Ideological roadblocks to humanizing dentistry, an evaluative case study of a continuing education course on social determinants of health

International Journal for Equity in Health

Research

Alissa Levine¹  Christophe Bedos²  Martine C Lévesque³ 

[1]Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montréal, Canada

[2]Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montréal, Canada

[3]Institut de recherche en santé publique de l’Université de Montréal (IRSPUM), Montréal, Canada

[4]École de santé publique de l’Université de Montréal, Faculté de médecine de l’Université de Montréal, Montréal, Canada

[5]Division of Oral Health and Society, Faculty of Dentistry, McGill University, Montréal, Canada

关键词: Oral Health;    Social Determinant;    Social Assistance;    Discriminatory Practice;    Dental Team;   

DOI  :  10.1186/s12939-015-0170-2

 received in 2014-10-30, accepted in 2015-04-21,  发布年份 2015

来源: Springer

【 摘 要 】

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.

【 授权许可】

CC BY   
© Lévesque et al.; licensee BioMed Central. 2015