Promoting Oral Health in High Caries Risk Children
Promoting Oral Health in High Caries Risk Children
This study involved a qualitative investigation utilizing semi-structured interviews. It was granted ethical approval by King's College London Biomedical Sciences, Dentistry, Medicine and Natural & Mathematical Sciences research ethics committee (Reference number: BDM/12/13-34). Information regarding the research team can be found in the (authors' information) section.
The targeted informants in this study were GDPs working in the referral area for King's College Hospital (KCH), which includes the south London Boroughs of Lambeth, Southwark and Lewisham (LSL), provided they had referred children for management of caries under general anaesthesia. These boroughs are some of the most highly deprived in England, ranking 15, 17 and 24 respectively in deprivation in 2010. They are also known to be culturally diverse, containing people from various ethnic minorities and immigrant backgrounds. The National Census in 2011 reported that almost 40% of adult residents in those areas were born outside the UK. The rate of child attendance for dental care is poor, and highly associated with social deprivation in those areas.
Purposive sampling, based on GA referral rates to hospital, was used. A list of general dental practices that had referred children to King's College Hospital from March 2011 to March 2012 was obtained and practices were sorted into three categories:
Invitation letters and information leaflets that detailed the aims and design of this research project were sent by post to practices from all three categories. Our aim was to collect the opinions of dentists of various ages, work experience, gender, and referral rate. Researcher (AA) followed the postal invitation with a phone call one week later to inquire about willingness to participate. He then arranged to visit those who agreed to take part to perform the interview face to face in the informant's own dental practice. Following a brief introduction, there was an opportunity for clarification and questions prior to obtaining written consent, and commencing the interview.
The interview schedule included open-ended questions and was divided into five discussion topics: (i) informants' basic information, (ii) experience with referral of children for management of caries under general anaesthesia, (iii) preventive dental care provided for those children, (iv) views on the hospital service, and (v) views on promoting the oral health of those children.
The design of the interview was re-assessed by the researchers after the first five interviews. At this stage, a further question regarding the informant's familiarity with England's preventive dentistry guideline (Delivering Better Oral Health: An evidence-based toolkit for prevention) was added.
All interviews were audio recorded and transcribed verbatim. All data were anonymised prior to analysis; informants are identified only by their referral rate, experience and gender. Descriptive statistics were used to present the demographics of informants. Framework Analysis, a rigorous approach for ordering, synthesising and presenting qualitative data, was used to report on the interviews. Microsoft Office Excel was used as the platform for analysis. An analytical framework was informed by relevant literature, interview schedule and emerging text of the interviews. Steps of analysis included familiarisation with raw data, development of a thematic index, theme refinement, charting into the relevant part of the framework and finally developing explanations and looking for applications to wider theory. The research team has met regularly during data collection and analysis to discuss the process of coding and theme assignment and any disagreements were solved by discussion. The consolidated criteria for reporting qualitative research (COREQ) were used as a guide to ensure quality.
Methods
This study involved a qualitative investigation utilizing semi-structured interviews. It was granted ethical approval by King's College London Biomedical Sciences, Dentistry, Medicine and Natural & Mathematical Sciences research ethics committee (Reference number: BDM/12/13-34). Information regarding the research team can be found in the (authors' information) section.
The targeted informants in this study were GDPs working in the referral area for King's College Hospital (KCH), which includes the south London Boroughs of Lambeth, Southwark and Lewisham (LSL), provided they had referred children for management of caries under general anaesthesia. These boroughs are some of the most highly deprived in England, ranking 15, 17 and 24 respectively in deprivation in 2010. They are also known to be culturally diverse, containing people from various ethnic minorities and immigrant backgrounds. The National Census in 2011 reported that almost 40% of adult residents in those areas were born outside the UK. The rate of child attendance for dental care is poor, and highly associated with social deprivation in those areas.
Purposive sampling, based on GA referral rates to hospital, was used. A list of general dental practices that had referred children to King's College Hospital from March 2011 to March 2012 was obtained and practices were sorted into three categories:
High referrers: 15+ referrals a year (7 practices).
Medium referrers: 5–14 referrals a year (36 practices).
Low referrers: <4 referrals a year (123 practices).
Invitation letters and information leaflets that detailed the aims and design of this research project were sent by post to practices from all three categories. Our aim was to collect the opinions of dentists of various ages, work experience, gender, and referral rate. Researcher (AA) followed the postal invitation with a phone call one week later to inquire about willingness to participate. He then arranged to visit those who agreed to take part to perform the interview face to face in the informant's own dental practice. Following a brief introduction, there was an opportunity for clarification and questions prior to obtaining written consent, and commencing the interview.
The interview schedule included open-ended questions and was divided into five discussion topics: (i) informants' basic information, (ii) experience with referral of children for management of caries under general anaesthesia, (iii) preventive dental care provided for those children, (iv) views on the hospital service, and (v) views on promoting the oral health of those children.
The design of the interview was re-assessed by the researchers after the first five interviews. At this stage, a further question regarding the informant's familiarity with England's preventive dentistry guideline (Delivering Better Oral Health: An evidence-based toolkit for prevention) was added.
All interviews were audio recorded and transcribed verbatim. All data were anonymised prior to analysis; informants are identified only by their referral rate, experience and gender. Descriptive statistics were used to present the demographics of informants. Framework Analysis, a rigorous approach for ordering, synthesising and presenting qualitative data, was used to report on the interviews. Microsoft Office Excel was used as the platform for analysis. An analytical framework was informed by relevant literature, interview schedule and emerging text of the interviews. Steps of analysis included familiarisation with raw data, development of a thematic index, theme refinement, charting into the relevant part of the framework and finally developing explanations and looking for applications to wider theory. The research team has met regularly during data collection and analysis to discuss the process of coding and theme assignment and any disagreements were solved by discussion. The consolidated criteria for reporting qualitative research (COREQ) were used as a guide to ensure quality.
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