Special Care Dentistry in Brunei Darussalam: What are the experiences of service providers? - A qualitative study

Abstract

Background: The introduction of Special Care Dentistry specialty in Brunei Darussalam provides the opportunity to develop a care pathway for people with disability. However, little is known about how dental services for these group are organised presently and what barriers and enablers the providers faced in providing dental care services for people with special health care needs.

Aims: To explore and understand the concepts of disability, the current provision of dentistry for people with special care needs (PSCN), and the facilitators and barriers encountered through the experiences of service providers in Brunei Darussalam.

Method: A qualitative research method was used, and data were collected using semi-structured interviews informed by an a priori topic guide. A diverse sample of clinicians, clinical managers and the wider dental team were approached using purposive and snowball sampling. Participants were drawn from primary and secondary care settings. The data were analysed using thematic analysis. Two independent researchers coded the interviews and met to agree on the final thematic framework.

Results: 46 individuals were approached and N=22 interviews were conducted and completed. Of the 22 participants 73% (n=16) were women; n= 17 dentists of whom n=6 had specialist qualifications and n=4 had a managerial role, n=3 dental nurses, n=2 were from the wider dental team. The interviews were conducted in two phases: from December 2018 to January 2019 and in August 2019. Four main themes relating to SCD were identified; (1) Concepts of disability, (2) The workforce in SCD, (3) The current provisions of SCD and (4) Facilitators and Barriers of SCD. A broad range of people with disability were acknowledged, however the complexities of the disabilities in terms of impact on function was poorly understood, and there were obvious gaps in knowledge observed. There seemed to be an attributed hierarchy to disability, where older people were revered and some groups appeared to hidden/unseen. Facilitators identified were the primary care focus, structure and organisation in Brunei, their cultural context, medical collaboration and individual clinicians who made things work - the problem solvers. Barriers identified were the lack of formal care pathway, lack of reasonable adjustment to people with special care dental needs, and participant's attitudes and training needs for which their discomfort and fear lead to avoidance in providing care for these group - the avoiders.

Conclusions: The current structure and organisational focus on primary care has the potential for optimal configuration of the provision of service for people with disabilities. However structured training in disability awareness and provision of dental care to people with special care needs is required to support the development of a care pathway in Brunei. Furthermore, there is a need to empower the problem solvers, and to engage and support the avoiders to ensure its success.