In this study we examined the experiences of “healthy” individuals who attended a BP screening for hypertension in a dental health care setting. We found that the participants described the experiences as “No big deal” and highlighted the fact that it was convenient and easy to have their BP measured during a visit to the dentist. I
n addition, it created an awareness of health, which was enhanced by performing BP monitoring at home. It was also educational, as it led to reflection on health and lifestyle. Another aspect that was highlighted in the interviews was possible dental fear, which could affect the BP measurement. As previously pointed out, the screening can result in false positive results, called White coat hypertension [15, 16]. This phenomenon can lead to unnecessary meetings, overcrowding in health care and some patients experiencing needless concern about their health . However, despite their fear of dentists, it emerged that the participants found it positive to have their BP checked during the dental visit.
Surprisingly, screening BP for hypertension does not seem to create as much anxiety as cancer screening [9, 10, 11] and cardiovascular disease does not appear to be a concern. This may be because high BP and hypertension are not perceived as a disease, but a chronic condition . The participants did not experience any major concern about the fact that at times their BP was high, such as during a dental visit. The home BP measurement probably helped to calm the participants, thus making them less anxious. In addition, hypertension is mainly a condition caused by an affluent lifestyle. The participants felt that it was good to know if they were in the risk group, as they believed that they could deal with the condition themselves through lifestyle changes or medication.
Previous research has addressed the issue of “labelling” and suggested that hypertension labelling might evoke fear of a serious disease in patients [19–21]. It has also been demonstrated that living with a chronic condition can be stigmatizing depending on the visibility of the condition and whether it is congenital or acquired. . Furthermore, it may lead to poorer physical and mental health as well as a limited life . The results of this study did not indicate any of these concerns. Instead, the findings clearly showed that the participants appreciated preventive healthcare measures and considered examinations and screening important. They expressed that it was valuable to know if they were in the risk zone, as early detection provides an opportunity to do something about it as well as stating that it was easy and educational to check their BP at home.
In recent years, a great deal has changed in both society and health care. The healthcare organization has altered its approach from seeing patients as passive recipients of care to encountering them as active partners with the right to be involved in and take responsibility for their own health. Self-care is mostly described as tasks performed by healthy persons to prevent the onset of an illness, while self-management involves tasks performed on a day-to-day basis to control or reduce the impact of an illness . Self-management could help patients to achieve BP control and prevent complications such as heart failure and stroke, thus improving their overall health status . This form of self-care for monitoring BP becomes lifestyle-centred and contextually anchored in the individual's own daily activities . This new perspective poses a challenge to promote and develop such self-care initiatives.
To enable broad preventive public health work, dental care in collaboration with the healthcare system could carry out regular medical screening to identify risk groups at an early stage, thereby reducing both oral and general ill health in the population.
The interviews clearly revealed that regular BP monitoring was desirable as an extra precaution because the participants believed it was important to know if they were in the risk zone, even at an early stage of the condition. The aim of BP screening in dental care is to identify patients at risk, not to make medical diagnoses. Therefore, it is essential to have well-established cooperation with primary healthcare for optimal management of opportunistic medical screening .
Limitations and strengths
Studies on individuals’ experiences of being offered BP screening are more or less non-existent. Therefore, should medically screening in dentistry be introduced, it is important to describe individuals’ experiences of screening for hypertension. Our results should be considered in the context of some limitations and strengths.
The first limitation is that because of the Covid-19 situation, most interviews were conducted by telephone.
It is possible that the participants experienced a distance between themselves and the interviewer and that a personal meeting would have led to a different result.
However, the authors are of the opinion that the data from the telephone interviews do not differ from those of the face-to-face interviews. The second limitation is that the participants were recruited from a medical screening study where the aim was to identify a link between oral status and cardiovascular risk factors so the focus may not have been on BP measurement. Finally, we know nothing about the participants’ socio-economic background, which could affect the result. There is also a possibility that those who agreed to participate are generally more positive about screening and prevention, which could also have an impact on the result. All interviews ended with a question about whether the participant wished to add anything.
Such a concluding question strengthens reliability, as it can provide additional relevant information that corresponds to the aim . A strength of the present study is the variation among the participants in terms of age, gender and screening outcome, which can contribute to a richer variation in experiences .
Another strength is the difference in the authors' knowledge base, pre-understanding and disciplines, which can be said to enhance the analysis process.