Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 22;22(1):533.
doi: 10.1186/s12913-022-07913-7.

Exploring the contexts, mechanisms and outcomes of a torture, abuse and dental anxiety service in Norway: a realist evaluation

Emilie Bryne  1 , Sarah Catherine Patricia Duff Hean  2 , Kjersti Berge Evensen  3 , Vibeke Hervik Bull  3
Affiliations

Exploring the contexts, mechanisms and outcomes of a torture, abuse and dental anxiety service in Norway: a realist evaluation

Emilie Bryne et al. BMC Health Serv Res. .

Abstract

Background: Torture, abuse and dental anxiety (TADA) are often precursors to developing a pathological relationship with dental care due to elevated anxiety. Consequently, patients who suffer from one or more of these tend to avoid dental services. This could leave them with severe tooth decay, which could affect their general and psychosocial health. Norwegian dental services have implemented the TADA service to specifically alleviate dental anxiety and restore oral health for the TADA patient group. However, the service has not been evaluated, and there is a need to understand how and why this service works, for whom, under what circumstances. Therefore, this study aimed to develop theories on how the service's structure alleviates dental anxiety and restores these patients' oral health. Although developed in a Norwegian context, these theories may be applicable to other national and international contexts.

Methods: This realist evaluation comprised multiple sequential methods of service and policy documents (n = 13), followed by interviews with service developers (n = 12).

Results: The analysis suggests that, by subsidising the TADA service, the Norwegian state has removed financial barriers for patients. This has improved their access to the service and, hence, their service uptake. National guidelines on service delivery are perceived as open to interpretation, and can hereby meet the needs of a heterogeneous patient group. The services have become tailored according to the available regional resources and heterogeneous needs of the patient population. A perceived lack of explicit national leadership and cooperative practices has resulted in regional service teams becoming self-reliant and insular. While this has led to cohesion within each regional service, it is not conducive to interservice collaborations. Lastly, the complexity of migration processes and poor dissemination practices is presumed to be the cause of the lack of recruitment of torture survivors to the service.

Conclusions: Policy documents and service developers described the TADA service as a hybrid bottom-up/top-down service that allows teams to practise discretion and tailor their approach to meet individual needs. Being free of charge has improved access to the service by vulnerable groups, but the service still struggles to reach torture survivors.

Keywords: Abuse; Dental anxiety; Dental health services; Dental phobia; Health services; Oral health; Oral health policy; Torture.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Steps of coding and cataloguing. The figure shows the steps of coding and cataloguing using an example of text from a policy document
Fig. 2
Fig. 2
TADA service pathways
See this image and copyright information in PMC

References

    1. Larijani HH, Guggisberg M. Improving clinical practice: what dentists need to know about the association between dental fear and a history of sexual violence victimisation. Int. J Dent. 2015;2015:452814. - PMC - PubMed
    1. Locker D, Clarke M, Payne B. Self-perceived oral health status, psychological well-being, and life satisfaction in an older adult population. J Dent Res. 2000;79(4):970–975. - PubMed
    1. Slade GD. Measuring oral health and quality of life. Chapel Hill: Department of Dental Ecology, School of Dentistry, University of North Carolina; 1997.
    1. Ng SK, Leung WK. Oral health-related quality of life and periodontal status. Community Dent Oral Epidemiol. 2006;34(2):114–122. - PubMed
    1. Leeners B, Stiller R, Block E, Görres G, Imthurn B, Rath W. Consequences of childhood sexual abuse experiences on dental care. J Psychosom Res. 2007;62(5):581–588. - PubMed

LinkOut - more resources