Oral Health Centre of Expertise Rogaland, Torgveien 21 B, 4016, Stavanger, Norway.
Faculty of Social Sciences, University of Stavanger, Postboks 8600 Forus, 4036, Stavanger, Norway.
BMC Health Serv Res. 2022 Apr 22;22(1):533. doi: 10.1186/s12913-022-07913-7.
Torture, abuse and dental anxiety (TADA) are often precursors to developing a pathological relationship with dental care due to elevated anxiety. Consequently, patients who suffer from one or more of these tend to avoid dental services. This could leave them with severe tooth decay, which could affect their general and psychosocial health. Norwegian dental services have implemented the TADA service to specifically alleviate dental anxiety and restore oral health for the TADA patient group. However, the service has not been evaluated, and there is a need to understand how and why this service works, for whom, under what circumstances. Therefore, this study aimed to develop theories on how the service's structure alleviates dental anxiety and restores these patients' oral health. Although developed in a Norwegian context, these theories may be applicable to other national and international contexts.
This realist evaluation comprised multiple sequential methods of service and policy documents (n = 13), followed by interviews with service developers (n = 12).
The analysis suggests that, by subsidising the TADA service, the Norwegian state has removed financial barriers for patients. This has improved their access to the service and, hence, their service uptake. National guidelines on service delivery are perceived as open to interpretation, and can hereby meet the needs of a heterogeneous patient group. The services have become tailored according to the available regional resources and heterogeneous needs of the patient population. A perceived lack of explicit national leadership and cooperative practices has resulted in regional service teams becoming self-reliant and insular. While this has led to cohesion within each regional service, it is not conducive to interservice collaborations. Lastly, the complexity of migration processes and poor dissemination practices is presumed to be the cause of the lack of recruitment of torture survivors to the service.
Policy documents and service developers described the TADA service as a hybrid bottom-up/top-down service that allows teams to practise discretion and tailor their approach to meet individual needs. Being free of charge has improved access to the service by vulnerable groups, but the service still struggles to reach torture survivors.
由于焦虑加剧，酷刑、虐待和牙科焦虑（TADA）通常是与牙科护理形成病态关系的前兆。因此，患有这些问题之一或多个问题的患者往往会避免接受牙科服务。这可能导致他们严重的龋齿，从而影响他们的整体和社会心理健康。挪威牙科服务机构已经实施了 TADA 服务，专门为 TADA 患者群体减轻牙科焦虑症并恢复口腔健康。然而，该服务尚未进行评估，需要了解该服务的结构如何以及为何能够为患者减轻牙科焦虑症并恢复其口腔健康，以及针对哪些人群、在哪些情况下有效。因此，本研究旨在制定关于该服务结构如何减轻牙科焦虑症并恢复这些患者口腔健康的理论。尽管这些理论是在挪威背景下制定的，但它们可能适用于其他国家和国际背景。
本真实主义评价采用了多种服务和政策文件的顺序方法（n=13），随后对服务开发人员进行了访谈（n=12）。
分析表明，挪威政府通过补贴 TADA 服务，为患者消除了经济障碍。这改善了他们获得服务的机会，从而提高了他们的服务利用率。服务提供方面的国家指南被认为具有开放性，因此可以满足患者群体的多样化需求。服务已经根据可用的区域资源和患者群体的多样化需求进行了调整。服务团队缺乏明确的国家领导和合作实践，被认为是导致区域服务团队变得自给自足和孤立的原因。虽然这导致了每个区域服务团队的凝聚力，但不利于服务间的合作。最后，移民过程的复杂性和不良的传播实践被认为是未能招募酷刑幸存者加入该服务的原因。
政策文件和服务开发人员将 TADA 服务描述为一种混合的自下而上/自上而下的服务，允许团队根据需要自由裁量并调整方法。该服务免费为弱势群体提供了获得服务的机会，但仍难以接触到酷刑幸存者。
