Exploring the oral health experiences of homeless people: a deconstruction–reconstruction formulation

Abstract

Objective To explore qualitatively, using a grounded theory approach, homeless people's awareness of their oral health needs and how they access dental services using a deconstruction–reconstruction formulation, and provide recommendations for service designers and dental professionals who work with people experiencing homelessness. Methods A qualitative study using grounded theory methodology was conducted. A purposive sample of homeless people was recruited from health facilities and organizations serving homeless populations in four Scottish cities and towns. Participants were interviewed about their oral health within the wider context of their experiences of homelessness. Initial research questions were open and focused on social processes such as oral health practices and interaction with dental services. Data collection and analysis were carried out simultaneously and iteratively, with emerging findings informing subsequent cycles. Data analysis was guided by Glaser and Strauss's grounded theory methodology and involved constant comparison, coding of transcripts and detailed memo‐writing. Results Thirty‐four homeless people took part. Participant experiences were conceptualized as a journey into and through the stages of homelessness, towards ‘reclaiming life’. Oral health experiences were mapped as a parallel 3‐stage journey from the deconstruction of self‐care, to the construction and maintenance of the neglected dentine, and finally to the reclamation of oral health resulting in a reconstructed functioning dentition. Conclusions This qualitative exploration using a deconstruction–reconstruction formulation has added to the understanding of homeless people's oral health awareness and dental treatment access while permitting an examination of the wider socioeconomic and psychosocial issues that disrupt their intentions to attend for treatment. These findings provide service designers and dental professionals with recommendations for the provision of responsive, acceptable and appropriate dental health services for those experiencing homelessness.

Barriers and enablers to accessing dental services for people experiencing homelessness: A systematic review

“…Mental health issues and psychosocial factors can exacerbate the prevalent dental anxiety/fear and further inhibit dental attendance . Furthermore, dependency issues (ie, drugs, alcohol) lead to self‐neglect and further decrease the priority placed upon oral health …”

“…The cost of care, along with any additional travelling costs, are inhibitory factors to homeless people attending a dental practice, particularly for those who need more than one course of treatment . The financial penalties for broken appointments and the resulting outstanding fines also impact on homeless people's ability to access dental care and retain their ongoing relationship with a dental practice . Having a hostel address or no fixed abode can preclude homeless people from registering with a dentist …”

“…3,15 Furthermore, dependency issues (ie, drugs, alcohol) lead to self-neglect and further decrease the priority placed upon oral health. 9,11,33,38 Lack of awareness of dental health status, low perceived need for dental treatment and having poor oral health expectations prevent homeless people from seeking dental care. 35,36,38 However, some authors report that this is not because oral health is not an important issue for homeless people.…”

“…9,11,33,38 Lack of awareness of dental health status, low perceived need for dental treatment and having poor oral health expectations prevent homeless people from seeking dental care. 35,36,38 However, some authors report that this is not because oral health is not an important issue for homeless people. Rather, oral health becomes low priority in face of other more imminent priorities.…”

Strengthening Social Interactions and Constructing New Oral Health and Health Knowledge: The Co-design, Implementation and Evaluation of A Pedagogical Workshop Program with and for Homeless Young People

“…Oral health, in this regard, is included in the CRFA and allows dentistry and oral health promotion to be key features in addressing the social aspects of psychosocial health and wellbeing, i.e., low self-esteem, reduced employment opportunities, or isolation. Despite these policy recommendations and CFRA interventions to prevent and/or solve health and oral health problems, young people experiencing homelessness continued to experience limited access and engagement with health and social care services [16,17]. Within a lexicon of mistrust, negativity, perceived stigmatization, and acknowledged awkwardness, [18,19], significant communication barriers exist between those utilizing and those providing oral health, health, and social services.…”