In total seventy-six dental professionals completed the survey online, a response rate of 9.6%. Findings have been collated and presented in response to our research objectives.
Demographics
Respondents ranged in age between 18 and 64, the majority being in the 25–34 age range (51.3% n = 39) with an even representation from 35 to 64 years of age. 90.8% were female (n = 69) and 9.2% male (n = 7). Many respondents (35.5% n = 27) had qualified 6–10 years previously.
Primary role and primary place of work
The largest proportion of respondents worked within the Hospital dental service 55.3% (n = 42) and Community dental services 40.8% (n = 31) with a small proportion of respondents working within general dental practise. 3.9% (n = 3).
Professional roles varied widely. Consultants and speciality registrars within the Hospital dental services make up the greatest proportion of responders 44.7% (n = 34), followed by representatives from Community dental services 35.4%, (n = 27).
Respondents were predominantly dentists 96% (n = 73) with 2.6% response from dental therapists (n = 2) and one dental student.
Provision of Oral health education
Most respondents felt that diet is a major component in oral health 94.7% (n = 72), whilst 5.3% disagreed (n = 4). Similarly, 96% (n = 73) of respondents felt that it is the responsibility of dental professionals to provide dietary counselling, with 80.3% (n = 61) of respondents reporting that they have adequate knowledge to provide this advice. There were a small number who were less confident in provision of oral health education (19.7%, n = 15).
80.3% of respondents (n = 61), were aware of the impact of food insecurity on oral health yet only 36.8% of respondents (n = 28) had the confidence to identify individuals that may be experiencing food insecurity and 32.9% (n = 25) were comfortable discussing this further.
Responsibilities as dental professionals
Many of the respondents 81.6% (n = 62) agreed that dental teams have a role in advising patients who experience food insecurity. Four respondents disagreed with this statement.
When asked to leave free comments, some respondents indicated that there are more appropriate services to aid patients:
“I don’t think this is my job to have these discussions. There are other more appropriate services who can provide this information.”
“I do not believe it is the role of dentists to act as social workers. I would of course direct families I felt were struggling to services which may help with this, but I do not feel that dentists should be the ones to be leading these discussions.”
Barriers
Figure 1 demonstrates that of the perceived barriers when discussing food insecurity with families. This included lack of time 65.8% (n = 50), lack of confidence to ask patients 77.6% (n = 59), and difficulties in identification of patients 71% (n = 54). Lack of knowledge 73.4% (n = 56) and counselling skills 68.4% (n = 52) was also identified as a barrier.
Answers to free text responses.
Other factors identified were remuneration, lack of public policies, onward support, reluctance from families to discuss and not within my role.
Support for the dental team
In total, 32.9% (n = 25) of respondents were aware of services that families with food insecurity can access and 18.4% (n = 14) were able to signpost for further support.
Thematic analysis
The word map (Fig. 2) demonstrates the main themes emerging when asked, what would enable the dental team to initiate a conversation regarding food insecurity?
Word map to demonstrate common themes in qualitative responses.
Patients
Respondents identified the need to communicate appropriately and sensitively with suggestions such as:
“Just be open and ask as part of the assessment” and “If parents and children are engaged and relaxed, they may well talk about food insecurity. Being sensitive to the fact that people with food insecurity may feel stigmatised whilst appreciating the “rights of the child” “and “being able to offer practical, realistic and holistic advice is very important in a non-judgemental way.”
There was the need to discuss this topic in a structured way to screen appropriately and ensure consistency in approach, for example “Agreeing a set question to ask that wouldn’t offend anyone.” And “I think you need a sentence that you can use directly as a question to all patients as part of your history taking, that you use regularly so that you feel comfortable saying it, much like asking about social care involvement or raising the issues of very high or very low BMI.”
One respondent highlighted the need to tailor diet advice commenting “I do worry about the lack of knowledge and skills around cooking and nutrition are adding to problems in everyday life. I think nutrition and basic cooking skills should be required for all children in secondary education. However, if a family is unable to afford to cook from scratch it is important to be sensitive. I get very concerned when colleagues talk about sugar in baked beans as an oral health problem when it is irrelevant as such foods are highly nutritious cheap and ok to eat cold if the electricity has been cut off.”
Training
There was a recognition amongst respondents that additional training in this area is needed before they are confident to discuss further, ranging from “training by an expert in the field about how to tackle a difficult conversation i.e., how to frame the question and to know what to ask / give appropriate advice” with a need for training in counselling and role play.
Additional training within the Undergraduate and Postgraduate training curriculum was also suggested by one respondent. “I always bring up socioeconomic issues with trainees and ways to ask questions respectfully in order to help patients/parents. Many trainees are from affluent backgrounds and have literally no idea how many of our patients live. I have over the years developed ways to ask kindly and without judgement if patients have toothbrushes or have a poor diet and trainees/undergrads should have this as part of their training”.
Resources
Respondents suggested the need for posters in waiting rooms, information leaflets and understanding of onward referrals with one suggesting, “Having a good resource that I can then signpost the patient to. It feels quite empty if we start a conversation and give advice, but then cannot signpost to the appropriate services. If I had a website / leaflet / pathway that I can then signpost the patient to I would have more confidence in starting the discussion.”
Again, a small number of respondents felt this was not within their role and one respondent highlighted the need for “More media and government coverage – social acceptance and knowledge on food insecurity”.
Differences based on time since graduation
Finally, differences were explored based on number of years’ experience and confidence levels. Respondents across all ranges were confident in providing dietary counselling. (Fig. 3).
Answers to Likert Scale responses.
Figure 3 demonstrates that a larger proportion of respondents are confident to provide dietary counselling across each category, however more respondents disagreed with the statement who had recently qualified in the last 10 years 5.3% (n = 4). This is a small number however and cannot be used to generalise across the group. All groups believe that dental health education is important with a small minority early in their career 0-10 years 5.3% (n = 3) who do not believe that this is the case.
Figure 4 demonstrates, there is a greater proportion of the group who would disagree or strongly disagree that they have the confidence to discuss food insecurity, and this is consistent across all age ranges.
Answers to Likert Scale responses.
Again, there appears to be a varied opinion as to levels of responsibility especially in the cohort recently qualified.