Zare Zahra, Bahrami Mohammad Amin, Iranmanesh Foad, Kavosi Zahra
Student Research Committee, Department of Health Care Management, School of Management and Medical Informatics, Shiraz University of Medical Science, Shiraz, Iran.
End of Life Care, Health Services Programs, Clinical System Support and Improvement, Department for Health and Wellbeing, South Australia Government, Adelaide, Australia.
BMC Oral Health. 2025 Jul 2;25(1):1002. doi: 10.1186/s12903-025-06392-6.
Patients with special health care needs (SHCN) are considered a vulnerable group due to their complex physical and mental conditions, which often limit their utilization of oral and dental health services (ODHS). So, this study examines the utilization of ODHS among patients with SHCN in Iran.
This qualitative study was conducted in Iran from September 2024 until January 2025. Informants were selected using purposive and snowball sampling. A semi structured interview guide was used to explore the perspectives of three groups: service providers, policymakers, and families of patients with SHCN. Data were analyzed using thematic analysis with MAXQDA 10.
Data from seventeen semi-structured interviews were thematically analyzed. Four overarching themes were identified: governance and policy landscape, professional competence and service readiness, sociocultural and familial dynamics, and care delivery processes. These themes encompassed both systemic and individual-level factors that either enabled or barred the utilization of ODHS among patients with SHCN. Informants emphasized that financial factors, clinical guidelines, insurance coverage, preventive healthcare systems, systematic approaches, and integrated information systems were major governance and policy-level factors. Within the second theme, training, motivations and attitudes, screening/specialized centers, and infrastructures and equipment were seen as significant measures to service provision. Sociocultural and familial dynamics-related subthemes included parents' and caregivers' knowledge and awareness, socioeconomic status, attitudes and stigma. In care delivery processes, geographic access and procedures and waiting lists emerged as key subthemes. Each of these factors could act as either a barrier or an enabler depending on how they are addressed in practice.
The findings of this study underscore the complex and multifactorial nature of factors influencing the utilization of ODHS among patients with SHCN. According to the results, both systemic and individual-level barriers and enablers play significant roles in shaping access to and utilization of ODHS. Addressing these challenges requires comprehensive, targeted policies that not only focus on improving the availability and accessibility of ODHS but also foster an environment that supports the continuous training of providers, enhances awareness among patients and their families, and ensures sufficient financial and infrastructural support.
有特殊医疗需求的患者（SHCN）因其复杂的身心状况而被视为弱势群体，这常常限制了他们对口腔和牙齿保健服务（ODHS）的利用。因此，本研究考察了伊朗有特殊医疗需求患者对口腔和牙齿保健服务的利用情况。
这项定性研究于2024年9月至2025年1月在伊朗进行。通过目的抽样和滚雪球抽样选取 informant。使用半结构化访谈指南来探究三组人员的观点：服务提供者、政策制定者以及有特殊医疗需求患者的家庭。使用MAXQDA 10软件通过主题分析对数据进行分析。
对17次半结构化访谈的数据进行了主题分析。确定了四个总体主题：治理与政策格局、专业能力与服务准备情况、社会文化与家庭动态以及护理提供过程。这些主题涵盖了影响有特殊医疗需求患者对口腔和牙齿保健服务利用的系统和个体层面的因素。 informant强调，财务因素、临床指南、保险覆盖范围、预防性医疗保健系统、系统方法和综合信息系统是主要的治理和政策层面因素。在第二个主题中，培训、动机和态度、筛查/专科中心以及基础设施和设备被视为服务提供的重要措施。与社会文化和家庭动态相关的子主题包括父母和护理人员的知识和意识、社会经济地位、态度和耻辱感。在护理提供过程中，地理可及性以及程序和等候名单成为关键子主题。这些因素中的每一个都可能成为障碍或促进因素，这取决于它们在实践中如何得到解决。
本研究结果强调了影响有特殊医疗需求患者对口腔和牙齿保健服务利用的因素具有复杂和多因素的性质。根据研究结果，系统和个体层面的障碍与促进因素在塑造口腔和牙齿保健服务的获取和利用方面都发挥着重要作用。应对这些挑战需要全面、有针对性的政策，这些政策不仅要关注提高口腔和牙齿保健服务的可获得性和可及性，还要营造一个支持对提供者进行持续培训、提高患者及其家庭的意识并确保有足够的财务和基础设施支持的环境。
