Twenty-four oral health academics participated in the nominal group and six participants responded to questions sent via email. The participants were all involved in the teaching of oral health students, roles varied from clinical educators, lecturers, subject and course coordinators. Thematic analysis of the participant responses demonstrates positive views about health promotion and four main themes were identified: Health education, structure of dental practice, work in progress and collaboration. A brief description of the four themes can be found in table 3. These themes are reported below using participant words (in italics) to illuminate the themes. The data will be identified with a tag (Poll Everywhere, group discussion or email), which indicates where the data was collected.
Theme 1: Health education
All of the participants were able to identify a range of different approaches and ways to undertake health promotion, which included advocacy, working with communities, behaviour change, empowering, looking at the social determinants of health and education. However, collectively education, behaviour change and raising awareness of oral health issues were mentioned more times than the other health promotion strategies.
“Providing oral health messages to enable individuals and public to make informed choice about their health” Poll Everywhere
Participants were asked to comment on whether they believed that this was a true representation of health promotion within dentistry when further explanation was sort through email and all the participants agreed.
“Dentistry does see education & behaviour change as the main idea of health promotion”- question sent via email
A reason to explain this reliance on behavioural approaches is that clinicians feel more competent and confident in behaviour change and feel this is where they will make the biggest impact. Another factor that can influence this is how dental practice is structured, health education and behaviour change approaches work well in clinical practice where dental professionals have time one on one with patients.
“This is the area where clinicians feel they can add most benefit to behaviour change and that they are competent in this aspect of oral health promotion.” question sent via email
“We spend far more time chair side than actually trying to make policy change” question sent via email
Theme 2: Structure of dental practice
Participants discussed how dental practice is organised and structured as an influence on health promotion within the field. Currently a curative based treatment approach underpins the field of dentistry and oral health. This approach means more emphasis is placed on treatment than prevention.
“Private practice employers want "bums on seats" not community service”-Poll Everywhere
“Biomedical approach supported by agenda of professional guilds” – group discussions
There is a lack of funding (government and private insurance) for health promotion within dentistry. Several participants mentioned the structure of funding within dentistry, which limits health promotion initiatives and promotes clinical treatment. Government funding prioritises treating disease rather than preventing disease as health promotion does not produce instant measurable results.
“[No] insurance rebates for health promotion interventions” – Poll Everywhere
“Limited public resources - prioritised on treating current disease first” – Poll Everywhere
“Health promotion does not produce instant measurable results. Therefore, unable to measure benefit- Poll Everywhere
Due to the lack of funding participants felt there is limited time given to health promotion in practice and they required more time than they are given to plan and implement health promotion. As there is little to no funding provided by private health insurance for health promotion in clinical dental care, limited time can be spent on it. Time spent in clinical practice needs to equal revenue raised.
“In practice it is at times difficult for management to see value in a operator [sic] taking time out to provide health promotion to the community”- Poll Everywhere
Another factor mentioned by participants was the lack of value placed on health promotion within dentistry. Participants spoke about the public not being interested in health promotion and that they did not see the value for money in health promotion compared to treatment. A discussion also centred around the lack of prestige of health promotion interventions. Participants felt that clinical practice is view as prestigious where there is not the same esteem placed on health promotion.
“Lack of value placed on health- at the patient level, at a managerial level- public and private practice”- group discussion
“Health promotion is deemed as less prestigious than clinical practice” – Poll Everywhere
Theme 3: Work in progress
All participants discussed the progress made towards prevention in dentistry but did acknowledge that there was still more work that was needed. Some participants recognised that this change would take time and there would be a generational change. Participants discussed the need for the profession to move away from the biomedical approach towards a preventative/population approach. This move would need to occur within dental practice and also in university training.
“The Dental profession as a whole still needs to acknowledge the necessity to reorientate the health care system to a preventive approach rather than a curative approach” - question sent via email
Theme 4: Collaboration
Collaboration was identified by the participants as an important factor of health promotion and saw it as an opportunity to be capitalised on within dentistry. Participants highlighted the need for dental professionals to work with other professionals (allied health and education) in order to provide a more holistic approach. Most participants acknowledged that the risk factors for oral disease are shared with other health conditions, therefore collaborating with other health professionals to address the risk factors rather than conditions themselves would be beneficial for everyone. It was stressed by participants to make multidisciplinary practice work they need to build trust and collaboration needs to occur not just on dental issues but other health issues.
“Actively working with health professionals, integrating oral health as an underpinning thread of all health promotion ... Getting back to 'we’”- Poll Everywhere
“Interdisciplinary relationships will help deliver health promotion that has a common risk factor approach” - question sent via email
Although participants were interested in collaborations with practitioners outside of oral health, they were also interested in collaborating more with other oral health professionals and community members. Participants acknowledged the need to develop relationships with influential members of the community so that health promotion efforts would be embraced by the community.
“Linking health promotion strategies between BOH [Bachelor of Oral Health] students and MOD [Dentistry] students” -Poll Everywhere
However, participants commented on the perceived difficulties when collaborating with other health professionals. These were the lack of opportunities when working clinically due to health professionals tending to work in silos.
“Each health profession sees their area as more important (work in silos)” - question sent via email