Developing Innovative Community Models to Reduce Oral Health Inequalities among People Experiencing Social Exclusion

  • Robert Vaughan Witton

Student thesis: Doctoral Thesis


Introduction: While oral health in the general population is improving, socially excluded people continue to suffer disproportionately high levels of oral diseases, poor oral health, and barriers to accessing dental care. Extensive research has shown that health inequalities result from the socioeconomic and environmental conditions that people are exposed to as they progress from birth to old age. Socially excluded groups often experience a ‘cliff-edge’ phenomenon whereby overlapping (and intersecting) factors lead to severe and multiple disadvantages.
Aim and objectives: The aim of this portfolio of works (20 papers in total) is to explore and understand the oral health care needs of socially excluded people, to identify any gaps or barriers they experience in accessing dental care, and to develop awareness and consideration of these groups in the future dental workforce.
•To develop a community engagement model in dental undergraduate education
•To explore oral health care needs of socially excluded people (focusing on homelessness, drug and alcohol, complex lives and asylum seekers and refugees)
•Conceptualise barriers and facilitators people from socially excluded groups experience in accessing oral health improvement services and dental care
•Identify perspectives from all stakeholders, including people with lived experience to inform improvement in oral healthcare services
•To develop integrated and accessible oral healthcare services for people from socially excluded groups
•To contribute to developing the evidence base and make recommendations to inform policy
Methods: Recently in the UK, action to address the needs of socially excluded groups has been raised up the agenda, and a Health Inclusion Model that incorporates education, practice and policy has been proposed to address the complex issues that socially excluded groups face in improving their oral health. The work presented in this thesis aligns with this call to action, which has developed community engagement as a guiding principle in dental education, service development and research. In response, the list of articles comprises 20 titles addressing the aim and objectives. There are ten research articles representing a range of different methodologies including quantitative, qualitative, mixed-methods and hybrid approaches such as Q-methodology, three case reports, five review articles summarising the literature and citing the authors' work, including, two letters and one technical report.
Results: There is a broad range of outputs presented in the papers with a focus on novel approaches to dental education and community models that report on and address unmet oral health care needs in socially excluded people, with exploration of participatory approaches in the development, implementation, and evaluation of the activities. In education, there is a description of the development of a community-engaged dental curriculum with examples of benefits to student learning, dental education, and people in local communities. Through a systematic review of the literature barriers and facilitators to accessing oral healthcare services for people from socially excluded groups have been identified and conceptualised. Community models have been developed and evaluated to contribute to the evidence base. There are limitations in the papers presented which are described in more detail in Appendix 6, and in each of the articles presented.
Conclusion: Working with students, people with lived experiences, patients, and community organisations as partners in the process can help us understand the challenges and changes required to improve oral health and oral healthcare services for people experiencing oral health inequalities due to social exclusion. Further work is required to develop the models further introducing more refined research approaches and using interventional designs.
Date of Award13 Feb 2024
Original languageEnglish
Awarding Institution
  • University of Portsmouth
SupervisorCarolina Machuca Vargas (Supervisor) & Chris Louca (Supervisor)

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