advice and care. The aim of this review was to identify the perceived barriers and facilitators to preventive oral health care from the perspectives of the oral healthcare team within the general dental practice. METHODS A search strategy was developed, piloted, and run in: Medline via Ovid, PsycInfo, Web of Science, SCOPUS, EMBASE, Conference Proceedings Citation Index- Science, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews and followed PRISMA guidelines. Identified records were screened independently by two researchers. Data were coded using the Theoretical Domains Framework (TDF) and analysed using narrative data synthesis. RESULTS 5610 papers were identified, and 19 included in this review. Thirteen papers focussed on dentists. Of the 106 items mapped onto the TDF, 48 were facilitators. The domains most frequently represented were, environmental context and resources, beliefs about consequences, social professional role and identity, skills, beliefs about capabilities and knowledge. Six studies focussed on dental hygienists. There were 47 items mapped onto the TDF, 18 were facilitators. The domains most frequently represented were environmental context and resources, social influences, beliefs about consequences and knowledge. CONCLUSIONS The review identified that the delivery of preventive activities did not focus solely on the patient and dental professional interaction as many previous studies have highlighted. The review found that multiple factors influence whether prevention is delivered to patients. The largest barrier and facilitator for the dental professionals identified in this review was the environmental context and resources. Further research is needed to evaluate the effectiveness of interventions that aim to promote preventive oral health care in primary care settings to understand whether they address the barriers identified in this review.
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Affiliation(s)
- H Leggett
- York Trials Unit, The University of York, York, UK.
| | | | - J Csikar
- The School of Dentistry, The University of Leeds, Leeds, UK
| | - J Owen
- The School of Dentistry, The University of Leeds, Leeds, UK
| | - S Edwebi
- The School of Dentistry, The University of Leeds, Leeds, UK
| | - G V A Douglas
- The School of Dentistry, The University of Leeds, Leeds, UK
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Serban S, Chapple ILC, D'Aiuto F, Douglas GVA, Pavitt S. Letter to the Editor: "Methodological Gaps in Studying the Oral-Systemic Disease Connection". J Dent Res 2021; 100:1299. [PMID: 34151634 DOI: 10.1177/00220345211024215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- S Serban
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, UK
| | - I L C Chapple
- School of Dentistry, University of Birmingham, Birmingham, UK
| | - F D'Aiuto
- Eastman Dental Institute, University College London, London, UK
| | - G V A Douglas
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, UK
| | - S Pavitt
- School of Dentistry, University of Leeds, Clarendon Way, Leeds, UK
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Thompson W, Tonkin-Crine S, Pavitt SH, McEachan RRC, Douglas GVA, Aggarwal VR, Sandoe JAT. Factors associated with antibiotic prescribing for adults with acute conditions: an umbrella review across primary care and a systematic review focusing on primary dental care. J Antimicrob Chemother 2019; 74:2139-2152. [PMID: 31002336 PMCID: PMC6640312 DOI: 10.1093/jac/dkz152] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION One way to slow the spread of resistant bacteria is by improved stewardship of antibiotics: using them more carefully and reducing the number of prescriptions. With an estimated 7%-10% of antibiotic prescriptions globally originating from dental practices and up to 80% prescribed unnecessarily, dentistry has an important role to play. To support the design of new stewardship interventions through knowledge transfer between contexts, this study aimed to identify factors associated with the decision to prescribe antibiotics to adults presenting with acute conditions across primary care (including dentistry). METHODS Two reviews were undertaken: an umbrella review across primary healthcare and a systematic review in dentistry. Two authors independently selected and quality assessed the included studies. Factors were identified using an inductive thematic approach and mapped to the Theoretical Domains Framework (TDF). Comparisons between dental and other settings were explored. Registration number: PROSPERO_CRD42016037174. RESULTS Searches identified 689 publications across primary care and 432 across dental care. Included studies (nine and seven, respectively) were assessed as of variable quality. They covered 46 countries, of which 12 were low and middle-income countries (LMICs). Across the two reviews, 30 factors were identified, with 'patient/condition characteristics', 'patient influence' and 'guidelines & information' the most frequent. Two factors were unique to dental studies: 'procedure possible' and 'treatment skills'. No factor related only to LMICs. CONCLUSIONS A comprehensive list of factors associated with antibiotic prescribing to adults with acute conditions in primary care settings around the world has been collated and should assist theory-informed design of new context-specific stewardship interventions.
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Affiliation(s)
- W Thompson
- University of Leeds, School of Dentistry, Leeds, UK
| | - S Tonkin-Crine
- University of Oxford, NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK
| | - S H Pavitt
- University of Leeds, School of Dentistry, Leeds, UK
| | - R R C McEachan
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | - V R Aggarwal
- University of Leeds, School of Dentistry, Leeds, UK
| | - J A T Sandoe
- University of Leeds/Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Rosing K, Leggett H, Csikar J, Vinall-Collier K, Christensen LB, Whelton H, Douglas GVA. Barriers and facilitators for prevention in Danish dental care. Acta Odontol Scand 2019; 77:439-451. [PMID: 30905244 DOI: 10.1080/00016357.2019.1587503] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To explore barriers and facilitators to oral disease prevention in Danish dental care from a multi-stakeholder perspective. Methods: Eleven semi-structured focus groups and interviews about Danish oral healthcare were conducted with 27 stakeholders (general public, dental teams, dental policy makers) in Copenhagen. Transcripts were analyzed using deductive thematic analysis independently by KR and HL, supervised by JC and KVC. Results: Seven broad themes were identified, including both barriers and facilitators: Knowledge and attitudes, Education and training, Regulation, Incentivization, Multidisciplinary approach, Access to care and the Dental professional-patient relationship. Whilst all themes were relevant to each group of stakeholders, the salient driver within each theme was different for each group. Conclusions: Stakeholder perspectives on the Danish Oral health care system suggest the following are important features for a preventively focused system: (a) Involving all stakeholders in oral healthcare planning. (b) Securing sufficient and ongoing briefing regarding disease prevention for all stakeholders. (c) Regulatory support and creation of incentives to promote and facilitate implementation of disease prevention. (d) Appropriate prevention for disadvantaged groups within society which may be possible to a higher degree by means of multidisciplinary collaboration. (e) Personal relations between the patient and the professional based on mutual trust.
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Affiliation(s)
- K. Rosing
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - H. Leggett
- School of Dentistry, University of Leeds, Leeds, UK
| | - J. Csikar
- School of Dentistry, University of Leeds, Leeds, UK
| | | | - L. B. Christensen
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - H. Whelton
- Oral Health Services Research Centre, College of Medicine & Health, University College Cork, Cork, Ireland
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Csikar J, Vinall-Collier K, Richemond JM, Talbot J, Serban ST, Douglas GVA. Identifying the barriers and facilitators for homeless people to achieve good oral health. Community Dent Health 2019; 36:137-142. [PMID: 31070874 DOI: 10.1922/cdh_4488csikar06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE A qualitative exploration of the barriers and facilitators for people experiencing homelessness achieving good oral health. PARTICIPANTS Adults using two homeless centres in Leeds. METHODS Focus group discussions were convened with homeless people using support services. Both an inductive and deductive approach to data analysis was taken. Themes were identified and then a framework applied to analysis using Nvivo software. RESULTS Three focus group discussions with 16 participants were conducted with people experiencing homelessness. The barriers identified were insufficient information on local dental services, negative attitudes of oral health professionals, low priority of dental care, anxiety and cost of dental treatments. Facilitators included single dental appointments, accessible dental locations and being treated with respect. CONCLUSIONS Despite the barriers that prevent people experiencing homelessness from maintaining and improving their oral health, the participants were aware that they needed oral healthcare and requested that dental services were made available to them and were accessible in line with their socioeconomic status and needs.
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Affiliation(s)
- J Csikar
- The University of Leeds School of Dentistry.,Public Health England
| | | | | | - J Talbot
- City Healthcare Partnership and Harrogate Hospitals
| | - S T Serban
- The University of Leeds School of Dentistry
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Leggett H, Duijster D, Douglas GVA, Eaton K, van der Heijden GJMG, O'Hanlon K, Whelton H, Listl S. Toward More Patient-Centered and Prevention-Oriented Oral Health Care: The ADVOCATE Project. JDR Clin Trans Res 2016; 2:5-9. [PMID: 30938642 DOI: 10.1177/2380084416668167] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ADVOCATE (Added Value for Oral Care) is a project funded by the European Commission's Horizon 2020 program, which aims to develop strategies for a system transition toward more patient-centered and prevention-oriented oral health care delivery within health care systems. This system should balance the restorative and preventive approaches in dental and oral health care. ADVOCATE is a partnership among 6 European Union member states, which involves collaboration among universities, state-funded health care providers, and private insurance companies in Denmark, Germany, Hungary, Ireland, the Netherlands, the United Kingdom, and Aridhia, a biomedical informatics company based in Scotland. There are 6 interrelated work packages, which aim to address the following objectives: 1) in-depth evaluation of oral health care systems in European Union member states to identify best system designs for oral disease prevention, 2) development of a set of measures to provide information on oral care delivery and oral health outcomes, 3) evaluation of a feedback approach in dental practice that aims to facilitate a change toward preventive oral health care delivery, and 4) economic evaluation of strategies to promote preventive oral health care and development of policy recommendations for oral health care systems. The project is novel in its use of data that are routinely collected by health insurance organizations, as well as the engagement of key stakeholders from dental teams, insurers, patients, and policy makers in guiding the development and progress of the project. This article outlines in detail the objectives and research methodology of the ADVOCATE project and its anticipated impact. Knowledge Transfer Statement: This commentary describes the development of policy options to promote a greater focus on disease prevention in general dental practice. The approach builds on identifying the comparative effectiveness of alternative incentive schemes, as well as methods to monitor clinical and patient-derived measures of success in creating health for patients. The article describes the development and application of the measures and the evaluation of their success in orienting clinical practice more toward disease prevention.
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Affiliation(s)
- H Leggett
- 1 School of Dentistry, University of Leeds, Leeds, UK
| | - D Duijster
- 2 Department of Social Dentistry, Academic Centre for Dentistry Amsterdam, Vrije Universiteit University, and University of Amsterdam, Amsterdam, the Netherlands
| | - G V A Douglas
- 1 School of Dentistry, University of Leeds, Leeds, UK
| | - K Eaton
- 1 School of Dentistry, University of Leeds, Leeds, UK
| | - G J M G van der Heijden
- 2 Department of Social Dentistry, Academic Centre for Dentistry Amsterdam, Vrije Universiteit University, and University of Amsterdam, Amsterdam, the Netherlands
| | - K O'Hanlon
- 3 Aridhia Informatics Ltd., Hobart House, Edinburgh, Scotland
| | - H Whelton
- 1 School of Dentistry, University of Leeds, Leeds, UK
| | - S Listl
- 4 Department of Conservative Dentistry, Translational Health Economics Group, Heidelberg University, Heidelberg, Germany.,5 Department of Quality and Safety of Oral Healthcare, Radboud University, Radboud UMC, Nijmegen, the Netherlands
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Kenny KP, Day PF, Douglas GVA, Chadwick BL. Primary care dentists' experience of treating avulsed permanent teeth. Br Dent J 2015; 219:E4. [DOI: 10.1038/sj.bdj.2015.673] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2015] [Indexed: 11/09/2022]
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Levin KA, Nicholls N, Macdonald S, Dundas R, Douglas GVA. Geographic and socioeconomic variations in adolescent toothbrushing: a multilevel cross-sectional study of 15 year olds in Scotland. J Public Health (Oxf) 2014; 37:107-15. [PMID: 24917568 DOI: 10.1093/pubmed/fdu034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study examined urban-rural and socioeconomic differences in adolescent toothbrushing. METHODS The data were modelled using logistic multilevel modelling and the Markov Chain Monte Carlo method of estimation. Twice-a-day toothbrushing was regressed upon age, family affluence, family structure, school type, area-level deprivation and rurality, for boys and girls separately. RESULTS Boys' toothbrushing was associated with area-level deprivation but not rurality. Variance at the school level remained significant in the final model for boys' toothbrushing. The association between toothbrushing and area-level deprivation was particularly strong for girls, after adjustment for individuals' family affluence and type of school attended. Rurality too was independently significant with lower odds of brushing teeth in accessible rural areas. CONCLUSION The findings are at odds with the results of a previous study which showed lower caries prevalence among children living in rural Scotland. A further study concluded that adolescents have a better diet in rural Scotland. In total, these studies highlight the need for an examination into the relative importance of diet and oral health on caries, as increases are observed in population obesity and consumption of sugars.
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Affiliation(s)
- K A Levin
- NHSGGC, Public Health Directorate, Gartnavel Royal Hospital, 1055 Great Western Road, G12 0HX, UK Ludwig Boltzmann Institute, Untere Donaustraße 47, 3rd Floor, Vienna A-1020, Austria
| | - N Nicholls
- MRC/CSO Social and Public Health Sciences Unit, 200 Renfield Street, Glasgow G2 3QB, UK
| | - S Macdonald
- MRC/CSO Social and Public Health Sciences Unit, 200 Renfield Street, Glasgow G2 3QB, UK
| | - R Dundas
- MRC/CSO Social and Public Health Sciences Unit, 200 Renfield Street, Glasgow G2 3QB, UK
| | - G V A Douglas
- Leeds Dental Institute, University of Leeds, Leeds LS2 9LU, UK
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