Perspectives and experiences of Thai adults using wheelchairs regarding barriers of access to dental services: a mixed methods study

Abstract

Purpose: To explore the perspectives and experiences of Thai wheelchair users regarding barriers of access to dental services and report potential solutions in terms of customer satisfaction.

Participants and methods: We conducted a 2-phase cross-sectional study with quantitative and qualitative components at a community club for individuals with disabilities in Pathum Thani province, Thailand, in February 2018. In quantitative phase, participants were interviewed using a structured questionnaire that consisted of 1) questions on demographic characteristics and 2) adapted questions that were based on the modified Penchansky and Thomas dimensions of access. Enter method of binary logistic regression analysis was used. Regarding qualitative phase, focus group discussions were conducted using the themes of a semi-structured discussion guide. Thematic analysis was used.

Results: A total of 156 wheelchair users participated in the quantitative phase. Most study participants had not attended dental care services in the previous year (78.2%). Multivariate analysis found a statistically significant association that indicated that participants who had education level ≤primary education were 3.5 times more likely to had not attended a dental appointment in the previous year (P=0.003). In the qualitative phase, 33 participants were included in 3 focus groups (each comprising 11 participants), they were wheelchair users with education >primary, who did not go to see a dentist in the previous 12 months. Findings of the 3 focus groups suggest generally negative views about Thai dental services for all dimensions of access.

Conclusion: This study reflects the unheard voices of wheelchair users and provides rigorous evidence in Thai context that difficulties of access to dental services persist. Policy makers and oral health professionals in oral health system should be alerted to the explicit barriers reported, such that equitable and equal dental services for disabled individuals can be developed.

Keywords: Thailand; barriers to care; dental service; focus group; physical disabilities; wheelchair user.