Barriers and facilitators to dental care during pregnancy: a systematic review and meta-synthesis of qualitative studies

Some barriers to dental treatment during pregnancy are poorly understood, especially those related to psychosocial factors, which are better explored in qualitative studies. The aim of this systematic review was to explore the barriers and facilitators to dental care during pregnancy through a thematic synthesis of qualitative studies. Qualitative or mixed-methods studies published in English, Portuguese, Spanish and French, from 2000 to 2016, were included. The search strategies were conducted in PubMed, Scopus, Web of Science, LILACS, BBO and CINAHL. To evaluate the quality of the studies, we used the Critical Appraisal Skills Programme tool. Thematic synthesis was performed in order to interpret and summarize the results. From 2,581 screened studies, ten were included in the synthesis. We found 14 analytical themes related to barriers and facilitators to dental care during pregnancy that interacted in complex ways: physiological conditions, low importance of oral health, negative stigma regarding dentistry, fear of/anxiety toward dental treatment, mobility and safety, financial barriers, employment, time constraints, social support, lack of information, health professionals’ barriers, family and friends’ advice, beliefs and myths about the safety of dental treatment. Myths and beliefs about oral health and dental treatment during pregnancy appear to be the most frequent barriers, both to pregnant women and to dentists or other health professionals. The findings of this review may support new studies, especially to test intervention protocols and to guide effective public policies for the promotion of oral health during pregnancy.

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General practitioners’ perspectives on the prevention of cardiovascular disease: systematic review and thematic synthesis of qualitative studies

BMJ Open ◽

10.1136/bmjopen-2017-021137 ◽

2018 ◽

Vol 8 (11) ◽

pp. e021137 ◽

Cited By ~ 5

Author(s):

Irene Ju ◽

Emily Banks ◽

Bianca Calabria ◽

Angela Ju ◽

Jason Agostino ◽

...

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

General Practitioners ◽

Health Professionals ◽

Qualitative Studies ◽

Patient Acceptance ◽

Prescribe Medication ◽

Primary Role ◽

Thematic Synthesis ◽

Cvd Prevention

ObjectiveCardiovascular disease (CVD) is a leading cause of morbidity and mortality globally, and prevention of CVD is a public health priority. This paper aims to describe the perspectives of general practitioners (GPs) on the prevention of CVD across different contexts.DesignSystematic review and thematic synthesis of qualitative studies using the Enhancing Transparency of Reporting the Synthesis of Qualitative research (ENTREQ) framework.Data sourcesMEDLINE, Embase, PsycINFO and CINAHL from database inception to April 2018.Eligibility criteria for selecting studiesWe included qualitative studies on the perspectives of GPs on CVD prevention.Data extraction and synthesisWe used HyperRESEARCH to code the primary papers and identified themes.ResultsWe selected 34 studies involving 1223 participants across nine countries. We identified six themes: defining own primary role (duty to prescribe medication, refraining from risking patients’ lives, mediating between patients and specialists, delegating responsibility to patients, providing holistic care); trusting external expertise (depending on credible evidence and opinion, entrusting care to other health professionals, integrating into patient context); motivating behavioural change for prevention (highlighting tangible improvements, negotiating patient acceptance, enabling autonomy and empowerment, harnessing the power of fear, disappointment with futility of advice); recognising and accepting patient capacities (ascertaining patient’s drive for lifestyle change, conceding to ingrained habits, prioritising urgent comorbidities, tailoring to patient environment and literacy); avoiding overmedicalisation (averting long-term dependence on medications, preventing a false sense of security, minimising stress of sickness) and minimising economic burdens (avoiding unjustified costs to patients, delivering practice within budget, alleviating healthcare expenses).ConclusionsGPs sought to empower patients to prevent CVD, but consideration of patients’ individual factors was challenging. Community-based strategies for assessing CVD risk involving other health professionals, and decision aids that address the individuality of the patient’s health and environment, may support GPs in their decisions regarding CVD prevention.

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SAT0643-HPR NURSE-LED CARE FROM THE PERSPECTIVE OF PEOPLE WITH EARLY RHEUMATOID ARTHRITIS: A QUALITATIVE SYSTEMATIC REVIEW

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.502 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1280.2-1281

Author(s):

A. M. T. Sweeney ◽

C. Mccabe ◽

C. Flurey ◽

J. Robson ◽

A. Berry ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Systematic Review ◽

Systematic Reviews ◽

Qualitative Studies ◽

Easy Access ◽

Nurse Specialist ◽

Care Needs ◽

Thematic Synthesis ◽

Early Ra ◽

Qualitative Systematic Review

Background:Nurse-led care has been shown to be clinically effective and cost effective in rheumatoid arthritis (RA) but the role of the nurse in early RA is not well defined. Evidence for processes of care in RA is limited and it is not known how well rheumatology nurse-led clinics meet care needs of people with early RA.Objectives:The aim of this study was to develop an understanding of rheumatology nurse-led care from the perspective of people with early RA.Methods:A qualitative systematic review was conducted. The review protocol is published in the International prospective register of systematic reviews.In March 2019, the following databases were searched: MEDLINE, EMBASE, CINAHL, PsycINFO and OpenGrey. Due to lack of studies in early RA this review included adults with early and established inflammatory arthritis, qualitative studies with data on patients’ perspectives of nurse-led care, published in peer-reviewed journals in English between 2010 and 2019. Two reviewers screened titles, abstracts and full texts. Data were extracted and managed in tables. Joanna Briggs Institute Critical Appraisal Checklist was used for quality assessment of the included studies. A thematic synthesis was undertaken using the framework of Thomas and Harden.1Results:The search identified 1034 records. After screening and assessing for eligibility, 8 qualitative studies were included in the review (133 patients), 2 studies included people with early RA. Three main themes were identified (Figure 1).Figure 1.Themes of nurse-led care from the perspective of people with RAProviding knowledge and skill. This theme delineated rheumatology nursing as providing professional expertise in the planning and delivery of care. The rheumatology nurse-led service included easy access via telephone helpline, consultations with the clinical nurse specialist for assessment of disease activity and care needs, planning of care, disease information and education, supporting self-management, and referral to rheumatologist and the multi-disciplinary team. People with RA highly valued the nurse expertise and specialist knowledge provided at nurse-led clinics.‘She was very good at informing me, so I have only praise for this ... because I have never had it like this before’. (Person with early RA).Using a person-centred approach.This theme showed nurse-led care using a person-centred approach combined with empathy and good communication skills, which created a good therapeutic environment. People with RA appreciated the person-centeredness, empathy and involvement of the nurse. ‘She is very sensitive. She can see if I am feeling bad and comes straight to me and asks: “How are you today?” ...You are treated and taken seriously’. (Person with early RA).Meeting patients‘ care needs. This theme presented nurse-led care as creating a sense of being empowered and psychologically supported in the management of RA and its impact. Nurse-led care made people with RA feel cared for, secure and confident. It added value to rheumatology care and made care complete.‘The thought of sticking a needle into my own stomach... it felt a bit like I would never manage to do that. However, they have been absolutely wonderful here ... and now I can do it myself’. (Person with early RA).Conclusion:Nurse-led care for people with RA is characterised by provision of rheumatology expertise using a person-centred approach, and patients‘ holistic care needs are being met. This study found a dearth of literature on perceptions of nurse-led care in people with early RA, which highlights the need for further research in this population.References:[1]Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews.BMC Med Res Methodol2008; 8: 45.Disclosure of Interests:Anne-Marie Tetsche Sweeney: None declared, Candy McCabe: None declared, Caroline Flurey: None declared, Joanna Robson: None declared, Alice Berry: None declared, Pamela Richards: None declared, Mwidimi Ndosi Grant/research support from: Bristol Myers Squibb, Consultant of: Janssen, Pfizer

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What are the barriers and facilitators to exercise and physical activity uptake and adherence among South Asian older adults: A systematic review of qualitative studies

Preventive Medicine ◽

10.1016/j.ypmed.2012.07.016 ◽

2012 ◽

Vol 55 (4) ◽

pp. 276-284 ◽

Cited By ~ 62

Author(s):

Maria Horne ◽

Stephanie Tierney

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Older Adults ◽

South Asian ◽

Qualitative Studies ◽

Barriers And Facilitators

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A systematic review and thematic synthesis of qualitative studies on maternal emergency transport in low- and middle-income countries

International Journal of Gynecology & Obstetrics ◽

10.1016/j.ijgo.2013.03.030 ◽

2013 ◽

Vol 122 (3) ◽

pp. 192-201 ◽

Cited By ~ 21

Author(s):

Amie Wilson ◽

Sarah Hillman ◽

Mikey Rosato ◽

John Skelton ◽

Anthony Costello ◽

...

Keyword(s):

Systematic Review ◽

Qualitative Studies ◽

Middle Income ◽

Thematic Synthesis ◽

Middle Income Countries ◽

Emergency Transport ◽

Low And Middle Income

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The effect of multimodal comprehensive care methodology training on oral health care professionals’ empathy for patients with dementia

BMC Medical Education ◽

10.1186/s12909-021-02760-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Masaki Kobayashi ◽

Mio Ito ◽

Yasuyuki Iwasa ◽

Yoshiko Motohashi ◽

Ayako Edahiro ◽

...

Keyword(s):

Health Care ◽

Oral Health ◽

Health Professionals ◽

Health Care Professionals ◽

Dental Treatment ◽

Oral Care ◽

Training Programme ◽

Comprehensive Care ◽

Dental Hygienists ◽

People With Dementia

Abstract Background The prevalence of oral diseases in people with dementia has increased, and patients with dementia have worse oral health than people without dementia. However, in the provision of oral care, these patients often exhibit care-resistant behaviours. Empathy is important for health care professionals who provide dental care for people with dementia. A study was conducted to assess whether a multimodal comprehensive care methodology training programme, Humanitude™, was associated with an improvement in empathy for people with dementia among oral health care professionals. Methods This research was a pre-post prospective study. A total of 45 dentists and dental hygienists participated in a 7-h multimodal comprehensive care methodology training programme. Participants’ empathy for their patients was evaluated with the Jefferson Scale of Physician Empathy-Health Professionals Version (JSPE-HP) before the training and 1 month after the training (primary outcome). Each participant listed 3 patients with poor oral health due to the refusal of usual oral care or dental treatment from his or her clinical practice. The oral health of the 3 care-resistant patients listed by each participant was evaluated by the Oral Health Assessment Tool (OHAT) before the training and 1 month after the training (secondary outcome). Results The post-training response rate was 87% (21 dentists and 18 dental hygienists). From pre-training to post-training, the multimodal comprehensive care methodology training significantly increased the mean empathy score (from 113.97 to 122.95, P < 0.05, effect size = 0.9). Regardless of gender, profession and years of clinical experience, all post-training subgroup scores were higher than the pre-training subgroup scores. The tongue, natural teeth, and oral hygiene scores of patients with dementia who resisted usual oral care or dental treatment, as assessed by the OHAT, were significantly improved compared with those before the training. Conclusions The multimodal comprehensive care methodology training was associated with an improvement in oral health professionals’ empathy for patients with dementia. These findings suggest that randomized controlled trials with large sample sizes will be needed. Trial registration UMIN Clinical Trials Registry (UMIN-CTR), UMIN000041687. Registered 4 September 2020 – Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047586

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The lived experience of people with obesity: study protocol for a systematic review and synthesis of qualitative studies

Systematic Reviews ◽

10.1186/s13643-021-01706-5 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Emma Farrell ◽

Marta Bustillo ◽

Carel W. le Roux ◽

Joe Nadglowski ◽

Eva Hollmann ◽

...

Keyword(s):

Systematic Review ◽

Lived Experience ◽

Health Care Providers ◽

Evidence Synthesis ◽

Qualitative Studies ◽

Qualitative Evidence Synthesis ◽

Care Providers ◽

Critical Appraisal Skills ◽

Health Complications

Abstract Background Obesity is a prevalent, complex, progressive and relapsing chronic disease characterised by abnormal or excessive body fat that impairs health and quality of life. It affects more than 650 million adults worldwide and is associated with a range of health complications. Qualitative research plays a key role in understanding patient experiences and the factors that facilitate or hinder the effectiveness of health interventions. This review aims to systematically locate, assess and synthesise qualitative studies in order to develop a more comprehensive understanding of the lived experience of people with obesity. Methods This is a protocol for a qualitative evidence synthesis of the lived experience of people with obesity. A defined search strategy will be employed in conducting a comprehensive literature search of the following databases: PubMed, Embase, PsycInfo, PsycArticles and Dimensions (from 2011 onwards). Qualitative studies focusing on the lived experience of adults with obesity (BMI >30) will be included. Two reviewers will independently screen all citations, abstracts and full-text articles and abstract data. The quality of included studies will be appraised using the critical appraisal skills programme (CASP) criteria. Thematic synthesis will be conducted on all of the included studies. Confidence in the review findings will be assessed using GRADE CERQual. Discussion The findings from this synthesis will be used to inform the EU Innovative Medicines Initiative (IMI)-funded SOPHIA (Stratification of Obesity Phenotypes to Optimize Future Obesity Therapy) study. The objective of SOPHIA is to optimise future obesity treatment and stimulate a new narrative, understanding and vocabulary around obesity as a set of complex and chronic diseases. The findings will also be useful to health care providers and policy makers who seek to understand the experience of those with obesity. Systematic review registration PROSPERO CRD42020214560.

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O impacto da Covid-19 na Odontologia – revisão sistemática

Full Dentistry in Science ◽

10.24077/2021;1246-1522 ◽

2021 ◽

Vol 12 (46) ◽

pp. 15-22

Author(s):

Ana de Lourdes Sá de Lira ◽

Francisca Janiele de Sousa

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Dental Care ◽

Dental Treatment ◽

Dental Trauma ◽

Urgent Care ◽

Inclusion Criteria ◽

Dental Clinics ◽

Mode Of Transmission ◽

Irreversible Pulpitis

This study aimed to review, qualify and summarize the existing evidence on associations and risk factors for Covid-19 during dental treatment and dentists’ knowledge about these risks. After being registered with PROSPERO, the systematic review was carried out in accordance with the PRISMA guidelines, with searches in electronic databases, in specific journals, manual searches and Google Scholar, without language restrictions, from December 2019 to August 2020. Two questions were asked to be investigated: did patients seek dental care in the emergency room and do dentists know the symptoms and the mode of transmission of Covid-19, feeling qualified to attend them? Only 6 articles were included because they met all defined inclusion criteria. It was concluded that endodontic urgencies and emergencies with symptomatic irreversible pulpitis are the most common, consisting of a much higher proportion of dental emergencies during Covid-19 epidemic compared with dental trauma and no-urgent care. Although dentists are aware of the symptoms, mode of transmission, infection controls, and measures in dental clinics, they do not feel confident about the correct measures to be taken to prevent Covid-19 for their staff and patients.

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