Twenty-four people participated in the nominal group and six participants responded to questions sent via email. The participants were all involved in the teaching of oral health students, roles varied from clinical educators, lecturers, subject and course coordinators. Thematic analysis of the participant responses demonstrates positive views about health promotion and possible opportunities for health promotion in practice. These themes are reported below using participant words (in italics) to illuminate the themes. The data will be identified with a tag (Polleverywhere, group discussion or email), which indicates where the data was collected. There was also a range of perceived barriers faced by oral health educators when trying to implement health promotion, such as, the curative approach to dentistry, lack of funding and time. The participants had ideas about how these barriers could be overcome. Using a thematic approach to data analysis of participant responses through the Polleverywhere, group discussions and email responses four main themes were identified.
Defining health promotion
Overall, the way health promotion was viewed and defined was holistic. All of the participants believed that health promotion was about improving health and ways to do so included advocacy, working with communities, behaviour change, empowering, looking at the social determinants of health and education. When asked what health promotion is, participants demonstrated a holistic understanding, however, collectively education and behaviour change were mentioned more times than the other health promotion strategies.
Participants were asked to comment on whether they believed that this was a true representation of health promotion within dentistry when further explanation was sort through email and all the participants agreed.
“Dentistry does see education & behaviour change as the main idea of health promotion”- question sent via email
A range of reasons were mentioned by participants in the email responses about why this is the case. They included: training at university is directed at education and behaviour change; there is a lack of support for other types of health promotion; clinicians feel more competent in behaviour change and feel this is where they will make the biggest impact and that spending time within a clinical setting is limiting to health promotion efforts.
“This probably stems from curriculum focus during their university training”- question sent via email
Opportunities
The participants discussed possible opportunities for health promotion in practice. These opportunities included; collaborating with health professionals and primary and secondary educators, capacity building for professionals outside of dentistry and innovative strategies including the use of social media and mass media.
Collaboration was identified by the participants as an important factor for developing health promotion opportunities. Participants highlighted the need for dental professionals to work with other professionals (allied health and education) in order to provide a more holistic approach.
“Actively working with health professionals, integrating oral health as an underpinning thread of all health promotion ... Getting back to 'we’”- Polleverywhere
Although participants were interested in collaborations with practitioners outside of oral health, they were also interested in collaborating more with other oral health professionals.
“Linking health promotion strategies between BOH [Bachelor of Oral Health] students and MOD [Dentistry] students” -Polleverywhere
Participants offered some useful suggestions for increasing opportunities for collaboration. The ways to increase collaboration included trust to be built with other health professionals and collaboration needing to occur not just on dental issues but other health issues. Furthermore, participants mentioned that the training of dental and health professionals needs to be interdisciplinary, to increase collaboration once students have graduated. However, participants commented on the perceived difficulties when collaborating with other health professionals. These were the lack of opportunities when working clinically and health professionals tending to work in silos.
“Each health profession sees their area as more important (work in silos)” - question sent via email
Barriers to health promotion
Participants mentioned barriers to oral health promotion. The most common barrier cited was the current curative based treatment approach that underpins the field of dentistry and oral health. That treatment is more important than prevention.
“Private practice employers want "bums on seats" not community service”- Polleverywhere
“Biomedical approach supported by agenda of professional guilds” – group discussions
Another barrier mentioned was the lack of funding for health promotion within dentistry. Several participants mentioned the structure of funding within dentistry, which limits health promotion initiatives and promotes clinical treatment.
“[No] insurance rebates for health promotion interventions” – Polleverywhere
“Limited public resources - prioritised on treating current disease first” – Polleverywhere
The lack of time practitioners have to implement health promotion was another barrier. There is limited time given to health promotion practice and participants felt that they required more time than they are given to plan and implement health promotion. This lack of time could be attributed or linked the lack of funding.
“In practice it is at times difficult for management to see value in a operator [sic] taking time out to provide health promotion to the community”- Polleverywhere
Other barriers were the lack of value placed on health promotion within dentistry, the delayed benefits of health promotion and lack of skills within the profession.
“Lack of value placed on health- at the patient level, at a managerial level- public and private practice”- group discussion
“Health promotion does not produce instant measurable results. Therefore, unable to measure benefit- Polleverywhere
“Lack of opportunities and support for clinicians to participate in health promotion activities”-Polleverywhere
Ways to overcome these barriers
The participants were given the opportunity to provide possible solutions to overcoming the above-mentioned barriers. Suggestions from participants included opportunities for qualified dental professionals to gain skills in oral health promotion; the training of dental professionals to move away from the biomedical model; opportunities to engage with existing already successful programs and further research into oral health promotion.
“Further education opportunities for people to develop their health promotion skills after their degree”- email
“Understand what is already occurring in your local community and to work with members to build on those successes”- email