Abstract
BackgroundFront line providers of care are frequently lacking in knowledge on and sensitivity to social and structural determinants of underprivileged patients’ health. Developing and evaluating approaches to raising health professional awareness and capacity to respond to social determinants is a crucial step in addressing this issue. McGill University, in partnership with Université de Montréal, Québec dental regulatory authorities, and the Québec anti-poverty coalition, co-developed a continuing education (CE) intervention that aims to transfer knowledge and improve the practices of oral health professionals with people living on welfare. Through the use of original educational tools integrating patient narratives and a short film, the onsite course aims to elicit affective learning and critical reflection on practices, as well as provide staff coaching.MethodsA qualitative case study was conducted, in Montreal Canada, among members of a dental team who participated in this innovative CE course over a period of four months. Data collection consisted in a series of semi-structured individual interviews conducted with 15 members of the dental team throughout the training, digitally recorded group discussions linked to the CE activities, clinic administrative documents and researcher-trainer field notes and journal. In line with adult transformative learning theory, interpretive analysis aimed to reveal learning processes, perceived outcomes and collective perspectives that constrain individual and organizational change.ResultsThe findings presented in this article consist in four interactive themes, reflective of clinic culture and context, that act as barriers to humanizing patient care: 1) belief in the “ineluctable” commoditization of dentistry; 2) “equal treatment”, a belief constraining concern for equity and the recognition of discriminatory practices; 3) a predominantly biomedical orientation to care; and 4) stereotypical categorization of publically insured patients into “deserving” vs. “non-deserving” poor. We discuss implications for oral health policy, orientations for dental education, as well as the role dental regulatory authorities should play in addressing discrimination and prejudice.ConclusionHumanizing care and developing oral health practitioners’ capacity to respond to social determinants of health, are challenged by significant ideological roadblocks. These require multi-level and multi-sectorial action if gains in social equity in oral health are to be made.
Highlights
Developing approaches to linking research on social determinants of health to clinical practices is considered a key strategy for tackling health inequities, and represents a growing interest in both public health and primary care [1,2,3]
We address the following research questions: 1) How do course participants perceive themselves to have evolved as a result of their participation in the course? and 2) in relation to practice improvements discussed throughout the training, what are the perceived barriers to change and objections raised? Transformative effects of the course are the focus of a second article linked to this case study [20]
In response to the continuing education, many participants describe new understandings and increased sensitivity as to the causes of poverty and welfare, aspects of life on welfare, or the impact of poverty on certain patient health behaviors. We elaborate upon these perceived course effects, alongside reported changes in self-awareness and action on the part of certain participants, in a second publication dedicated to this case study [20]
Summary
Developing approaches to linking research on social determinants of health to clinical practices is considered a key strategy for tackling health inequities, and represents a growing interest in both public health and primary care [1,2,3]. A few initiatives have aimed to support general practitioners’ capacity to respond to patients’ social problems by facilitating collaboration with community referral specialists or with public health networks, members of which are trained in building cross-sector and multiagency relationships [4]. Notwithstanding their potential to help integrate social determinants into primary care practitioner agendas, a much more fundamental issue must be addressed alongside such collaboration-focused avenues. Front line providers of care are frequently lacking in knowledge on and sensitivity to social and structural determinants of underprivileged patients’ health. Through the use of original educational tools integrating patient narratives and a short film, the onsite course aims to elicit affective learning and critical reflection on practices, as well as provide staff coaching
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