By Word of Mouth: A Qualitative Approach to Understanding the Integration of Preventive Dental Health in Primary Care Settings
Childhood and adolescence are sensitive periods in the lifespan when oral and craniofacial appearances can help determine social interactions and lifetime outcomes. In this respect, oral health can be viewed as more than just brushing or flossing for healthy teeth; children’s oral health can influence their social development and behaviors, impact their academic growth, affect their guardian’s responsibility for healthcare cost and create a potential pathway for negative impacts on quality of life. Access to quality oral healthcare is vital for the prevention of unwanted diseases and to avoid the burden of oral health complications. Oral health disparities may not be the consequence of negligence, but rather, the result of unmet needs and limited access to quality oral health care. Collaborations within systems of care that include medical and dental health professionals may lead to opportunities for improvements in oral health and overall health among children and adolescents. This research study was focused on medical-dental collaboration model and its potential to provide an opportunity to meet the oral health needs of children and adolescents. Therefore, the overall goal of this study was to understand how preventive dental health was integrated in the pediatric primary care settings that participated in the Quality through Technology & Innovation in Pediatrics (QTIP) demonstration project.
Data were collected from August 2014 – January 2015 and analyzed in two stages. First, we conducted a directed content analysis using data provided by the QTIP project director. Second, twenty-two QTIP participants were interviewed using qualitative methods. Overall, the process evaluation data suggested that the principles of preventive dental health integration were successfully implemented as result of the QTIP demonstration project. Through examination of the process evaluation domains of fidelity, dose delivered, reach and dose received, we were able to determine to what extent primary care pediatric practices engaged with materials and trainings of the QTIP demonstration project and how primary care pediatric practices integrated preventive dental health in their medical settings. Through the qualitative interviews we identified seven key themes related to the feasibility of integrating preventive dental health: 1) communication between staff members; 2) role delineation; 3) preventive dental health education and training; 4) sustaining improvement; 5) willingness to engage in QTIP recommendations for preventive dental health; 6) parent behaviors and 7) practice-based recommendations for preventive dental health integration. We also categorized each practice as having a strong, moderate, or weak preventive dental health implementation based on their perceived achievement of preventive dental health integration in their medical setting. Overall, the findings of this dissertation revealed that preventive dental health integration has the potential to be a feasible and effective strategy to improving the oral health outcomes for children and adolescents in South Carolina (SC).