Inclusion oral health:Advancing a theoretical framework for policy, research and practice

In response to headlines about the oral health of persons experiencing social exclusion resonating in high-income countries, and research demonstrating the need for urgent action, a symposium entitled ‘International Perspectives on Socially Inclusive Dentistry: A Call to Action’ was organized for the IADR International Meeting of 2018. The aim of the symposium was to initiate an international dialogue on barriers to care, multidisciplinary action, and examples of best practice for service delivery for people experiencing social exclusion; in other words, to develop the idea of inclusion oral health. Through our international exchange, what emerged was an awareness of a lack of professional consensus: What exactly is inclusion oral health? A theoretical framework to push forward the policy, research and practice agenda was clearly needed. This paper advances such a framework. Over the decades, dentistry has forged an approach to service delivery mainly through a business, demand-led model. While oral health continues to improve globally, an important consequence of this approach is that it compounds the social exclusion that many people are already experiencing because of a constellation of economic, political, cultural and individual factors. Thus, many people are simply not getting the dental care they need. In contrast, drawing on the theoretical literature on social exclusion, intersectionality and othering, we suggest that dentistry could act as an agent for social inclusion as a more responsive, all-encompassing form of oral health care and delivery. This paper advances a theoretical framework for inclusion oral health and an action plan to show how inclusion oral health may become one solution in an armamentarium to tackle the global phenomena of oral health inequities.<br/

Factors affecting general practice collaboration with voluntary and community sector organisations.

Collaborative working between general practice (GP) and voluntary and community sector (VCS) organisations is increasingly championed as a means of primary care doing more with less and of addressing patients' "wicked problems". This paper aims to add to the knowledge base around collaborative practice between GPs and VCS organisations by examining the factors that aid or inhibit such collaboration. A case study design was used to examine the lived-experience of GPs and VCS organisations working collaboratively. Four cases, each consisting of a GP and a VCS organisation with whom they work collaboratively, were identified. Interviews (n = 18) and a focus group (n = 1) were conducted with staff within each organisation. Transcribed data were analysed thematically. Whilet there are similarities across cases in their use of, for example, Health Trainers and social prescribing, the form and function of GP-VCS collaborations were unique to their local context. The identified factors affecting GP-VCS collaboration reflect those found in previous service evaluations and the broader literature on partnership working; shared understanding, time and resources, trust, strong leadership, operational systems and governance and the "negotiation" of professional boundaries. While the current political environment may represent an opportunity for collaborations to develop, there are issues yet to be resolved before collaboration-especially more holistic and integrated approaches-becomes systematically embedded into practice

Lifestyle risk factor communication by nurses in general practice: Understanding the interactional elements

Aim: This paper seeks to explore general practice nurses\u27 perceptions of interactional factors supporting communication with patients about lifestyle risk. Design: Qualitative descriptive study embedded in a concurrent mixed methods design. Methods: Fifteen Australian general practice nurses were interviewed following video-recorded chronic disease management consultations between August 2017 - March 2018. Results: The theme of \u27Interactional Factors\u27 comprised of the subthemes \u27Relational factors\u27 and \u27Patient factors\u27. Relational factors referred to communication techniques and methods supporting temporal continuity with patients about lifestyle risk. Patient factors included consumers\u27 motivation, willingness, and readiness to prioritize lifestyle changes. Lack of awareness of the nurses\u27 role was perceived to have an impact on initiation of lifestyle risk conversations. Conclusion: Strategies optimizing continuity of nursing care enhance the capacity for lifestyle risk reduction conversations with patients. Ongoing training in patient-centred communication and increasing patients\u27 awareness of general practice nurses\u27 roles would also better support these discussions. Impact: This research identifies ways the general practice nurses\u27 role in supporting lifestyle risk reduction can be improved. Optimizing the general practice nurses\u27 role in lifestyle risk communication can enhance the behaviour change and chronic disease management