Improving access to dental services and promoting oral health for adults experiencing homelessness in a non-capital city area of Victoria : a multi methods study

In Australia, homeless adults suffer high levels of untreated oral disease and their oral health related quality of life (OHRQoL) is poor. Having a dental check-up on an annual basis is recommended by dentists, allows preventive dental treatments to be performed and leads to better oral health outcomes. Another means to improve oral health is to increase levels of oral health literacy. The OHRQoL of adults experiencing homelessness is improved following comprehensive dental care. Thus, facilitating regular dental visiting for check-ups, providing comprehensive dental care and promoting oral health will lead to improved oral health and a better OHRQoL for adults experiencing homelessness. However, even when there is a perceived need for dental care, homeless adults tend not to visit the dentist and instead wait until they have a dental problem. This suggests that certain barriers prevent adults experiencing homelessness from accessing dental care. In Australian capital cities, barriers to dental care including the cost of dental care, a lack of motivation, not knowing where to seek care, fear, a lack of transport and a lack of suitable facilities have been identified. In addition to adults experiencing homelessness, people living outside of Australian capital cities also have poor oral health. Little is known about the oral health of homeless adults living outside of capital cities or the factors that influence their access to dental care. To improve the oral health of homeless adults who live in a non-capital city area of Victoria it will be important to identify the barriers that prevent their access to and uptake of dental care and develop strategies to overcome them. The aim of this research was to design a program to be used by dental service providers in a non-capital city area of Victoria that would facilitate visiting for dental check-ups and preventive dental care by adults experiencing homelessness and enable the promotion of oral health. A two-phase qualitative multi-method research design was used to achieve this aim. Phase 1 included a transcendental phenomenological study involving adults experiencing homelessness and a qualitative descriptive study involving homelessness and housing support workers. The multimethod design explored homeless adults' dental care pathways and the barriers and enablers of dental care, as perceived by homelessness-support workers. Study findings were categorised using a patient-centred access to health care framework. The findings of Phase 1 were used to inform Phase 2 of the study. Phase 2 of the research involved using the findings from Phase 1 to design a dental program that would facilitate access to and uptake of dental care by adults experiencing homelessness and enable oral health promotion. The dental program design was presented to a group of local stakeholders and its feasibility assessed. Factors influencing access to and uptake of dental care were identified. Barriers included; the organisation of government-funded dental services, the multiple competing needs of adults experiencing homelessness, the cost of care, the fear of being judged, anxiety and managing appointments. Enablers included; providing outreach dental services, the use of Priority Access Cards (PACs) and co-locating dental health services with other health and support services. A two-stage dental program was designed that utilised outreach dental services to provide dental care and advice, PACs to facilitate access to dental services, the provision of free oralhygiene products, drop-in dental appointments, and dental services co-located with other health services. Outreach dental services should be organised in collaboration with homelessness-service providers including those providing mental health services. Dental services should focus on building trust and provide care and advice at convenient locations. Stakeholders believed the dental program was feasible but highlighted that it also needed to be sustainable. The barriers to dental care for adults experiencing homelessness in a non-capital city area of Victoria are complex and include the organisation of government-funded dental services. The dental program designed as a result of this study incorporated outreach dental services, allowing drop-in dental visits, PACs, free dental care and products, dental services co-located with other health services and represents a change from the traditional dental practice model. The dental program designed in this study will facilitate access to and uptake of dental care for adults experiencing homelessness in a non-capital city area of Victoria and enable the promotion of oral health which will lead to better oral health outcomes and an improved OHRQoL.