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Oral health-related salutogenic factors: reviewing factors promoting oral health in older people and exploring dental professionals' perspective
Malmö universitet, Odontologiska fakulteten (OD).
2023 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

The overarching aims of this thesis were to study oral health-related salutogenic factors among older people and explore dental professionals’ perceptions of their role in the practice of oral health promotion.Study I was an integrative review describing salutogenic factors reportedly associated with oral health and oral health-related quality of life in older people. A framework for identifying salutogenic factors, combining two theories of health, was developed. 58 papers were included in the review and 77 salutogenic factors were identified. However, there is a lack of studies with specific reference to salutogenic factors among older people.

Study II was a cross-sectional study based on data for patients 60 years or older derived from a previous population-based epidemiological study. Several significant associations between outcome variables and salutogenic factors were identified. Of those, 13 previously unreported salutogenic factors could be added to the framework developed in Study I.

Studies III and IV were qualitative interview studies using in-depth interviewsfor data collection and qualitative content analysis methodology for data analysis.

Study III focused on exploring salutogenic factors related to oral health in twelve orally healthy patients 75 years or older. The findings highlighted the importance of patients’ internal resources, dental professionals, family, and society in supporting and reinforcing lifelong oral health.

Study IV focused on exploring dental professionals’ perceptions of their role in the practice of oral health promotion and included eleven dentists and dental hygienists. The participants perceived promotion of oral health to be an important aspect of their professional role. They aspired to patient participation in the decision-making process and educational activities, as well as practicing and evaluating skills development.

In conclusion, there is a need for consistency in definition of outcomes measures and hypothesis-driven research within salutogenic research in oral health field. The large number of salutogenic factors found supporting oral health among older people indicates the complexity of salutogenesis and the need for robust analyzing tools. Combining two theories of health was useful for exploring salutogenic factors related to oral health and for providing a plain overview of areas lacking knowledge, which in turn can facilitate the generation of hypotheses and therefore relevant salutogenic research.This combination could contribute to a more balanced image of factors influencing oral health, including dental professionals’ roles, and help identify critical next steps in determining priorities and allocating resources promoting good oral health in individuals and populations. Moreover, oral health-related salutogenic factors identified in the qualitative studies; i.e., categories, merit further exploration in quantitative research.

Ort, förlag, år, upplaga, sidor
Malmö: Malmö University Press, 2023. , s. 73
Serie
Malmö University Odontological Dissertations, ISSN 1650-6065
Nationell ämneskategori
Odontologi
Identifikatorer
URN: urn:nbn:se:mau:diva-58094DOI: 10.24834/isbn.9789178773381ISBN: 978-91-7877-339-8 (tryckt)ISBN: 978-91-7877-338-1 (digital)OAI: oai:DiVA.org:mau-58094DiVA, id: diva2:1734821
Disputation
2023-02-24, Klerken, KL:2370 Aula, Smedjegatan 16, Malmö, 09:15 (Svenska)
Opponent
Handledare
Tillgänglig från: 2023-02-07 Skapad: 2023-02-07 Senast uppdaterad: 2023-08-22Bibliografiskt granskad
Delarbeten
1. Salutogenic factors for oral health among older people: an integrative review connecting the theoretical frameworks of Antonovsky and Lalonde
Öppna denna publikation i ny flik eller fönster >>Salutogenic factors for oral health among older people: an integrative review connecting the theoretical frameworks of Antonovsky and Lalonde
2021 (Engelska)Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 79, nr 3, s. 218-231Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective The aim of this integrative review was to describe salutogenic factors associated with oral health outcomes in older people, from the theoretical perspectives of Antonovsky and Lalonde. Material and methods This study was based on a primary selection of 10,016 articles. To organize reported salutogenic factors, the Lalonde health field concept and Antonovsky's salutogenic theory were cross tabulated. Results The final analysis was based on 58 studies. The following oral health outcome variables were reported: remaining teeth, caries, periodontal disease, oral function and oral health related quality of life (OHRQoL). We could identify 77 salutogenic factors for oral health and OHRQoL. Salutogenic factors were identified primarily within the fields of Human Biology (such as 'higher saliva flow', 'BMI < 30 kg/m(2)' and 'higher cognitive ability at age 11'), Lifestyle (such as 'higher education level', 'social network diversity' and 'optimal oral health behaviour') and Environment (such as 'lower income inequality', 'public water fluoridation' and 'higher neighbourhood education level'). In the age group 60 years and over, there was a lack of studies with specific reference to salutogenic factors. Conclusions The results provide an overview of salutogenic factors for oral health from two theoretical perspectives. The method allowed concomitant disclosure of both theoretical perspectives and examination of their congruence. Further hypothesis-driven research is needed to understand how elderly people can best maintain good oral health.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2021
Nyckelord
Health field concept, oral health, oral health-related quality of life, salutogenesis
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:mau:diva-41095 (URN)10.1080/00016357.2020.1849790 (DOI)000619032000001 ()33596156 (PubMedID)
Tillgänglig från: 2021-03-09 Skapad: 2021-03-09 Senast uppdaterad: 2023-08-22Bibliografiskt granskad
2. Exploring salutogenic factors supporting oral health in the elderly
Öppna denna publikation i ny flik eller fönster >>Exploring salutogenic factors supporting oral health in the elderly
2022 (Engelska)Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 80, nr 4, s. 241-251Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aim To explore associations between salutogenic factors and selected clinical outcome variables of oral health in the elderly, combining Antonovsky's salutogenic theory and the Lalonde Health Field concept. Methods The subjects comprised 146 individuals, aged 60 years and older, who had participated in a population-based epidemiological study in Sweden, 2011-2012, using questionnaire and oral examination data. A cross-sectional analysis used the selected outcome variables, such as number of remaining teeth, DMFT-index and risk assessment, and salutogenic factors from the questionnaire, clustered into domains and health fields, as artifactual-material, cognitive-emotional and valuative-attitudinal. This selection was based on findings from our previous analysis using a framework cross-tabulating two health models. The purpose was to facilitate analysis of associations not previously addressed in the literature on oral health. Bivariate and Multiple Linear Regression analyses were used. Results Numerous salutogenic factors were identified. Significant associations between outcome variables and salutogenic factors previously unreported could be added. Regression analysis identified three contributing independent factors for 'low DMFT'. Conclusions This study supports the usefulness of a salutogenic approach for analysing oral health outcomes, identifying university education, the importance of dental health organization recall system and close social network, as important salutogenic factors. The large number of salutogenic factors found supporting oral health among the elderly indicates the complexity of salutogenesis and the need for robust analysing tools. Combining two current health models was considered useful for exploring these covariations. These findings have implications for future investigations, identifying important research questions to be explored in qualitative analyses.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2022
Nyckelord
Oral health, salutogenesis, observational study, social determinants of health, elderly
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:mau:diva-46767 (URN)10.1080/00016357.2021.1990995 (DOI)000710378500001 ()34693858 (PubMedID)
Tillgänglig från: 2021-11-09 Skapad: 2021-11-09 Senast uppdaterad: 2023-08-22Bibliografiskt granskad
3. Self-perceived oral health-related salutogenic factors in orally healthy older Swedes. A qualitative interview study.
Öppna denna publikation i ny flik eller fönster >>Self-perceived oral health-related salutogenic factors in orally healthy older Swedes. A qualitative interview study.
2022 (Engelska)Ingår i: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 80, nr 5, s. 354-362Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: This study aimed to explore oral health-related salutogenic factors in orally healthy older Swedish people, applying the three components of Antonovsky's Sense of Coherence (SOC) concept: comprehensibility, manageability and meaningfulness.

MATERIAL AND METHOD: Interviews were conducted with 12 orally healthy patients, aged 75 years and older, enrolled at public dental clinics. The interviews were subjected to qualitative content analysis, applying the SOC concept as the theoretical framework.

RESULTS: Three themes were formulated under the predefined SOC components, describing the central meaning of the informants' perception of factors favourable to their good oral health. The theme 'comprehension of cause and effect' consisted of three categories, for example importance of oral hygiene, and reflected the component comprehensibility. The theme 'living in confidence and trust in supporting society' consisted of five categories, for example self-esteem, and reflected the component manageability. The theme 'good oral health as a basis for satisfaction and social confidence' consisted of two categories, for example social norms, and reflected the component meaningfulness.

CONCLUSION: This study discloses how orally healthy elderly Swedish people perceive the lifelong impact of salutogenic factors in response to lifelong stressors on their oral health and highlights the important roles of their internal resources, dental professionals, family and society in supporting and reinforcing lifelong oral health.

Ort, förlag, år, upplaga, sidor
Taylor & Francis, 2022
Nyckelord
oral health, qualitative research, salutogenesis, sense of coherence, social determinants of health
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:mau:diva-49061 (URN)10.1080/00016357.2021.2014068 (DOI)000729051600001 ()34893001 (PubMedID)
Tillgänglig från: 2021-12-29 Skapad: 2021-12-29 Senast uppdaterad: 2023-08-22Bibliografiskt granskad
4. Dental professionals' perception of their role in the practice of oral health promotion: a qualitative interview study
Öppna denna publikation i ny flik eller fönster >>Dental professionals' perception of their role in the practice of oral health promotion: a qualitative interview study
2023 (Engelska)Ingår i: BMC Oral Health, ISSN 1472-6831, E-ISSN 1472-6831, Vol. 23, nr 1, artikel-id 43Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective

To explore dental professionals’ perceptions of their role in the practice of oral health promotion.

Material and method

In-depth interviews were conducted with three dentists, one specialist dentist and seven dental hygienists. All were employed in the public dental service in Kalmar County, Sweden and had at least two years’ work experience. The interview questions addressed the experience and views of dental professionals with reference to their role in the practice of health promotion. The interview data were subjected to qualitative content analysis.

Results

Analysis revealed two themes which capture the essence of the dental professionals’ perception of their role in the practice of oral health promotion. One theme, having person-focused approach, comprised four categories: ‘considering the patient’s life situation’, ‘establishing a trusting relationship with patients’, ’strengthening patients’ commitment to oral health’ and ‘health education’. The other theme, perceiving social responsibility for oral health, comprised three categories: ‘dissemination of oral health knowledge’, ‘interprofessional collaboration’ and ‘equality in oral health care’.

Conclusion

Dental professionals perceived promotion of oral health to be an important aspect of their professional role. They aspired to patient participation in the decisionmaking process and educational activities, as well as practising and evaluating skills development. Although the dental professionals perceived that they undertook health promotion activities, they did not clearly distinguish between oral health promotion and disease prevention. There was intra- and interprofessional agreement among the dentists and dental hygienists with respect to expected outcomes for health promotion activities.

Ort, förlag, år, upplaga, sidor
BioMed Central (BMC), 2023
Nyckelord
salutogenesis, Ottawa Charter, helath promotion
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:mau:diva-58093 (URN)10.1186/s12903-023-02756-y (DOI)000918442200004 ()36698102 (PubMedID)2-s2.0-85146747153 (Scopus ID)
Tillgänglig från: 2023-02-07 Skapad: 2023-02-07 Senast uppdaterad: 2023-10-18Bibliografiskt granskad

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