The contributions of qualitative research towards dental public health practice

Dental public health (DPH) researchers have traditionally relied on quantitative methods for scientific enquiry. This paper argues that qualitative methodology can make a significant contribution to DPH knowledge and practice because it allows researchers to answer important questions of relevance to procedure and policy that are difficult to answer satisfactorily using quantitative methods alone. Qualitative research can also challenge the norms and assumptions of DPH practice. There are tensions in the relationship between qualitative research and the prevailing paradigm of evidence-based practice (EBP) which potentially influence the utility of DPH-related qualitative research. However, the relevance of qualitative research is increasing as the scope of EBP enquiry extends beyond questions of effectiveness, and methods are developed for incorporating qualitative research into systematic reviews.

Should All Deaf Children Learn Sign Language?

Every year, 10,000 infants are born in the United States with sensorineural deafness. Deaf children of hearing (and nonsigning) parents are unique among all children in the world in that they cannot easily or naturally learn the language that their parents speak. These parents face tough choices. Should they seek a cochlear implant for their child? If so, should they also learn to sign? As pediatricians, we need to help parents understand the risks and benefits of different approaches to parent-child communication when the child is deaf [corrected].

Defining patient-centred care in dentistry? A systematic review of the dental literature

Objective This paper presents the results of a systematic review, designed to explore how patient-centred care (PCC) is defined in the dental literature.Method An electronic search of MEDLINE (1946-2012), Embase (1980-2012) PsycINFO (1806-2012), the Cochrane Library and non-peer reviewed literature was conducted using a standardised search protocol. Definitions of patient centred care were identified and scored on two criteria to evaluate quality of definition and quality/type of evidence.Results Of the 28 papers included in the review the majority provided definitions of PCC synonymous with good quality general care (holistic, humanitarian). Only three mentioned the provision of information and the tools to facilitate informed choice. Less than a third of the papers included in this review were based on empirical evidence, and of those that were, only one was an RCT study.Conclusion The evidence suggests that the concept of PCC is neither clearly understood nor empirically and systematically assessed in dental settings. Whilst most authors seem to suggest that PCC is about delivering care that is humane, involving good communication and shared decision-making, there is no work assessing these concepts empirically or relating them to practical outcomes.

Health care professionals' understanding and day-to-day practice of patient empowerment in diabetes; time to pause for thought?

This exploratory study examines what Health Care Professionals (HCPs) working with diabetes patients, understand by the term 'empowerment', their attitudes towards it and whether they believe they practise in ways consistent with empowerment principles. A small sample of diabetes HCPs (N=13), from National Health Service (NHS) hospital, walk-in and General Practitioner (GP) clinics in South-East England, was interviewed. In-depth semi-structured interviews established attitudes towards and use of empowerment in day-to-day practice. Interviews were recorded, transcribed verbatim and analysed thematically. There was no clear specific understanding of what empowerment is and what it involves, although there was broad reporting of factors around education and informed choices. Disagreement was evident about the level of freedom patients should have in making choices - from leading them to the 'right' choice to an acceptance that they may have the right to choose not to be empowered. No consensus emerged on what is successful empowerment and how it is measured. The resistance of some patients to the process of empowerment in its original definition of active partnership in care, was seen as problematic by HCPs. Although empowerment is a popular concept in theory, its practical, clinical implementation day to day, can be problematic.

Patient-centred care--what is it and how is it practised in the dental surgery?

OBJECTIVES

This paper explores the understanding and practice of patient-centred care (PCC) within dentistry. The aim of the research was to explore the nature of PCC, how PCC is taught and how it is practiced within a dental setting.

METHODS

The results of a qualitative, interview-based study of dental professionals working across clinical and teaching positions within a dental school are presented.

RESULTS

Results suggest that a shared understanding of PCC revolves round a basic sense of humanity ('being nice to patients'), giving information that is judged, by the clinician, to be in the patient's best interest and 'allowing' patient choice from a set of choices made available to patients by the clinicians themselves.

CONCLUSIONS

This research suggests that significant work is needed if dentists are going to conform to the General Dental Council guidelines on patient-centred practice and a series of recommendations are made to this end.

The context of empowerment and self-care within the field of diabetes

There is a growing emphasis within the diabetes literature on the importance of empowerment as a way of encouraging people to take control of and responsibility for the successful management of their disease. Patients are actively encouraged to become active participants in their care, and there is an expectation that health-care professionals will facilitate this process. This article uses Bourdieu’s concept of field, as a bounded social space in which actors conduct their lives day-to-day, to explore the context within which issues of empowerment are addressed and negotiated. The practice of empowerment within the biologically defined and biomedically ‘policed’ field of diabetes is explored using empirical data from a study of diabetes health-care professionals’ understanding and practices around empowerment. It is concluded that rather than promoting active self-management and empowerment, the nature of the field of diabetes, and in particular its privileging of the biomedical, can mitigate against people with diabetes negotiating the field effectively and taking control of the disease and its management.

Barriers and opportunities of empowerment as applied in diabetes settings: a focus on health care professionals' experiences

This exploratory study examines the opportunities and barriers health care professionals (HCPs) working with diabetes patients face when they try to implement the rhetoric of patient empowerment in practice. A small sample of diabetes HCPs (N=13), from National Health Service (NHS) hospital, walk-in and general practitioner (GP) clinics in South-East England, was interviewed through in-depth semi-structured interviews. Interviews were recorded, transcribed verbatim and analysed thematically. The analysis showed that empowerment was seen as beneficial for patients and HCPs. Time and resources could be moved from successfully empowered patients and focussed on more complex patients, this was termed 'selective empowerment'. The main barriers to empowerment were identified as a lack of resources, time and HCPs trained in empowerment techniques. Empowerment is a popular concept in theory, and presents HCPs with several opportunities but also important barriers in its practical, clinical implementation day-to-day.

Reaching A Female Majority: A Silent Transition for Dentistry in the United Kingdom

This paper highlights the process of transition to a female majority for dentistry, examines various influences on this trajectory, and considers the implications for the profession, health systems and patients, as well as individual dentists.This celebratory transition has been facilitated by educational systems that provide both males and females with equal opportunities and is supported by legislation, as well as societal change that has spanned decades. In crossing this gender representation threshold, we have outperformed doctors nationally.In order to embrace our highly educated workforce and support them to better serve their patients and the population, urgent debate and action aimed at reshaping current systems of dental care provision are required. In this regard, flexible working arrangements, together with reshaping professional leadership to better represent the workforce, as well as changes in terminology can all play their part; however, we will need careful discussions about how this might happen effectively.A collaborative effort between the dental profession and wider health systems is required to ensure that there are opportunities for everyone to flourish and contribute back to the profession and society. Our medical counterparts have been considering how healthcare should be shaped creatively, particularly in relation to working patterns, economic models and quality patient care: we need to catch up.

Comparative optimism about infection and recovery from COVID-19; Implications for adherence with lockdown advice

Background

Comparative optimism, the belief that negative events are more likely to happen to others rather than to oneself, is well established in health risk research. It is unknown, however, whether comparative optimism also permeates people’s health expectations and potentially behaviour during the COVID‐19 pandemic.

Objectives

Data were collected through an international survey (N = 6485) exploring people’s thoughts and psychosocial behaviours relating to COVID‐19. This paper reports UK data on comparative optimism. In particular, we examine the belief that negative events surrounding risk and recovery from COVID‐19 are perceived as more likely to happen to others rather than to oneself.

Methods

Using online snowball sampling through social media, anonymous UK survey data were collected from N = 645 adults during weeks 5‐8 of the UK COVID‐19 lockdown. The sample was normally distributed in terms of age and reflected the UK ethnic and disability profile.

Findings

Respondents demonstrated comparative optimism where they believed that as compared to others of the same age and gender, they were unlikely to experience a range of controllable (eg accidentally infect/ be infected) and uncontrollable (eg need hospitalization/ intensive care treatment if infected) COVID‐19‐related risks in the short term (P < .001). They were comparatively pessimistic (ie thinking they were more at risk than others for developing COVID‐19‐related infection or symptoms) when thinking about the next year.

Discussion

This is one of the first ever studies to report compelling comparative biases in UK adults’ thinking about COVID‐19.

Insights into the oral health beliefs and practices of mothers from a north London Orthodox Jewish community

BACKGROUND

The objective of this study was to explore oral health knowledge and beliefs and access to dental care in a culturally distinct Orthodox Jewish community in North London, with a view to informing local health policy.

METHODS

A dual method qualitative approach to data collection was adopted in this study utilising semi-structured face to face interviews and focus groups with women from this North London orthodox Jewish community. In total nine interviews and four focus groups were conducted with a purposive sample of thirty three mothers from the community aged 21-58 years. The data were transcribed and analysed using Framework Methodology

RESULTS

Cultural influences, competing pressures and perceptions of hereditary influences, together with a lack of contemporary oral health knowledge are the main factors affecting oral health knowledge and beliefs. This supported an overall perspective of disempowerment or a perceived lack of control over oral health behaviours, both for mothers and their children. Community signposting pointed mothers to dental services, whilst family pressures together with inadequate capacity and capability and generic barriers such as fear and cost acted as barriers. Mothers from this community welcomed community development initiatives from the NHS.

CONCLUSIONS

The results of this study provide insight into the challenges of a culturally isolated community who would welcome community support through schools and expanded culturally appropriate opening hours to improve access to dental care.

Loneliness in later life: Preliminary findings from the Growing Older project

Loneliness is consistently presumed to be a specific ‘social problem’, which accompanies old age and growing older. Ninety per cent of the general population of Britain feel that loneliness is particularly a problem associated with old age. Data concerning the prevalence of loneliness amongst the population aged 65 and over are provided from a quantitative survey of 999 people across Great Britain using a special module commissioned from the ONS Omnibus survey. The overall self‐reported prevalence of loneliness shows little change in the post‐war period and challenges the stereotype that the problem of loneliness and isolation has become more prevalent. Socio‐demographic and health factors were associated with loneliness but contact with family and friends was not. Both quantitative and qualitative data sets illustrate the importance of loss as a theme underpinning experiences of loneliness. Further analysis of these data offers the potential to develop a better understanding of what loneliness really is, what it means to those who experience it may offer the potential to develop interventions and strategies to ‘protect’ older people from this problem.

A Qualitative Exploration of Motivation to Self-Manage and Styles of Self-Management amongst People Living with Type 2 Diabetes

The study examined the motives that people living with type 2 diabetes (T2D) had for self-managing their condition and ways they used to assess the success of their self-management efforts. Using semistructured interviews (N = 25), focus groups (3 × N = 12 participants), and open-ended questionnaires (N = 6), people living with and self-managing T2D were recruited from a community-based T2D participation group. Most participants were older (aged 60+) and lived in a socioeconomically deprived area in the United Kingdom. Data were analysed thematically using framework analysis. Patients' motives for self-management included (i) concern about the anticipative effects of T2D; (ii) wishing to "stay well"; (iii) maintaining independence; (iv) reducing the need for healthcare professionals; and (v) improving quality of life. Six self-management styles were found and pertained to self-managing: (i) through routinisation; (ii) as a burden; (iii) as maintenance; (iv) through delegation; (v) through comanagement; and (vi) through autonomy. Motivators for self-management shaped the criteria people used to judge the success of their self-management practices and influenced their self-management style. The findings show that styles of T2D self-management are mediated and moderated by sociocontextual issues. Healthcare professionals should take these into account when supporting people living with T2D.

Everyday experiences of people living with dementia and their carers relating to oral health and dental care

Little is known about how community-dwelling people with dementia, as well as their carers, look after their oral health and use dental care. This exploratory study aimed to explore the beliefs, experiences and practices about oral health of people living with dementia and their carers. We used an ethnographic qualitative approach conducting face-to-face interviews at home with people living with dementia and/or carers. Interview data and field notes were analysed thematically using framework methods. We approached volunteers registered with the online UK. Join Dementia Research network from whom a total of 17 participants were recruited in 2018. Five interviews were conducted with carers alone, two with a person living with dementia alone, and five with a carer and person with dementia jointly. Three main themes emerged: oral health is not prioritised; access to dental care is shaped by increasing disability; and the importance of continuity of care. While people living with dementia and their carers may view oral health important once prompted, many reported difficulties in undertaking or assisting with daily self-care and accessing dental services, particularly as dementia progresses. We draw out implications for the organisation and delivery of public and private dental services.

Denture use and osteoradionecrosis following radiotherapy for head and neck cancer: A systematic review

BACKGROUND

It is strongly recommended to extract teeth with poor prognosis in head and neck cancer (HaNC) patients prior starting treatment with radiotherapy to avoid need for extraction post-radiotherapy and prevent development of osteoradionecrosis (ORN). Dental extraction means that patients are often left with insufficient teeth leading to psychological problems and reducing their quality of life post-radiotherapy. Some clinicians do not advocate the use of dentures in HaNC patients claiming that dentures might lead to soft tissue irritation followed by ORN when constructed on irradiated jaws.

AIMS

This systematic review aimed to investigate the existing evidence regarding the impact of denture use on the development of ORN in HaNC patients post-radiotherapy.

METHODS

This systematic review followed the Preferred Reporting Item for Systematic Review and Meta-analyses (PRISMA) guideline. Three database systems were used: Ovid Medline, EMBASE and PsycINFO. PROSPERO was searched for ongoing or recently completed systematic reviews. The https://ClinicalTrials.gov was searched for ongoing or recently completed trials. The Joanna Briggs Institute critical appraisal tools were used to assess quality of studies being reviewed.

RESULTS

Only three retrospective case-control studies were included. Numbers of participants included in the three studies are limited with incomparable types of mucosal dentures. None of the studies described the method of measurement of the exposure (denture use) in a standard, validated and reliable way.

CONCLUSION

The three included studies suggested no link between denture use and development of ORN. However, very little evidence exists and the robustness of the studies is questionable. Well-powered studies are needed.

Civil society and the Health and Social Care Act in England and Wales: theory and praxis for the twenty-first century

In this paper we revisit the notion of civil society in the light of recent attempts to privatize health care in England via the passing of the Health and Social Care Act of 2013. This legislation promises a re-commodification of the National Health Service (NHS) in England. The Bill was bitterly contested during its passage through parliament, most vigorously in 2011. Much of the opposition occurred at a time of widespread, global rebellion, most notably in the 'Arab uprisings' and through the 'occupy movement'. Despite a plethora of protests, we argue, a non-porous boundary between what we call the 'protest sector' of civil society and the wider public sphere of the lifeworld has become apparent in England. A good deal of collective action, whether campaign-focused (like opposition to the Health and Social Care Bill) or more generalized (like rejections of corporate greed), has so far proved ineffective, at least in the short-term; no crisis of legitimation is apparent. We highlight a new 'class/command dynamic', leading to oligarchic rule, in the present era of financial capitalism. We use this health care case-study to re-examine the notion of civil society and its changing properties in what Castells calls a 'networked society'. The contribution ends with a discussion of the role of the sociologist re-civil society and the advocacy of both 'action' and 'foresight sociologies'.

Antibiotic prophylaxis in dentistry: part II. A qualitative study of patient perspectives and understanding of the NICE guideline

BACKGROUND

The National Institute for Health and Clinical Excellence (NICE) recommendations in 2008 for antibiotic prophylaxis before dental treatment contradict previous practice. There is a potential difficulty in explaining the new guidance to patients who have long believed that they must receive antibiotics before their dental treatment.

AIM

This study investigated the patient-related barriers and facilitating factors in implementation of the NICE guidance.

METHODS

In-depth interviews were conducted with nine patients concerning their views about barriers and factors that could influence the implementation of the NICE guidance on antibiotic prophylaxis before dental treatment. Data were analysed using framework analysis.

RESULTS

For patients the rationale for the NICE guidance was unclear. They understood that at the population level the risk of infective endocarditis was less than the risk of adverse reaction to antibiotics. However, on an individual level they felt that the latter risk was negligible given their previous experience of antibiotics. They were aware that standards of care change over time but were concerned that this may be an example where a mistake had been made. Patients felt that the characteristics of the person advising them about the new guidance were important in whether or not they would accept them - they wished to be advised by a clinician that they knew and trusted, and who was perceived as having appropriate expertise.

CONCLUSIONS

Patients generally felt that they would be most reassured by information provided by a clinician who they felt they could trust and who was qualified to comment on the issue by respecting their autonomy. The implications of the findings for the development of patient information are discussed.

Cleft lip and palate in context: Learning from, and adding to, the sociological literature on long-term conditions

Cleft lip and palate is a common congenital anomaly affecting males and females. While there is psychological research on cleft lip and palate, there is relatively little research exploring the social context of cleft lip and palate and the experiences of living with the condition on a daily basis. Drawing on common themes emerging from sociological work which have explored the experiences of people living with long-term conditions (uncertainty, social relations, self-esteem and self-image and biomedical concerns), we argue that these themes can be used to help elucidate the experiences of people living with cleft lip and palate. Within this framework, the findings of a qualitative study exploring the experiences of people living with cleft lip and palate are presented. The results suggest that all four themes can be found within the accounts of people living with cleft lip and palate, and there are many commonalities between the experiences of these people and those living with other long-term conditions. Conversely there are interesting areas of divergence. Unlike most long-term conditions, cleft lip and palate is not degenerative and treatment means symptoms will reduce over time. This is reflected in narratives around ‘normality’ as the endpoint of the care pathway. In addition, prenatal diagnosis means that the vast majority of participants within this study were born into, and grew up within, the care pathway. This has implications for the way in which cleft lip and palate is understood and the provision of information, relationships with members of the care team over time and the temporal and contextualised impact of cleft lip and palate on social relations and the self.

Family functioning and dental caries among preschool children

OBJECTIVES

To investigate the relationship of family functioning with dental caries among 3-4-year-olds and the role of family functioning in explaining the relationship of family socioeconomic status (SES) with childhood dental caries.

METHODS

Data from 761 parent-child dyads who took part in the East London Oral Health Inequalities study were analyzed. Family functioning was assessed using the 60-item family assessment device that yielded scores on general functioning and six domains (roles, communication, problem-solving, affective involvement, affective responsiveness, and behavior control). Children were clinically examined at home for dental caries. The association of family functioning and family SES (education and socioeconomic classification) with dental caries (dmft and dt scores) was tested using negative binominal regression while adjusting for child and parental demographic factors.

RESULTS

Children from families with unhealthy general functioning had 1.49 (95% CI: 1.01-2.20) and 1.84 (95% CI: 1.20-2.82) times greater dmft and dt, respectively, than those from families with healthy functioning after adjustment for confounders. The estimates for the associations of parental education and socioeconomic classification with dmft and dt were attenuated by around 12%-18% after adjusting for family functioning. Of the six family functioning domains assessed, only unhealthy behavior control in the family was associated with greater numbers of decayed teeth after adjustments.

CONCLUSIONS

This study showed that unhealthy family functioning was associated with dental caries among young children. Family functioning partly explained the relationship between family SES and childhood dental caries.