Janine Owens

Seen and heard: towards child participation in dental research

BACKGROUND There has been an increasing emphasis in many countries worldwide to capture the views of children on health services and research. A previous systematic review found that most oral health research from 2000 to 2005 was conducted on children and highlighted the need for greater research with children. AIM To describe the extent to which oral health research between 2006 and 2014 has been conducted with or on children. DESIGN Systematic review. Electronic databases were searched for the literature on child dental health. Each identified paper was examined by two researchers and categorised based on the extent to which children were involved in the research, the type of study (evaluative or otherwise), the country of origin, and the clinical discipline. RESULTS The search included 2950 papers after application of the exclusion criteria. Of these, 17.4% were with children, 18.3% involved the use of proxies (parents or clinician), and 64.2% were on children. CONCLUSIONS The proportion of studies from 2006 to 2014 involving research with children has increased from 7.3% in 2000-2005. This systematic review provides evidence for movement towards childrens involvement in dental research over the last 10 years. Future dental research must focus on incorporating childrens perspectives into the evaluation of dental treatments to improve outcomes for children.

People with learning disabilities and specialist services

Valuing people and Valuing peoples oral health both advocate choice and inclusion for people with learning disabilities. Research suggests that services and policy and guidance, while prescriptive and available, have not been effective in reducing oral health inequalities for people with learning disabilities. There is a risk that specialist services led by newly created consultants in special care dentistry may have the unintended effect of reducing choice if general dental practitioners are encouraged to refer all those with learning disabilities. A modified model of access is proposed that primary care organisations could use as a commissioning tool for dental contracts to facilitate choice and maximise involvement in oral health care for those with learning disabilities.

Exploring the critiques of the social model of disability: the transformative possibility of Arendt's notion of power

The social model of disability has demonstrated political success for disabled people in society. At the same time, it has been labelled an outdated ideology in need of further development. While the social model of disability has been used successfully for political activism, it has simultaneously created conflict and tensions in disability studies, sociology and the sociology of the body. This article sheds light on the confusion surrounding the social model of disability by discussing the historical emergence of its different forms. It then proceeds to analyse and evaluate key criticisms of the social model of disability. The article then goes on to explore the relevance of different forms of power to the current discourse on disability before proceeding to explore in depth what might be gained from the approach of one particular theorist on power; Hannah Arendt. It suggests that there may be merit in drawing on Arendt and illustrates some of the benefits of a more nuanced idea of a pluralistic body and experiences.

Impairment effects, disability and dry mouth: Exploring the public and private dimensions

Existing accounts of dry mouth concentrate on the medical dimensions and almost completely neglect to consider its social dimensions. Simultaneously, debates on disability have highlighted an apparent split between the individual (medical) and social models of disability. The concept of ‘impairment effects’ aims to address this dichotomised approach. Impairment effects consider the everyday impact of people’s impairments on their lives in conjunction with the disabling impacts encountered through their relations with society, and society’s relations with them. This study indicates that identity and self became entangled with impairment effects and a form of disablism. The authors argue that impairment effects are, at times, a useful concept, but in some instances may actually overcomplicate things. By analysing the public and private dimensions of a chronic condition such as dry mouth, we have been enabled to explore the boundary between public and private lives. As a consequence, using public and private accounts may assist us to better locate the point where impairment ends and disability begins.

Analysing people with head and neck cancers’ use of online support groups

Online support groups have become a familiar source of social support for people with a variety of health issues. To date, no research has investigated the use of such groups by people with head and neck cancer (HN the Social Support Behaviour Code and the scheme of Coursaris & Liu (2009), were used to analyse the content of support-seeking and support-offering messages. The results suggested that the most frequently offered types of social support by group members were informational (43.4%) and emotional (32.4%), followed by esteem (15.6%) and network support (6.1%), whereas little tangible assistance was offered (2.4%). The content of support-seeking messages included group members sharing personal experience (31.5%), with the most frequent sought support being informational support (25.5%). The OSGs can be advantageous to people with H&N cancer, especially for those with appearance or speech problems to mitigate their embarrassment and facilitate interaction with others. The present findings suggest that such OSGs can be promising sources of H&N cancer-related informational and emotional support for the recipients, whether they are patients, family members or carers.

The acceptability of care delegation in skill-mix: The salience of trust

The aim of this research was to explore the acceptability of care delegation in skill-mix, using the views and experiences of patients and parents of children treated by dental therapists as a case study. A purposive sample of 15 adults whose care, or that of their children, had been delegated to dental therapists in English dental practices was interviewed using narrative and ethnographic techniques (July 2011 - May 2012). Experiences were overwhelmingly positive with the need for trust in clinicians and the health system emerging as a key factor in its acceptability. Perceptions of general and dental health services ranged from them being a collectivist public service to a more consumerist marketised service, with the former seemingly associated with notions of dentistry as a trusted system working for the social good. Interpersonal trust appeared built, sustained (and undermined) by the affective behaviour, perceived competence, and continuity of care with clinicians providing care, and contributed to trust in the system. It also appeared to compensate for gaps in knowledge needed for patient decision-making. Overall, where trust existed, delegation of care was acceptable. An increasingly marketised health system, and emphasis on the patient as a consumer, may challenge trust and acceptability of delegation, and undermine the notion of patient-centred health care.

Barriers to oral health promotion in the Republic of Ireland

Aims: This paper discusses the evaluation of a multi-sector oral health promotion intervention in the Republic of Ireland for children with disabilities. It argues that a lack of awareness about the context of interventions means that sometimes people’s health concerns remain unaddressed through a lack of participation. This may actually increase rather than decrease health inequalities. Implementing qualitative methods to provide a context before proceeding with interventions may assist in providing approaches that are fit for purpose when trying to include people in health promotion. Methods: A purposive sample of 15 parents or carers of children with disabilities and 18 non-dental professionals were interviewed in either focus groups or on a one-to-one basis. Results: The qualitative analysis indicated that budget constraints were affecting joint working because non-dental professionals were overstretched, feeling that they only had the capacity to carry out day-to-day work with parents and children. The daily demands of caring for a child with disabilities for many parents meant that they were tied to a day-to-day existence. Conclusions: The qualitative evaluation suggested that an initial lack of knowledge about structural, procedural, and budgetary barriers, coupled with insight into the daily demands on parents caring for children with disabilities, meant that all parents were not enabled. Therefore, achieving the aims of the plan could not be a total success for all parents and children from the outset.

Oral health promotion for children with disabilities in the Republic of Ireland: independent qualitative evaluation of a multi-sectoral oral health promotion intervention for children with disabilities.

Children with disabilities are a marginalized group in relation to health in the Republic of Ireland, and oral health is frequently relegated to a position of little or no importance by parents, paid carers, and non-dental professionals. Subsequently, there is often a higher need for treatment and inpatient procedures that could be prevented. Introducing a health promotion intervention which aimed to reduce the need for dental treatment was envisioned as being the way forward. A qualitative evaluation of the context for implementation highlighted barriers in achieving the aims of the plan.

The Role of the Qur’an and Sunnah in Oral Health

The aim of this study was to explore the ways in which the main texts in Islam, Holy Qur’an and the Sunnah of the Prophet Mohammed (pbuh), contribute to understandings of oral health. The AHadith provide guidance for oral health-related behaviour but were written at a time when their symbolic meanings were perhaps vastly different to those of today. In gaining more insight into the ways Islamic HRB shape oral health-related practices and outcomes, if at all, we may be better placed to develop a more culturally sensitive and diverse dental public health and oral health promotion which takes into account religious dimensions, mediating factors, HRB and salutogenic mechanisms.

The acceptability of healthcare: from satisfaction to trust

The assessment of healthcare quality increasingly emphasises lay acceptability, as evidenced by the emergence of patient satisfaction and patient-centred care in the literature and in policy. In this paper we aim to provide a conceptual overview of acceptability and propose ways to enhance its assessment. Firstly, we map how acceptabilitys importance in quality assessments has increased and how the term acceptability has been used as synonymous with patient satisfaction, despite it being a broader concept. We then critique the concept of patient satisfaction and its measurement and challenge its use as an indicator of acceptability and quality. By drawing on our research and those of others, the second half of the paper describes how trust in clinicians and health services has emerged as a related concept, including a theoretical discussion of trust in healthcare outlining how it can be built, undermined and abused. We propose trust as an alternative indicator of acceptability in healthcare quality and review its measurement. Finally, we consider how healthcare policy may impact on trust and make recommendations for future research.