School of Dentistry, University of Leeds, Leeds, UK.
JDR Clin Trans Res. 2021 Jan;6(1):96-108. doi: 10.1177/2380084420926972. Epub 2020 May 21.
Dental caries, gum disease, and tooth loss are all preventable conditions. However, many dental care systems remain treatment oriented rather than prevention oriented. This promotes the treatment of oral diseases over preventive treatments and advice. Exploring barriers to prevention and understanding the requirements of a paradigm shift are the first steps toward delivering quality prevention-focused health care.
To qualitatively explore perceived barriers and facilitators to oral disease prevention from a multistakeholder perspective across 6 European countries.
A total of 58 interviews and 13 focus groups were undertaken involving 149 participants from the United Kingdom, Denmark, Germany, the Netherlands, Ireland, and Hungary. Interviews and focus groups were conducted in each country in its native language between March 2016 and September 2017. Participants were patients ( = 50), dental team members ( = 39), dental policy makers( = 33), and dental insurers ( = 27). The audio was transcribed, translated, and analyzed via deductive thematic analysis.
Five broad themes emerged that were both barriers and facilitators: dental regulation, who provides prevention, knowledge and motivation, trust, and person-level factors. Each theme was touched on in all countries; however, cross-country differences were evident surrounding the magnitude of each theme.
Despite the different strengths and weaknesses among the systems, those who deliver, organize, and utilize each system experience similar barriers to prevention. The findings suggest that across all 6 countries, prevention in oral health care is hindered by a complex interplay of factors, with no particular dental health system offering overall greater user satisfaction. Underlying the themes were sentiments of blame, whereby each group appeared to shift responsibility for prevention to other groups. To bring about change, greater teamwork is needed in the commissioning of prevention to engender its increased value by all stakeholders within the dental system.
The results from this study provide an initial first step for those interested in exploring and working toward the paradigm shift to preventive focused dentistry. We also hope that these findings will encourage more research exploring the complex relationship among dental stakeholders, with a view to overcoming the barriers. In particular, these findings may be of use to dental public health researchers, dentists, and policy makers concerned with the prevention of oral diseases.
龋齿、牙周病和牙齿缺失都是可预防的疾病。然而，许多牙科保健系统仍然以治疗为导向，而不是以预防为导向。这促进了口腔疾病的治疗，而不是预防治疗和建议。探索预防的障碍，并了解范式转变的要求，是提供以预防为重点的优质保健服务的第一步。
从 6 个欧洲国家的多利益攸关方角度，定性探讨口腔疾病预防的感知障碍和促进因素。
2016 年 3 月至 2017 年 9 月，在每个国家用母语进行了 58 次访谈和 13 次焦点小组，共涉及来自英国、丹麦、德国、荷兰、爱尔兰和匈牙利的 149 名参与者。参与者包括患者（50 人）、牙科团队成员（39 人）、牙科政策制定者（33 人）和牙科保险公司（27 人）。对音频进行了转录、翻译和演绎主题分析。
出现了五个广泛的主题，这些主题既是障碍也是促进因素：牙科监管、谁提供预防、知识和动机、信任和个人层面的因素。每个主题都在所有国家都有涉及；然而，围绕每个主题的重要性，各国之间存在明显差异。
尽管系统之间存在不同的优势和劣势，但提供、组织和利用每个系统的人都面临着预防的类似障碍。调查结果表明，在所有 6 个国家，口腔保健中的预防都受到各种因素的复杂影响，没有任何特定的牙科保健系统能为用户提供更大的满意度。在主题背后是一种责备的情绪，每个群体似乎都将预防的责任推卸给其他群体。为了带来变革，需要在预防的委托方面加强团队合作，使所有利益相关者在牙科系统内都能认识到预防的价值。
本研究的结果为那些有兴趣探索和努力实现以预防为重点的牙科范式转变的人提供了初步的第一步。我们还希望这些发现将鼓励更多的研究探索牙科利益攸关者之间的复杂关系，以期克服障碍。特别是，这些发现可能对关注口腔疾病预防的牙科公共卫生研究人员、牙医和政策制定者有用。
