Evidence summary: what do we know from qualitative research about people's care-seeking about oral health?

Subjects

Key Points

  • Care-seeking: patients trying to obtain care/advice/treatment from a health professional/service.

  • Patient acceptance of healthcare: the seeking and acceptance by patients of health services.

  • Qualitative research: research that derives data from observation, interviews, or verbal interactions and focuses on meanings and interpretations of the participants.

  • Oral health: the optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease.

Abstract

Since August 2009, members of the Primary Care Dentistry Research Forum (http://www.dentistryresearch.org) have taken part in an online vote to identify questions in day-to-day practice that they felt most needed to be answered with conclusive research. The question which receives the most votes each month forms the subject of a critical appraisal of the relevant literature. Each month a new round of voting takes place to decide which further questions will be reviewed. Dental practitioners and dental care professionals are encouraged to take part in the voting and submit their own questions to be included in the vote by joining the website.

The paper below details a summary of the findings of the ninth critical appraisal. In conclusion, the critical appraisal showed a wide range of factors that infl uence care-seeking about oral health. These included both barriers and triggers to care-seeking. Only five papers were found that provided relevant data, and their data collection settings varied widely. Further research into care-seeking about oral health would be useful for both policy makers and practitioners in understanding patients' needs.

Background

Within medical and nursing literature, both quantitative and qualitative data collection methods have been used to describe people's care-seeking or help-seeking behaviour.1,2,3,4,5 Healthcare policy and service redesign may be informed by use of this evidence that places an understanding of the individual patient at the core.6

In oral health, what is understood about people's perceptions towards care-seeking? There is literature that mainly derives from use of (semi-)quantitative research methods, including the Adult Dental Health Survey.7,8,9,10,11 However, exploration of the subjective factors influencing people's care-seeking behaviour using qualitative research methods may reveal additional insights.

Aim

This review aimed to identify and summarise UK primary research studies which have adopted qualitative research data collection methods using open questions to explore people's care-seeking or help-seeking about oral health.

Review method

An initial search was made of Ovid MEDLINE® (1950 to week 3, May 2010) using search terms 'patient acceptance of health care'; health knowledge, attitudes, practice; choice behaviour; and decision making. One hundred and fifty-one titles were identified, 18 of which were relevant to the UK. Four papers were retrieved as full text and examined; one title was rejected.

Further searches included:

  • Ovid MEDLINE® (1950 to week 4, May 2010) using the search terms patient acceptance of health care; motivation; dental 'seeking strategies'; UK. One hundred and fifty-two titles were identified and four papers retrieved as full text and examined. All four titles were rejected

  • Ovid MEDLINE® (1950 to week 4, May 2010) using the search terms patient acceptance of health care; narration (relating the particular and the personal in an individual's life story); attitude to health; UK. Sixty-one were titles identified and all 61 titles rejected

In addition, CEBD, Cochrane Oral Health Group, ADA, TRIP database, social sciences databases (Science Direct, ASSIA (CSA), Web of Science, EBSCO, SwetsWise), and individual journal searches including Evidence-Based Dentistry, Journal of Evidence-Based Dental Practice, and Journal of the American Dental Association. Ten titles were identified and retrieved as full text and examined. Eight titles were rejected.

Findings

Three hundred and seventy-four titles and abstracts arising from the web-based searches were screened. Eighteen potentially relevant papers were retrieved as full text and reviewed. Five of these 18 papers provided relevant findings, having used open questions as part of a qualitative method to develop insight into patients' care-seeking about oral health.

The studies' authors' interpretations of patients' subjective perceptions of oral health-related care-seeking are simply listed in Table 1, structured under the headings of barriers or triggers to care-seeking. These interpretations are further summarised in Figures 1 and 2.

Table 1 Details of studies and researchers' interpretations of people's subjective perceptions about oral health-related care-seeking
Figure 1
figure1

Researchers' interpretations of patients' perceived barriers to care-seeking

Figure 2
figure2

Researchers' interpretations of patients' perceived triggers to care-seeking

We could find very few qualitative research studies that had used open questions to elucidate UK people's care-seeking about oral health. Of the five papers located, there was considerable diversity in the setting of the data collection, for example emergency dental care hospital, cancer care centre, people's homes. In addition, the reason for care-seeking varied, such as retrospective accounts of patients with oral cancer diagnosis, patients seeking emergency dental care, and others who gave accounts of factors that may influence their care-seeking for the protection of their oral health. As such, no synthesis of the findings was attempted. However, despite the range of people and places, it is apparent that there was considerable commonality of factors that are barriers and triggers to seeking care from a dentist.

Advancing the qualitative review

In-depth analysis of the findings of the presented qualitative studies may be undertaken, although there are no 'gold' standard methods amongst the various existing methods for conducting syntheses of qualitative research. One possible approach, meta-ethnography, synthesises qualitative data across studies to permit identification of concept relationships, translation and synthesis into one another.12 Such synthesis is beyond the scope of a rapid review.

Conclusions

It appears that relatively few studies using qualitative research methods have been undertaken in the UK to understand people's care-seeking about oral health. The current findings indicate that a wide range of factors influence care-seeking about oral health, either as a trigger or barrier to care.

Further research into people's care-seeking about oral health would provide a useful addition to policymakers' and practitioners' understanding of their needs.

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Arianne Matlin, British Dental Association, 64 Wimpole Street, London, W1G 8YS info@dentistryresearch.org; Tel: +44 (0)20 7563 4583 Sponsored by the Shirley Glasstone Hughes Trust

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Fox, C. Evidence summary: what do we know from qualitative research about people's care-seeking about oral health?. Br Dent J 209, 225–231 (2010). https://doi.org/10.1038/sj.bdj.2010.796

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