Abstract:To advance our understanding of inclusion oral health and to address the impact of social exclusion upon oral health, this group of papers sets out to provide an argument for the need for social and community-based interventions, theoretically underpinned by pluralistic definitions of evidence-based practice and the radical discourse of health promotion for those experiencing exclusion. Using the definition and framework of inclusion oral health, these papers illustrate the requirement for mixed-methods resear… Show more
“…Wright presented a conference paper on intersectionality, oral health and tobacco use focusing on Black people in the United States 36 . Freeman 37 and our own commissioned narrative review 17 considered intersectionality in the context of social inclusion, othering and stigmatization.…”
Section: What Do We Know About the Application Of Intersectionality Imentioning
confidence: 99%
“…Their stories informed the development of culturally sensitive oral health promotion involving members of the community as actors in an audio‐visual tool 57 . Co‐production has challenges, however, which could be the reason why there are few examples of co‐produced interventions addressing oral health inequalities 37,61,62 . Barriers include dominant expert‐based research processes, 54 differing priorities, 63 and a lack of knowledge and understanding about what co‐production means 64,65 …”
Section: What Do We Know About the Application Of Intersectionality Imentioning
This paper is the second of two reviews that seek to stimulate debate on new and neglected avenues in oral health research. The first commissioned narrative review, “Inclusion oral health: Advancing a theoretical framework for policy, research and practice”, published in February 2020, explored social exclusion, othering and intersectionality. In it, we argued that people who experience social exclusion face a “triple threat”: they are separated from mainstream society, stigmatized by the dental profession, and severed from wider health and social care systems because of the disconnection between oral health and general health. We proposed a definition of inclusion oral health and a theoretical framework to advance the policy, research and practice agenda. This second review delves further into the concept of intersectionality, arguing that individuals who are socially excluded experience multiple forms of discrimination, stigma and disadvantage that reflect intersecting social identities. We first provide a theoretical and historical overview of intersectionality, rooted in Black feminist ideologies in the United States. Our working definition of intersectionality, requiring the simultaneous appreciation of multiple social identities, an examination of power and inequality, and a recognition of changing social contexts, then sets the scene for examining existing applications of intersectionality in oral health research. A critique of the sparse application of intersectionality in oral health research highlights missed opportunities and shortcomings related to paradigmatic and epistemological differences, a lack of robust theoretically engaged quantitative and mixed methods research, and a failure to sufficiently consider power from an intersectionality perspective. The final section proposes a framework to guide future oral health research that embraces an intersectionality agenda consisting of descriptive research to deepen our understanding of intersectionality, and transformative research to tackle social injustice and inequities through participatory research and co‐production.
“…Wright presented a conference paper on intersectionality, oral health and tobacco use focusing on Black people in the United States 36 . Freeman 37 and our own commissioned narrative review 17 considered intersectionality in the context of social inclusion, othering and stigmatization.…”
Section: What Do We Know About the Application Of Intersectionality Imentioning
confidence: 99%
“…Their stories informed the development of culturally sensitive oral health promotion involving members of the community as actors in an audio‐visual tool 57 . Co‐production has challenges, however, which could be the reason why there are few examples of co‐produced interventions addressing oral health inequalities 37,61,62 . Barriers include dominant expert‐based research processes, 54 differing priorities, 63 and a lack of knowledge and understanding about what co‐production means 64,65 …”
Section: What Do We Know About the Application Of Intersectionality Imentioning
This paper is the second of two reviews that seek to stimulate debate on new and neglected avenues in oral health research. The first commissioned narrative review, “Inclusion oral health: Advancing a theoretical framework for policy, research and practice”, published in February 2020, explored social exclusion, othering and intersectionality. In it, we argued that people who experience social exclusion face a “triple threat”: they are separated from mainstream society, stigmatized by the dental profession, and severed from wider health and social care systems because of the disconnection between oral health and general health. We proposed a definition of inclusion oral health and a theoretical framework to advance the policy, research and practice agenda. This second review delves further into the concept of intersectionality, arguing that individuals who are socially excluded experience multiple forms of discrimination, stigma and disadvantage that reflect intersecting social identities. We first provide a theoretical and historical overview of intersectionality, rooted in Black feminist ideologies in the United States. Our working definition of intersectionality, requiring the simultaneous appreciation of multiple social identities, an examination of power and inequality, and a recognition of changing social contexts, then sets the scene for examining existing applications of intersectionality in oral health research. A critique of the sparse application of intersectionality in oral health research highlights missed opportunities and shortcomings related to paradigmatic and epistemological differences, a lack of robust theoretically engaged quantitative and mixed methods research, and a failure to sufficiently consider power from an intersectionality perspective. The final section proposes a framework to guide future oral health research that embraces an intersectionality agenda consisting of descriptive research to deepen our understanding of intersectionality, and transformative research to tackle social injustice and inequities through participatory research and co‐production.
“…(Thomson and Ma 2014; GBD 2017 Oral Disorders Collaborators et al 2020). Ecosocial theory and intersectionality provide useful and holistic frameworks for addressing issues in health and now in oral health (Freeman 2020; Muirhead et al 2020). These 2 approaches are synergistic, offering important opportunities to reconceptualize research and practice.…”
Section: Discussionmentioning
confidence: 99%
“…Oral care should be closely aligned with culturally appropriate and community-centered primary care that highlights the importance of centring the consumer voice in decisions related to their care, enhancing understanding that every older person has a different perspective (Freeman 2020). Some of the approaches to care (e.g., interdisciplinary) then fit in our understanding from research.…”
Poor oral health affects the health and well-being of older adults in many ways. Despite years of international research investigating poor oral health among older adults, it has remained a largely unresolved problem. The aim of this article is to explore the combination of 2 key frameworks, ecosocial theory and intersectionality, to guide our exploration and understanding of oral health and aging and help inform research, education, policy, and services. Proposed by Krieger, ecosocial theory is concerned with the symbiotic relationship among embodied biological processes and social, historical, and political contexts. Building on the work of Crenshaw, intersectionality explores how social identities such as race, gender, socioeconomic status, and age interconnect in ways that can enhance privilege or compound discrimination and social disadvantage. Intersectionality offers a layered understanding of how power relations reflected in systems of privilege or oppression influence an individual’s multiple intersecting social identities. Understanding this complexity and the symbiotic relationships offers an opportunity to reconsider how inequities in oral health for older adults can be addressed in research, education, and practice and increase the focus on equity, prevention, interdisciplinary care, and use of innovative technology.
“…2 As a result, many groups in society are likely to experience some degree of social exclusion and are oftentimes referred to homogenously as 'vulnerable groups' . 2,3 In the UK, the concept of inclusion health has been developed to describe approaches to address the complex cliff edge of extremely poor health outcomes, typically experienced by people who are socially excluded. 4 More recently, an inclusion oral health framework has been proposed that made recommendations for actions for service delivery and research.…”
Introduction
Poor oral health and barriers to accessing dental services are common among people experiencing social exclusion. This population experience a disproportionate and inequitable burden of oral disease. A small number of dental services have published models of care that target this population, but no national surveys have been conducted.
Aims
This study aims to identify what types of services are providing dental and oral healthcare for people experiencing social exclusion in England and the models of delivery adopted by these services.
Methods
A snowballing sampling strategy was used to identify services that provide targeted for adults experiencing social exclusion. The study used a survey to collect data about the location, service models and barriers and enablers of these services.
Results
In total, 74 responses from different services met the inclusion criteria for the study. Seventy one were included in the mapping exercise and 53 provided free-text comments that contributed to an understanding of barriers and enablers of services.
Discussion
Most services operated to meet the needs of the mainstream population and described inflexibilities in their service design models as barriers to providing care for socially excluded groups.
Conclusion
Limitations of current models of service delivery create frustrations for providers and people experiencing social exclusion. Creative commissioning and organisational flexibility are key to facilitating adaptable services.
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