A recent study on disability and oral health (DOH) found low prioritization and low oral health literacy among member states of the Association of Southeast Asian Nations (ASEAN) and suggests the need to train more dental providers.
Additionally, social perceptions remain a challenge in Special Care Dentistry (SCD) services in the region, and increased support at the state level is needed to improve DOH in ASEAN.
“This is the conundrum of a disadvantaged cohort, a neglected aspect of health, within poor communities,” the researchers said. “A deliberate multi-sector effort is paramount to internally align national strategies, in order to achieve equity for DOH in every ASEAN country.”
This study used a new quasi-qualitative survey distributed electronically to dentists with specialist DOH training in ASEAN within the International Disability and Oral Health Association network from September 2018 to June 2020. researchers then categorized “barriers” and “improvements” into five dimensions of health care.
Of the responses received from Brunei, Indonesia, Malaysia, Thailand, Singapore and the Philippines, 21 were deemed valid. [Proc Singap Healthc 2022;doi:10.1177/20101058221111579]
Health care providers rated adequate training (relevance) as the highest priority factor. On the other hand, patients considered low oral health literacy (ability to perceive) to be most important. Collectively, social perception was seen as a “major challenge in dental practices”.
Finally, the suggested “ways to collaborate” were categorized as follows: Engagement, Advocacy, Policy, Specialty, and Development.
Theory of change
“When implementing improvements for disadvantaged cohorts, one must consider whether the suggested solutions would indeed create the desired social impact (i.e. improved oral health among people with disabilities [PWD]),” the researchers said.
“This is further developed in the ‘theory of change’ concept,” they added. [Stanford Soc Innov Rev 2010;8:47-51]
Promoting public health is a possible target of the theory of change to address weak “perceptual capacity”, according to the researchers. Disability support communities, training institutions or health services could implement oral health training for caregivers.
Previous studies have shown how oral health education programs for healthcare providers and caregivers have been successful in improving long-term oral hygiene, particularly across different cultural landscapes and disability profiles. . [Int Dent J 1999;49:82-89; Community Dent Health 2015;32:137-142; Rev Odontol UNESP 2017;45:284-291;
J Intellect Dev Disabil 2012;50:219-232]
“This ‘theory of change’ needs to be person-centred to address the first step – ‘accessibility’ – [and] therefore stimulate later stages of health-seeking behaviors,” the researchers said. [https://apps.who.int/iris/handle/10665/44575; http://www.myhealth.gov.my/en/dental-treatment-home-possible/]
SCD as a specialty
Another common theme among survey responses was the commissioning of SCD as a recognized dental specialty, which was also mentioned as an area of collaboration for the ASEAN DOH community.
“In comparing financial structures, such as publicly funded versus privately funded programs, levels of health literacy, and different stages of health system development, the limited literature implicates [that] there could be considerable difficulties when implementing a specialty such as SCD in the public health system,” the researchers said. [J Int Oral Health 2020;12:1-7;
Tzu Chi Med J 2019;31:232-239]
It should be noted that the UN Convention on the Rights of Persons with Disabilities has been ratified by all ASEAN member states.