OBJECTIVES: The aim of this study was to evaluate staff-assessed care quality as an indicator of register-based measures of care quality at dental clinics, more specifically register-based measures of survival of dental fillings and initiation of preventive treatments for caries patients.

METHODS: This prospective study includes data from cross-sectional workplace psychosocial risk assessment surveys at dental clinics and register data on survival of dental fillings, and initiation of preventive treatment for caries patients obtained from the Swedish Quality Registry for Caries and Periodontal Disease (SKaPa) Demographic background data on the age, gender, income level and place of birth of patients was obtained from Statistics Sweden (SCB). The data were analysed using discrete-time multilevel survival analysis and multiple linear regression analysis.

RESULTS: The results showed that staff-assessed care quality rated by the total staff or by dental nurses at the clinic predicted the risk of replacement of dental fillings made due to a caries diagnosis during the 3-year follow-up period, controlling for potential confounding due to patient demographic characteristics (age, sex, income and country of birth). In contrast, the better the staff-assessed care quality at the clinic, the smaller the proportion of the patients received preventive care in addition to operative caries therapy when controlling for potential confounding due to patient demographics. Care quality assessed by dentists at the clinic did not predict either of these outcome measures.

CONCLUSIONS: Premature failure of dental fillings is costly for both patients and society, which leads to a need for relevant measures for following dental care quality. Our findings indicate that staff-assessed care quality - a cheap and easy measure to collect and follow continuously in dental practice - can be used to monitor aspects of quality in real time in order to facilitate continuous improvement and quickly amend quality problems. Also, it can be used for integrating quality improvement in systematic work environment risk management.

Socioeconomic position, expressed in terms like educational level, income, wealth or origin, is a strong predictor of most health outcomes. Sustainable efforts for good and equitable health need to draw on theories that consider power relations as well as scientific methods for health promotion, prevention and /or treatment. Systematic planning and documentation is required. The perspective should include not only life style habits but also issues like discrimination and stigmatization. Control and influence from participants are necessary to assure that goal-setting and measures taken are adequate.

Health inequity emerges from structural issues and is mediated by mechanisms on different levels, mechanisms of which some are difficult to describe and analyze. Regrettably, health care systems, including public health interventions, in many cases reinforce this inequity. Health care staff’s personal perspectives and prerequisites (e.g regarding education and income) often differ from the corresponding ones in groups with the less favorable health outcomes. That is one reason why efforts for equitable health need to involve perspectives, prerequisites and health motives of “targeted” individuals and groups as salient parts of interventions, from the planning stage and throughout. A complementary way to prevent intervention procedures from consolidating current positions of power is to allow for professionals to continuously perform critical reflection of their own presuppositions and prejudices in relation to actions and results.

The use of determinants from Social Cognitive Theory (SCT) (self- efficacy, observational learning, facilitating, expectations of outcome, reciprocal determination) enables planning that consider not only individuals and groups but also their social context. Systematic use of strategies from SCT, critical reflection and formative as well as summative evaluations allow for quality assurance and knowledge development.

HEM draws on theories for health behavior and power relations. The methodology contains a structured documentation for formative and summative purposes. Strive for a high level of participation, control and influence from individuals and community members is a foundation pillar. Systematic use of theories allows for answering the fundamental question “in what way do we anticipate the planned intervention to contribute to closing the health gap?” Social Cognitive Theory (SCT) considers social and physical environment. HEM currently involve several SCT determinants in planning and evaluation; self- efficacy, observational learning, facilitating, expectations of outcome, reciprocal determination. The qualitative procedure is described below. Numeric data are also collected.

Step one (before action, e.g. a dialogue-meeting): Consider which determinant(s) may be affected by the planned action, and by what mechanisms.

Step two: Carry out the action.

Step three: Describe what happened, based on input from the participants and the anticipated determinants and mechanisms.

Step four: Systematic self-critical review based on common grounds for discrimination. Examples: Was it difficult to engage or include participants because of language, gender, function variation, national background or other factor? In retrospect, can you identify stereotypes in the examples you used? Did anybody else at the event act to maintain prejudice or exclusion?

Step five: consider implications for methodological development.

Step six: Formative collective evaluation based on reflections from step four and implications from step five.

Stakeholders using HEM gather regularly for workshops based on their HEM-reports, aiming at developing tools for increasing health equity. HEM is implemented in public health work of Angered Hospital and the Dental Public Health, Region Västra Götaland, and is used by 20 different stakeholders. A web-application has been developed to facilitate documentation and spread.

Background: For an intervention to contribute to decreased health gaps, people living in underserved areas must participate in the research-to-action process during the development of the intervention.

Methods for increased engagement and participation have been developed within the community-based participatory research (CBPR) paradigm. Group Level Assessment (GLA) is a qualitative, participatory methodology that is designed for a large group to generate and evaluate relevant needs and priorities within a lens of action for positive social change. Influence of researchers is tuned down in favour of partnership and impact from the community. Ideally, the process results in participant-driven data and relevant action plans. The aim was to apply GLA to generate reflections on the situation in the community, aligning towards action for change.

Methods: We applied GLA together with people living in Gårdsten, an underserved Swedish suburb where obesity, caries and other illnesses are prevalent. Residents were recruited by posters and post cards at a community center and by snowball sampling. In total, 47 residents attended at least one of eight GLA sessions held over a five-month time period. The majority were women. Outcomes were reflections, suggestions and actions for change.

Results: Themes were: resident pride of the area, the importance of communication and of places to meet, a feeling of being abandoned by society, and a desire for more collaboration between schools and parents. Immediate results were a language café and inquiries from the community about information regarding teeth, food and health. When the results were presented for stakeholders in a report and an exhibition, new collaborations were founded and old were refreshed.

Conclusions: GLA helped residents identify what they thought valuable and relevant concerning health issues and supported them in taking actions to achieve change.

Key messages:

Participatory processes that directly engage community residents can result in fruitful discussions and actions.Methodologies like GLA that support such processes may contribute to closing the health gap. 

The aim was to, in an oral health promoting setting in low socioeconomic areas, implement a method aiming at improving quality of work by assessing both formative and summative results. The overall aim is to decrease health inequity.

Methods: Five teams of dental hygienists (n = 5) and dental nurses (n = 3), who operated in socioeconomic low-status areas, participated. The teams were performing health promoting activities on arenas as for example family-centrals. These teams were introduced on how to report health promoting activities according to the Health Equilibrium Methodology (HEM), which is based on Social Cognitive Theory. Following questions were put and answered in every report: Which health determinants were targeted? Did any person seem to perceive him-/herself excluded? Did anything unexpected happen? What to think about next time? Quantitative data were also documented: Almost six-hundred individuals were included in a total of 36 reports. Of these 50% were adults/parents and the rest children, most of them between 1-6 years old. The reports were written directly into a database after every activity and then processed by a facilitator and later discussed with the teams in workshops every third month.

Results: Analysis of the reports shows that the implementation of health promoting activities according to HEM included the following: -Identification of important health determinants. - Attention on how to get everyone involved and if anything unexpected happened. - Suggestions for change for the next time. Throughout the workshops the team-members exchanged experiences.

Conclusions: The HEM-method facilitates depicting and discussing the process of health promotion with focus on health equity. Thereby the method has a potential to support development of high-quality health-promoting activities in populations with low socioeconomic status. It may also lead to a better professional self-confidence.

In Sweden, the National Board of Health and Welfare forecasts a decrease in dentists with 26% and an increase in dental hygienists with 47% until the year of 2023. This, together with changes in both epidemiology, especially of dental caries, and political priorities, calls for an effective and well-developed cooperation between dentists and dental hygienists in future dentistry. Hence, the aim of this project was to investigate whether highlighting teamwork during the undergraduate studies of dental students and dental hygiene students could improve the students' holistic view on patients as well as their knowledge of and insight into each other's future professions. Thirty-four dental students and 24 dental hygiene students participated in the study. At the beginning of their final year in undergraduate education, a questionnaire testing the level of knowledge of the dental hygienists' clinical competences was completed by both groups of students. In addition, activities intending to improve teamwork quality included the following: (i) a seminar with a dentist representing the Public Dental Health Services in Sweden, (ii) dental students as supervisors for dental hygiene students, (iii) planning and treatment for shared patients and (iv) students' presentations of the treatments and their outcomes at a final seminar. The project was ended by the students answering the above-mentioned questionnaire for the second time, followed by an evaluation of the different activities included in the study. The knowledge of dental hygienists' competences showed higher scores in almost all questions. Both groups of students considered the following aspects important: seminars with external participants, dental students acting as supervisors and planning and treating shared patients. By initiating and encouraging teamwork between dental students and dental hygiene students, it is possible to increase knowledge on dental hygienists' competence and also to develop and strengthen a holistic view on patients and dental work, thereby preparing both groups of students for their professional life.

An effective and well developed cooperation between dentists and dental hygienists is crucial in future dentistry. In Sweden the National Board of Health and Welfare forecast of a decrease of dentists with 26% and an increase of dental hygienists with 47% until year 2023. Clinical teamwork is introduced and performed when the students start their last year at the dental school in Malmö. The aim of this project is to study if highlighting teamwork during these undergraduate studies will improve the holistic view on patients by development of the educational context as well as to improve quality of dental care and use of available recourses by knowledge of competence of the respective professionals.

This project focuses on students’ proficiency to learn in a problem-based curriculum at the Faculty of Odontology at Malmö University. We have developed a series of metacognitive workshops designed to make students more aware of the structure of a fruitful problem-solving rationale. A play exemplifying a condensed low-achieving tutorial was performed live by students, followed by discussions. In other workshops, the students analyzed tutorial reports with reference to the problem-solving structure and also tried to write new cases from given curricular goals. The students exposed to the exercises displayed a higher metacognitive awareness than students not exposed and they also felt that their tutorial work had improved. In conclusion, to enhance learning, it is desirable to boost students’ metacognitive awareness and it is also possible to do so.

The purpose of this project was to create a web based course with the following characteristics. It should provide a flexible and free learning environment where students' problem-solving skills and meta-cognitive awareness were developed. Problem based learning (PBL) was chosen as the pedagogical concept where collaboration was mixed with individual contributions, thus challenging and testing different competencies of the students. To further stimulate interaction, several modes of communication were provided at the web site. Assessment was formative. Facilitators feedback was clearly/firmly scheduled and kept low in order to create independent and self-reliant students and to avoid investing unreasonable resources. Contact with experts were possible throughout the course and the course was concluded with an online seminar with opportunities to pose questions to the experts. The web site and its functions were designed to be easy to use and available with simple technology. In conclusion this course model functioned fairly well; the students were overall satisfied and we think that we accomplished, to a certain degree, our purposes. In coming courses, we intend to stimulate more discussions in order to further develop group collaboration, and to firmly hold on to the demands on equipment to be able to attend the course. The course may well serve as a model for other web based PBL-courses.

This paper describes how dental hygienist students have used and developed a web site during a two year undergraduate programme. The programme is based on a Problem Based Learning concept at the Faculty of Odontology at Malmö University in Sweden. The web site was first used for administration of the courses, but with time different modes of supporting the PBL process were developed. These modes originated from both students and from the course director. In a questionnaire and in interviews, students were asked about how the web site had been used for communication between students and between students and teachers. They were also asked to comment on how their written tutorial reports, posted on the web site after each case, affected the collaboration in the tutorials and also their learning. Finally, we asked if the students thought that their use of the web site and computers in general had changed during the education. The questionnaire and the interviews were completed at the time of graduation. The written notes and reports of the cases enhanced and supported the students’ learning and some students recognized a change in how they used the web site. Most students also declared that their ability to use different computer programmes had improved. The students strongly recommended a continued use of the web site in the dental hygienist education. The communication and feed back between students and teachers were considerably improved, though new ways should be tried in order to stimulate experts to take more active part in the students’ learning process.