1. Oral Health Promotion Jane Sixsmith Department of Health Promotion National University of Ireland, Galway

2. Acknowledgements Research Undertaken by Fionnuala Taylor Dillon, Sharon Friel, Cecily Kelleher, Jane Sixsmith With Janas Harrington, Maria Dineen, Eithne White, Ruth Boland, Maureen Death, Simon Comer

3. Context Sub section of Lots undertaken by Oral Health Services Research Centre, University Dental School and Hospital, Cork

4. Oral Health Promotion Any planned effort to build healthy public policies, create supportive environments, strengthen community action, develop personal skills or re-orientate health services in the pursuit of oral health goals (WHO,1986)

5. Main Concepts Equity and equality Empowerment Advocacy (Schou & Locker, 1997; WHO, 1986)

6. Levels of Influence Micro Level Individual socio-demographic and economic characteristics Meso level Interactions with other groups, social networks, institutions or dental health practices Macro Level Policy and culture

7. Special Needs those with medical, physical, developmental or psychological conditions who are at increased risk of developing oral health problems (Pan European Task Force, 1998) Those socially disadvantaged or excluded (Davis et al., 2000)

8. Special Needs Groups People with disabilities Older people in long term care Members of the Traveller community Refugees / asylum seekers Homeless people Medical card holders

9. Research Review of Oral Health promotion People with special needs perceptions of oral health and providers perceptions of people with special needs needs

10. Aims and Objectives

11. Oral Health Promotion Review To gather information on the structures, process and outcomes of oral health promotion / education initiatives and resources To identify performance indicators for programmes reviewed To identify success factors for oral health promotion To develop a future framework for action for oral health promotion

12. Special needs groups To explore the attitudes, knowledge and behaviour of special needs groups in relation to their oral health To identify the perceived availability, accessibility and acceptability of dental services for special needs groups To explore the attitudes, knowledge and behaviour of dental service providers towards special needs groups

13. Oral Health Research Special Needs GroupsOral Health Promotion/Education Review Focus Groups InterviewsPostal SurveyTelephone Interview Travellers People with disabilities General population Elderly people in residential care Homeless people Refugees / asylum seekers Dental personnel and non-dental personnel Key service personnel

14. Samples and Response Focus GroupsInterviewsPostal SurveyTelephone Interviews Special Needs GroupsOral Health Promotion Review Travellers N=30 People with disabilities and carers N=78 General population: Medical card holders N= 19 Non medical card holders N=21 Elderly people in long term care & carers N= 31 Homeless people N= 21 Refugees / asylum seekers N=22 Dental Personnel: Private and public dentists Dental nurses Hygienists Non Dental Personnel: H Promotion Managers Directors of Public Health Community Nutritionists Healthcare companies N= 360 (53%) Key Service Personnel N=22

15. Results

16. Oral Health Promotion Review Past Ad hoc Low priority of oral health Present Conducive policy Supportive environments Developing personal skills Re-orientation of services Future Community participation Conducive policy Supportive environments Re-orientate services

17. Special Needs Groups Importance of oral health Impact of oral health on daily living Knowledge of oral health Contributing factors Oral health services Sources of information Experiences of services Access Perceived effectiveness of service Barriers Service improvements

18. Importance of Oral Health Older people – no impact Carers of elders – social, eating Other groups – impact of oral ill health Social interaction Eating Health generally (general population)

19. Knowledge of Oral Health Causes of Oral Health Good oral hygiene practices Dietary factors Amount not frequency of sugar Visiting dentist Fluoride not identified by any group Causes of oral ill health Opposite of above Medication (older people, carers of those with disability)

20. Sources of Information Health Boards Dentist Media Family / Friends GP Support organisations Schools No need of info

21. Oral Health Information Generally treatment focused Oral hygiene Diet

22. Experiences General population Elders Homeless people Refugees / asylum seekers People with Disabilities Travellers

23. Barriers to Service Cost Physical access (to and within) Fear Lack of information No time / inconvenience Lack of perceived need

24. Perceived effectiveness of service Treatment Organisation

25. Accessed Services Health Board Clinics Private Dentist Dental Hospitals A&E Departments Hospital School

26. Service providers Contact with People with disabilities Elderly Travellers Homeless Refugees / asylum seekers Where? Health board clinic, general dental practice, hospital, school.

27. Identified oral health needs Regular use of dental services Improved oral health maintenance Health education Barriers to service provision Physical barriers Lack of time Long waiting lists Difficulty in accessing client group Difficulties in accessing general aneasthetic facilities Attitudes, beliefs and prejudices of staff + other clients

28. Service Improvements Education and training of staff Specialist posts for groups Improved physical environment Improved communication and greater access to information Increased funding

29. Oral Health Promotion Organisational Dedicated national oral health promotion policy with oral health integrated into other relevant strategy documents. Coherent strategic policy at regional level with formal structures for OHP Regional coordination of on going activity Inter-organisational Co-ordinated development of multisectorial working Intra organisational Co-ordinated development of skills necessary for effective OHP

30. Special Needs Groups Professional Co-ordinated integration of dental and other health services Training and increased awareness of needs Individual Accessible information oral health Service Societal Lack of access due to environmental barriers Lack of public concern for oral health

31. Conclusion