Paying Lip Service? – The Role of Health-Carers in Promoting Oral Health, a Pilot Qualitative Study

Aim: This pilot study explores the awareness of risk factors for dental disease and appropriate health behaviours for oral health and willingness to perform oral health promotion within a group of health-care professionals. Methods: A qualitative focus group method was chosen as the most appropriate way of exploring these issues. In doing so, the participants would be able to express their thoughts and opinions openly on a range of ideas. Within this social context, the participants were also able to respond to the ideas and comments of their peers. Eleven participants, six school nurses and five health visitors were invited to the study. Results: Six school nurses and three health visitors accepted invitations and were included in the focus group. Overall there was an awareness of four of the five risk factors for dental disease reported in the Scientific Basis of Oral Health Education. Appropriate health behaviours for oral health, included using fluoride toothpastes of adequate strength with no rinsing following brushing, were promoted. However, there was poor understanding of the underpinning science on which messages were based. There was little awareness of methods to improve concordance (as opposed to compliance) within patients. It became clear that as individuals, they felt a sense of responsibility to be involved in oral health promotion. Three overarching themes emerged. The first summarises the attitudes the groups had with regard to role and limitations, sub themes included responsibility and reality. The second described obstacles for patients, sub themes included access, barriers and consequences. The third surrounded effective communication, sub themes included messages and cohesive approach. Concluding remarks: Health promotion includes health protection, prevention and health education and individual health-carers have little influence on certain aspects of health promotion such as policies on health protection. The reality of preventing dental disease is scientifically understood by the dental profession. However, the reality of social structure, as perceived by the health-carers is such that the norms of social policy and social behaviour out-weigh what is scientifically possible in controlling dental diseases. This reality is compounded by a perceived lack of ‘personal responsibility' by the non-compliant patient. Social division is a possible outcome if stereotyping of non-compliant patients persists. The prevalence and distribution of dental caries in the community needs to be made clearer for health-carers. Only then can it be understood that dental caries is mainly a disease of lower socio-economic groups. Training in health behaviour change principles specific to the needs of the target group is required. This involves understanding that their own value systems may differ from their patients.