Oral and dental health utilization among patients with special health care needs: a qualitative study in Iran.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.