Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Research
  • Published:

Strategies to improve oral health behaviours and dental access for people experiencing homelessness: a qualitative study

Abstract

Objectives The present study aimed to identify strategies to improve oral health behaviours as well as access to and provision of dental care for people experiencing homelessness.

Method We conducted focus groups with people living in a residential homeless centre and semi-structured interviews with other stakeholders working with or supporting people experiencing homelessness. Following an inductive approach, thematic analysis was used to synthesise the findings on NVivo software.

Results Participants included 11 British males experiencing homelessness and 12 other stakeholders from various professional backgrounds. Themes identified included: awareness and empowerment; supportive environment and dental health system; flexible and holistic care; outreach and community engagement; collaboration with other health and social services; and effective communication.

Conclusions Efforts to improve oral health among people experiencing homelessness via improved oral health habits and engagement with services need to be directed at both the recipients of care and the healthcare teams. Well-powered empirical studies are needed to evaluate whether the strategies identified can improve engagement and care provision for this population.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Organisation for Economic Cooperation and Development (OECD). HC3.1 Homeless population. 2019. Available at https://www.oecd.org/els/family/HC3-1-Homeless-population.pdf (accessed July 2020).

  2. Shelter. 320,000 people in Britain are now homeless, as numbers keep rising. 2018. Available at https://england.shelter.org.uk/media/press_releases/articles/320,000_people_in_britain_are_now_homeless,_as_numbers_keep_rising (accessed July 2020).

  3. Wilson W, Barton C. Households in temporary accommodation (England). 2019. Available online at https://commonslibrary.parliament.uk/research-briefings/sn02110/ (accessed July 2020).

  4. Fazel S, Geddes J R, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet 2014; 384: 1529-1540.

  5. Morrison D S. Homelessness as an independent risk factor for mortality: results from a retrospective cohort study. Int J Epidemiol 2009; 38: 877-883.

  6. Simons D, Pearson N, Movasaghi Z. Developing dental services for homeless people in East London. Br Dent J 2012; DOI: 10.1038/sj.bdj.2012.891.

  7. Daly B, Newton T, Batchelor P, Jones K. Oral health care needs and oral health-related quality of life (OHIP-14) in homeless people. Community Dent Oral Epidemiol 2010; 8: 136-144.

  8. Groundswell. Healthy Mouths: A peer-led health audit on the oral health of people experiencing homelessness. 2017. Available at https://groundswell.org.uk/wp-content/uploads/2018/10/Groundswell-Healthy-Mouths-Report-Final-Web-2017.pdf (accessed July 2020).

  9. Caton S, Greenhalgh F, Goodacre L. Evaluation of a community dental service for homeless and 'hard to reach' people. Br Dent J 2016; 220: 67-70.

  10. Csikar J, Vinall-Collier K, Richemond J M, Talbot J, Serban S T, Douglas G V A. Identifying the barriers and facilitators for homeless people to achieve good oral health. Community Dent Health 2019; 36: 137-142.

  11. Parker E J, Jamieson L M, Steffens M A, Cathro P, Logan R M. Self-reported oral health of a metropolitan homeless population in Australia: comparisons with population-level data. Aust Dent J 2011; 56: 272-277.

  12. Daly B, Newton T J, Batchelor P. Patterns of dental service use among homeless people using a targeted service. J Public Health Dent 2010; 70: 45-51.

  13. Paisi M, Kay E, Plessas A et al. Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review. Community Dent Oral Epidemiol 2019; 47: 103-111.

  14. Coles E, Edwards M, Elliot G M, Freeman R, Heffernan A, Moore A. The oral health of homeless people across Scotland: Report of the homeless oral health survey in Scotland, 2008-2009. 2011. Available at https://dentistry.dundee.ac.uk/sites/dentistry.dundee.ac.uk/files/smile4life_report2011.pdf (accessed July 2020).

  15. Hill K B, Rimington D. Investigation of the oral health needs for homeless people in specialist units in London, Cardiff, Glasgow and Birmingham. Prim Health Care Res Dev 2011; 12: 135-144.

  16. Conte M, Broder H L, Jenkins G, Reed R, Janal M N. Oral health, related behaviours and oral health impacts among homeless adults. J Public Health Dent 2006; 66: 276-278.

  17. Public Health, Office of the Director of Public Health, Plymouth City Council. Index of Multiple Deprivation (IMD) 2019: Plymouth summary analysis. 2019. Available at https://www.plymouth.gov.uk/sites/default/files/IMD%202019%20report%20Final%200.1.pdf (accessed July 2020).

  18. Paisi M, Witton R, Burrows M et al. Management of plaque in people experiencing homelessness using 'peer education': a pilot study. Br Dent J 2019; 226: 860-866.

  19. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77-101.

  20. Nunez E, Gibson G, Jones J A, Schinka J A. Evaluating the impact of dental care on housing intervention programme outcomes among homeless veterans. Am J Public Health 2013; DOI: 10.2105/AJPH.2012.301064.

  21. Coles E, Freeman R. Exploring the oral health experiences of homeless people: a deconstruction-reconstruction formulation. Community Dent Oral Epidemiol 2016; 44: 53-63.

  22. Webb L, Sandhu S, Morton L et al. A dental student view on learning gained through Inter-Professional Engagement with people experiencing homelessness. Educ Prim Care 2019; 30: 319-321.

Download references

Acknowledgements

We would like to thank all our participants for their contributions, and the Oral and Dental Research Trust (GSK Research Award) for funding this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Martha Paisi.

Ethics declarations

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Paisi, M., Witton, R., Withers, L. et al. Strategies to improve oral health behaviours and dental access for people experiencing homelessness: a qualitative study. Br Dent J (2020). https://doi.org/10.1038/s41415-020-1926-7

Download citation

  • Published:

  • DOI: https://doi.org/10.1038/s41415-020-1926-7

This article is cited by

Search

Quick links