Oral Health Promotion

Jane SixsmithDepartment of Health PromotionNational University of Ireland, Galway

Acknowledgements

Research Undertaken by

Fionnuala Taylor Dillon, Sharon Friel, Cecily Kelleher, Jane Sixsmith

With Janas Harrington, Maria Dineen,

Eithne White, Ruth Boland, Maureen D’eath, Simon Comer

Context

Sub section of Lots undertaken by Oral Health Services Research Centre, University Dental School and Hospital, Cork

Oral Health Promotion ‘ Any planned effort to build healthy

public policies, create supportive environments, strengthen community action, develop personal skills or re-orientate health services in the pursuit of oral health goals’

(WHO,1986)

Main Concepts Equity and equality

Empowerment

Advocacy(Schou & Locker, 1997; WHO, 1986)

Levels of Influence Micro Level

Individual socio-demographic and economic characteristics

Meso level Interactions with other groups, social

networks, institutions or dental health practices

Macro Level Policy and culture

‘Special Needs’ ‘ those with medical, physical,

developmental or psychological conditions who are at increased risk of developing oral health problems ‘

(Pan European Task Force, 1998)

Those socially disadvantaged or excluded (Davis et al., 2000)

Special Needs Groups People with disabilities Older people in long term care Members of the Traveller community Refugees / asylum seekers Homeless people Medical card holders

Research Review of Oral Health promotion

People with special needs perceptions of oral health and providers perceptions of people with special needs needs

Aims and Objectives

Oral Health Promotion Review To gather information on the structures,

process and outcomes of oral health promotion / education initiatives and resources

To identify performance indicators for programmes reviewed

To identify success factors for oral health promotion

To develop a future framework for action for oral health promotion

Special needs groups To explore the attitudes, knowledge and

behaviour of special needs groups in relation to their oral health

To identify the perceived availability, accessibility and acceptability of dental services for special needs groups

To explore the attitudes, knowledge and behaviour of dental service providers towards special needs groups

Oral Health Research

Special Needs Groups Oral Health Promotion/Education Review

Focus Groups Interviews Postal Survey Telephone Interview

TravellersPeople with disabilities

General population

Elderly people in residential careHomeless peopleRefugees / asylum seekers

Dental personnel and non-dental personnel

Key service personnel

Samples and Response

Focus Groups Interviews Postal Survey Telephone Interviews

Special Needs Groups Oral Health Promotion Review

Travellers N=30

People with disabilities and carers N=78

General population:

Medical card holders N= 19Non medical card holders N=21

Elderly people in long term care & carers N= 31Homeless people N= 21Refugees / asylum seekers N=22

Dental Personnel:Private and public dentistsDental nursesHygienistsNon Dental Personnel:H Promotion ManagersDirectors of Public HealthCommunity NutritionistsHealthcare companies

N= 360 (53%)

Key Service Personnel

N=22

Results

Oral Health Promotion Review

Past• Ad hoc• Low priority of oral health

Present• Conducive policy• Supportive environments• Developing personal skills• Re-orientation of services

Future• Community participation• Conducive policy• Supportive environments• Re-orientate services

Special Needs Groups Importance of oral health

• Impact of oral health on daily living

Knowledge of oral health• Contributing factors

Oral health services Sources of information Experiences of services

• Access• Perceived effectiveness of service• Barriers

Service improvements

Importance of Oral Health Older people – no impact

Carers of elders – social, eating

Other groups – impact of oral ill health Social interaction Eating Health generally (general population)

Knowledge of Oral Health Causes of Oral Health

Good oral hygiene practices Dietary factors

• Amount not frequency of sugar Visiting dentist Fluoride not identified by any group

Causes of oral ill health Opposite of above Medication (older people, carers of those with

disability)

Sources of Information Health Boards Dentist Media Family / Friends GP Support organisations Schools No need of info

Oral Health Information Generally treatment focused

Oral hygiene

Diet

Experiences General population Elders Homeless people Refugees / asylum seekers People with Disabilities Travellers

Barriers to Service Cost Physical access (to and within) Fear Lack of information No time / inconvenience Lack of perceived need

Perceived effectiveness of service

Treatment

Organisation

Accessed Services Health Board Clinics Private Dentist Dental Hospitals A&E Departments Hospital School

Service providers Contact with

• People with disabilities• Elderly• Travellers• Homeless• Refugees / asylum seekers

Where?• Health board clinic, general dental practice,

hospital, school.

Identified oral health needs• Regular use of dental services• Improved oral health maintenance• Health education

Barriers to service provision• Physical barriers• Lack of time• Long waiting lists• Difficulty in accessing client group • Difficulties in accessing general aneasthetic

facilities• Attitudes, beliefs and prejudices of staff• + other clients

Service Improvements Education and training of staff Specialist posts for groups Improved physical environment Improved communication and

greater access to information Increased funding

Oral Health Promotion Organisational

• Dedicated national oral health promotion policy with oral health integrated into other relevant strategy documents.

• Coherent strategic policy at regional level with formal structures for OHP

• Regional coordination of on going activity

Inter-organisational• Co-ordinated development of multisectorial working

Intra organisational • Co-ordinated development of skills necessary for effective

OHP

Special Needs Groups Professional

Co-ordinated integration of dental and other health services

Training and increased awareness of needs Individual

Accessible information• oral health• Service

Societal Lack of access due to environmental barriers Lack of public concern for oral health

Conclusion