Hannah G Dahlen1, Maree Johnson2, Julia Hoolsema3, Tiffany Patterson Norrie4, Shilpi Ajwani5, Anthony Blinkhorn6, Sameer Bhole7, Sharon Ellis8, Ravi Srinivas9, Albert Yaacoub10, Andrew Milat11, John Skinner12, Ajesh George13. 1. School of Nursing & Midwifery, Western Sydney University, Ingham Institute Applied Medical Research, Parramatta 2150, Australia. Electronic address: H.Dahlen@westernsydney.edu.au. 2. Faculty of Health Sciences, Australian Catholic University, Ingham Institute Applied Medical Research, Sydney 2060, Australia. Electronic address: Maree.Johnson@acu.edu.au. 3. Centre for Oral Health Outcomes & Research Translation (COHORT), Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool 1871, Australia. Electronic address: 17966157@student.westernsydney.edu.au. 4. COHORT, Western Sydney University, South Western Sydney Local Health District, Ingham Institute Applied Medical Research, Liverpool 1871, Australia. Electronic address: Tiffany.Patterson@sswahs.nsw.gov.au. 5. Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney Research, Sydney 2010, Australia. Electronic address: Shilpi.Ajwani@health.nsw.gov.au. 6. Faculty of Dentistry, University of Sydney, Sydney, 2006, Australia. Electronic address: anthony.blinkhorn@sydney.edu.au. 7. Sydney Local Health District Oral Health Services, Sydney Dental Hospital, University of Sydney, Sydney Research, Sydney 2010, Australia. Electronic address: Sameer.Bhole@health.nsw.gov.au. 8. Camden and Campbelltown Hospitals, South Western Sydney Local Health District, 2170, Australia. Electronic address: sharon.ellis@sswahs.nsw.gov.au. 9. South Western Sydney Local Health District Oral Health Services, COHORT, Western Sydney University, University of Sydney, Ingham Institute Applied Medical Research, Liverpool, Australia. Electronic address: ravi.srinivas@sswahs.nsw.gov.au. 10. Nepean Blue Mountains Local Health District Oral Health Services, Penrith, Australia. Electronic address: albert.yaacoub@health.nsw.gov.au. 11. Centre for Epidemiology and Evidence, NSW Ministry of Health, University of Sydney, Australia. Electronic address: amila@doh.health.nsw.gov.au. 12. Faculty of Dentistry, University of Sydney, Sydney, 2006, Australia. Electronic address: john.skinner@health.nsw.gov.au. 13. COHORT, Western Sydney University, South Western Sydney Local Health District, University of Sydney, Ingham Institute Applied Medical Research, Translational Health Research Institute, Liverpool 1871, Australia. Electronic address: a.george@westernsydney.edu.au.
Abstract
BACKGROUND: Despite links between poor maternal oral health, adverse pregnancy outcomes and early childhood decay there is limited emphasis on maternal oral health in Australia. To address this, the Midwifery Initiated Oral Health Dental Service (MIOH-DS) program was developed in collaboration with the Australian College of Midwives. AIMS: To undertake a process evaluation and explore perceptions of midwives involved in the MIOH-DS program to determine its practicability, acceptability and feasibility if it were to be up-scaled and implemented into clinical practice. METHODS: Qualitative content analysis was undertaken on data from three focus groups with 21 midwives. FINDINGS: Midwives generally found the MIOH-DS to be acceptable and feasible with potential for widespread scalability. The trust women had in midwives was an important factor in gaining women's attention about oral health in pregnancy. The program assisted in increasing midwives' knowledge and awareness, though some felt it was outside their scope of practice. The oral health assessment tool was acceptable to midwives but some concerns were expressed about undertaking a visual oral inspection. Most midwives stated they were now confident with referring individuals to a dentist. Significant barriers to widespread implementation included the cost of dental care and the continued lack of awareness and misconceptions pregnant women had towards oral health. CONCLUSION: Midwives found the MIOH-DS to be acceptable and feasible which are two important barriers to potential implementation at scale. Misconceptions over the importance of oral health by women and cost of accessing dental services still need resolving.
BACKGROUND: Despite links between poor maternal oral health, adverse pregnancy outcomes and early childhood decay there is limited emphasis on maternal oral health in Australia. To address this, the Midwifery Initiated Oral Health Dental Service (MIOH-DS) program was developed in collaboration with the Australian College of Midwives. AIMS: To undertake a process evaluation and explore perceptions of midwives involved in the MIOH-DS program to determine its practicability, acceptability and feasibility if it were to be up-scaled and implemented into clinical practice. METHODS: Qualitative content analysis was undertaken on data from three focus groups with 21 midwives. FINDINGS: Midwives generally found the MIOH-DS to be acceptable and feasible with potential for widespread scalability. The trust women had in midwives was an important factor in gaining women's attention about oral health in pregnancy. The program assisted in increasing midwives' knowledge and awareness, though some felt it was outside their scope of practice. The oral health assessment tool was acceptable to midwives but some concerns were expressed about undertaking a visual oral inspection. Most midwives stated they were now confident with referring individuals to a dentist. Significant barriers to widespread implementation included the cost of dental care and the continued lack of awareness and misconceptions pregnant women had towards oral health. CONCLUSION: Midwives found the MIOH-DS to be acceptable and feasible which are two important barriers to potential implementation at scale. Misconceptions over the importance of oral health by women and cost of accessing dental services still need resolving.
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