|Year : 2015 | Volume
| Issue : 1 | Page : 32-37
A community participatory model of mobile dental service-survey among stakeholders
Biney Anne Thomas1, Laxman Kumar Ranganathan2, Mini E Jacob3, Naseeb C Mann4, George C Mathew5, Clarence J Samuel3
1 Believers Church Hospital, Thiruvalla, Kerala, India
2 Kingston Public Hospital, Jamaica
3 Department of Community Medicine, Christian Medical College, Ludhiana, Punjab, India
4 Department of Community Dentistry, Christian Dental College, Ludhiana, Punjab, India
5 Department of Oral and Maxillary Surgery, Christian Dental College, Ludhiana, Punjab, India
|Date of Web Publication||14-Jan-2015|
Dr. Clarence J Samuel
Department of Community Medicine Christian Medical College, Ludhiana - 141 008, Punjab
Source of Support: None, Conflict of Interest: None
Background: The mobile dental service (MDS) at Ludhiana is a unique model of oral health care delivery which enables rural communities to develop their own creative system through partnerships, for ensuring consistent oral health care delivery in the underserved areas. Objectives: The objective of this study was to assess the satisfaction among the stakeholders participating in the MDS program of a premier Dental College in Ludhiana. Methodology: A cross-sectional survey was conducted in 12 villages of Ludhiana district in Punjab where the MDSs were being provided. Four hundred and fifty patients, 50 organizers and 40 service providers were interviewed separately with pretested questionnaires. Results: About 98.4% of the patients were completely satisfied with the overall care provided. 71.1% of the patients felt there was increased times in services and 76.7% felt that there was inadequate referral network. Most patients were satisfied with the communication skills of the doctors. 57.5% of the organizers felt that the overall care provided in the MDSs was consistently good and high quality in spite of challenging infrastructure. 100% of the health care providers felt that working in the MDS was a good learning experience in spite of the heavy workload and infrastructure challenges. Conclusion: The study reveals that the MDS is a satisfactory mode of dental care delivery for all the stakeholders involved. Despite the challenges, this partnership program can be nurtured as a successful model of oral health care delivery in underserved areas.
Keywords: Community dentistry, community participation, dental clinics, mobile health units, oral health care, rural
|How to cite this article:|
Thomas BA, Ranganathan LK, Jacob ME, Mann NC, Mathew GC, Samuel CJ. A community participatory model of mobile dental service-survey among stakeholders. CHRISMED J Health Res 2015;2:32-7
|How to cite this URL:|
Thomas BA, Ranganathan LK, Jacob ME, Mann NC, Mathew GC, Samuel CJ. A community participatory model of mobile dental service-survey among stakeholders. CHRISMED J Health Res [serial online] 2015 [cited 2020 Jan 29];2:32-7. Available from: http://www.cjhr.org/text.asp?2015/2/1/32/149342
| Introduction|| |
In India, poverty, nonavailability of dental services a high illiteracy rate and poor awareness about oral health in rural areas  worsen the burden of dental disease. , India's dentist-to-population ratio is 1:12,000 and is 1:30,000 in rural areas, that is only 10% dentists for 72% of the nation's population. ,
Since 2005, mobile dental service (MDS) in our institution forms an innovative method for providing comprehensive dental services to underserved and inaccessible areas at its doorstep. The MDS success is based on the circle of trust between the dental service providers, Community-based organizations and the community (service utilizers).
There was a need to study to MDS regarding the fulfillment of expectations, perceptions, and experiences of the various stakeholders, hence this project was undertaken.
| Methodology|| |
The study was conducted in the field practice areas of a premier teaching dental hospital in Ludhiana District, Punjab. The MDS survey was conducted in 12 villages out of the 22 in Ludhiana district, which the mobile van visits as per the schedule [Figure 1].
The study was a cross-sectional survey using quantitative research methodology. The study sites were selected by random sampling from the camps that would be conducted in a month. All the stakeholders involved in the MDSs, that is, patients, organizers, and service providers at each site were included in the study. Three separate questionnaires were developed and pretested for interviewing patients, organizers, and service providers. The questionnaires were in the local language for the patients and the organizers and English for the service providers. Face validity was established by pilot testing and a team of experts.
The patient survey was conducted on all the patients who underwent treatment in these 12 sites. Children <16 years of age were excluded from the study. All the patients who underwent treatment procedure and gave verbal consent were included in the study. A total of 450 patients was interviewed in the survey which assessed the satisfaction of the patients in relation to the services provided by the organizers, as well as the service providers.
Camp organizer survey
The organizers belonged to the community where the camp was conducted and consisted of community leaders, elected representatives, nonresident Indians, social organizations (NGOs), and philanthropists. Forty organizers were interviewed for the study. The survey among the organizers assessed their efficiency in planning and organizing the services and satisfaction with the health personnel and their services. The organizers were involved in conducting camps at their villages regularly, and therefore, the survey assessed their experiences with several camps that had been conducted by them.
Service provider survey
All the service providers at the 12 dental clinics interviewed. The dentists, dental assistants, and the technicians were included in the study. The survey assessed the experiences of the service providers with all the camps they had participated.
| Results|| |
The demographic profile of the patients surveyed is shown in [Table 1]. [Table 2] describes the results of the survey. More than 98.4% of the patients interviewed were happy and satisfied about their overall experience with the mobile services. Over 80% of the patients were completely satisfied with the care provided by the dentists and the supporting staff in the mobile clinics, and 86.7% expressed complete satisfaction with the dentist's willingness to listen. Nearly, 70.2% of the patients responded that the service providers explained the overall condition about the oral health. Among the negatives, 76.7% of the patients felt that there was no adequate referral service for further treatment procedures while 71.1% patients were not satisfied with the long waiting times for treatment at the camps.
The demographic profile of the organizers is shown in [Table 3], and the results of the survey are shown in [Table 4]. The clinic site was selected by 75% of the organizers based on the perception of need. Half (50%) of the organizers considered the infrastructure adequate for the services and 75% of the organizers felt that the service providers were competent enough to meet the demands of a large client population. Nearly, 57.5% of organizers expressed overall satisfaction with the care provided in the MDSs saying it is consistently good and of a high standard.
Survey among service providers
[Table 5] shows the results of the survey among the service providers. Most of the service providers felt that decision-making was delayed due to the limited diagnostic aids. Over 60% of the service providers felt that the limited infrastructure of the clinic site had an impact on the quality of work done. 96% of the service providers said that segregation of biomedical waste was an area of concern in the mobile clinic. The majority (58%) had no problems communicating with the patient all the time whereas 42% were able to communicate occasionally. All the service providers agreed that the work exposure at the MDS provided a good learning experience in spite of the heavy workload and infrastructure challenges.
| Discussion|| |
The overall turnout of women at the MDS was good when we consider the skewed sex ratio in the state of Punjab. There could be several other reasons why women accessed the MDS. The mobile clinic brought dental services close to home. Rural women have responsibilities like cooking and childcare which often prevent them from traveling far to receive healthcare for themselves. Moreover, travel is expensive, and these women do not generally control the financial resources at home. It is encouraging to note that rural women had identified their need for oral health care even though their literacy rates were low in comparison to the men.
Most of the patients who utilized the services belong to the elderly age group of 60 years and above. Recent demographic trends show that India has a rapidly growing population of the elderly.  The elderly population utilized the MDS mainly for the denture rehabilitation program. As our population continues to age, there will be a greater need for denture services  and the mobile clinic need to be equipped to meet this growing need.
The survey revealed that most of the patients were satisfied with the publicity campaign prior to the mobile clinics. A study conducted in the rural areas of Saudi Arabia showed that lack of publicity and advertising has a negative impact on the mobile clinic services.  Accessibility and utilization of mobile health services vary greatly according to how well the services are publicized. 
One of the salient findings of the study was that most of the patients were completely satisfied with the willingness of the service providers to listen to their problems and to explain the treatment procedure. Barnes N found that the dentist's willingness to talk and listen to patients is an important criterion for effective communication.  Other studies also report on the importance of communication and information-giving in fostering patient satisfaction. , This could be the main reason why the overall satisfaction was high. This confirms the findings of Zini et al., who reported that the two highest predictors of patient satisfaction were the professionalism of the dentist and a good attitude of dentists toward the patients. 
One of the factors that brought discontentment among the patients was the delay in services mostly due to the large numbers arriving at the camp site, malfunctioning equipment, and less number of personnel. Prolonged waiting time has also been reported as an item of dissatisfaction by several researchers. , The patients were dissatisfied with the referral system which was in place. If they required services which were not available at MDS, they had to travel a long distance to receive care at a tertiary care hospital as there was no secondary level health care available. The rural population was also reluctant to undergo procedures which required multiple visits to the main clinic due to financial constraints and lack of understanding of dental procedures.
The greatest strength of this program is the community participation [Figure 2]. The community is engaged in active partnership with the teaching hospital in planning and implementing the dental services for its members.  Community-based organizations which take the lead in organizing the services are critical partners, because they have the trust of the community; they know the language and culture of community  and have the skills required for coordinating the program. A survey conducted among the organizers revealed their efficiency in planning and organizing the MDS and their satisfaction with the outcome.
The organizers responsible for the publicity campaign were not always able to provide adequate campaigning prior to the clinics. Despite this, the attendance at the clinics was very high, and the patients were completely satisfied by the campaigning. This could be because, in rural areas, such information is passed on by word of mouth. A study in India has revealed that the word of mouth publicity and advocacy by satisfied patients serve as an important public relation strategy in rural areas.  The organizers view that the service providers were competent in meeting the needs of the large number of patients in the prevailing circumstances is a result of the patients positive response to the communication skills  and the active involvement of the workforce.
The infrastructure such as lighting and water supply at the venues for procedures like making impressions in the denture camps often made the tasks challenging. In a nonconventional mode of care delivery in rural areas, there are limitations which the service providers face. Nevertheless, the organizers agreed that the service providers were competent and innovative in meeting the needs of the population with the facilities available.
Studies by Corah et al.  show that effective communication by service providers increased patient utilization of dental services and enhanced the perceived technical competence of the dentist. Some of the service providers from out of Punjab felt that they were not able to communicate with the patient adequately in the local dialect and hence had to rely on colleagues for assistance. This does not seem to have affected the quality of the services as the patient survey revealed that the patients were satisfied with the communication skills of the service providers. Studies have shown that bilingual-bicultural dentists are able to effectively communicate and respond to the challenges of serving culturally diverse population. 
The major factors that showed decreased satisfaction among the service providers were the condition of the equipment, inadequacy of diagnostic aids and the difficulties in maintaining the sterilization and biomedical waste management practices. The MDS was at times not able to practice these procedures as per protocol due to inadequate funding and the high inflow of patients. The service providers were content with the infrastructure of the rural campsite signifying that dental graduates can easily adapt and provide services in rural settings using MDS.
Despite the high and strenuous workload, all the members of the service providing team agreed that through the MDS, they improved professionally, and the learning experience was worth the effort.
Since the final program is a result of the combined efforts of the organizer, the dental team, and the cooperation of the patients the study has included all the variables pertaining to each of their respective areas.
| Limitations|| |
This study looked at perceptions of service delivery, expectations of the patients, organizers, and providers. The questions regarding cost, time for the procedure would be as per their perceptions hence not asked for specifically.
| Conclusion|| |
The majority of mobile clinic patients were satisfied with the overall care provided in spite of the referral system and the delay in services. The organizers were also satisfied with their contribution to the functioning of the MDS and its outcome despite the challenges with infrastructure. The service providers also expressed satisfaction with the overall quality of treatment they could provide despite the high workload and challenging infrastructure. All the problems as are easily solvable with increased funding and a few innovations.
A large number of patients cared for, and the variety of dental procedures performed emphatically proves that the MDS is a very cost efficient and sustainable model. The findings of this study, which reveal the high rates of satisfaction of the stakeholders, provides the evidence that, despite the challenges, this partnership program can be nurtured as a successful model of oral health care delivery in underserved areas.
| References|| |
Sandesh N, Mohapatra AK. Street dentistry: Time to tackle quackery. Indian J Dent Res 2009;20:1-2.
Nair MK, Renjit M, Siju KE, Leena ML, George B, Kumar GS. Effectiveness of a community oral health awareness program. Indian Pediatr 2009;46 Suppl: S86-90.
Lal S, Paul D, Pankaj, Vikas, Vashisht BM. National Oral Health Care Programme implementation strategies. Indian J Community Med 2004;29:3.
Kreyer R. Immediate complete denture prosthetics: The demand for lower-cost treatment solutions is on the rise. Inside Dent Technol 2011;2:2.
Aljasir B, Alghamdi MS. Patient satisfaction with mobile clinic services in a remote rural area of Saudi Arabia. East Mediterr Health J 2010;16:1085-90.
Field KS, Briggs DJ. Socio-economic and locational determinants of accessibility and utilization of primary health-care. Health Soc Care Community 2001;9:294-308.
Barnes NG. Open wide: An examination of how patients select and evaluate their dentist. Health Mark Q 1985;3:49-56.
Garfunkel E. The consumer speaks: How patients select and how much they know about dental health care personnel. J Prosthet Dent 1980;43:380-4.
Murtomaa H, Masalin K. Public image of dentists and dental visits in Finland. Community Dent Oral Epidemiol 1982;10:133-6.
Zini A, Pietrokovsky J, Dgani A, Dgani R, Handelsman M. Survey of patient satisfaction at the Yad Sarah Geriatric Dental clinic. Refuat Hapeh Vehashinayim 2006;23:36-41, 70.
Mansour AA, al-Osimy MH. A study of satisfaction among primary health care patients in Saudi Arabia. J Community Health 1993;18:163-73.
Ali M el-S, Mahmoud ME. A study of patient satisfaction with primary health care services in Saudi Arabia. J Community Health 1993;18:49-54.
Lear JG, Foster HW Jr, Wylie WG. Development of community-based health services for adolescents at risk for sociomedical problems. J Med Educ 1985;60:777-85.
Chan M, Haines T, Riungu J, Aslanyan G, Wong BL. The role of NGO s in health care services for immigrants and refugees. Proceedings of the Workshop Fourth International Metropolis Conference. Washington D.C, Dec7-11; 1999. Available from: http://www.ccrweb.ca/files/ngohealth.pdf
. [Last cited on 2011 Apr 25].
Hamilton MA, Rouse RA, Rouse J. Dentist communication and patient utilization of dental services: Anxiety, inhibition and competence enhancement effects. Health Commun 1994;6:137-58.
Corah NL, Gale EN, Illig SJ. Assessment of a dental anxiety scale. J Am Dent Assoc 1978;97:816-9.
Keene V. Overcoming language barriers in our increasingly diverse nation. Northwest Dent 2009;88:52-3.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]