Bridging the Gap to Oral Health

Abstract

Abstract Background Although oral health is important for overall well-being, people in the Netherlands in a low socio-economic position experience barriers to accessing dental care. These barriers are multifaceted, including financial constraints, limited health literacy, and psychological factors such as shame and stress. In response, the municipality of Nijmegen launched a pilot intervention to increase access to oral healthcare, (re-)establish preventive engagement, and reduce health disparities. This realist evaluation (RE) explores how, why, for whom, and in what circumstances the pilot contributes to participants' intention to (re-)engage with regular dental care.

Methods This study was conducted in four phases. The initial programme theory was developed through analysis of eleven documents and interviews with three policymakers. Next, fourteen semi-structured interviews were conducted with pilot stakeholders, including policymakers, social workers, dental students, coordinators, experts-by-experience, and a participant. Interview data were analysed using context-mechanism-outcome coding, and theories were refined in an iterative process.

Results The pilot lowered financial barriers by offering free preventive check-ups and, if necessary, treatments. Furthermore, the project provided warm referrals and supportive guidance in adjusting health insurance and arranging a future dental check-up. While these resources were effective for participants experiencing dental issues, they were less successful in promoting preventive engagement. In practice, no participants without dental issues entered the pilot, thus its preventive ambition largely translated into curative care. Although some participants were temporarily motivated to improve oral care, this is unlikely to lead to lasting behavioural change. Structural stress and unchanged circumstances, e.g. inability to change health insurance, reinforced this effect. A further critical limitation was that social workers often failed to inform clients about the pilot, partly because they perceived ambiguities surrounding the intervention.

Conclusion The pilot was successful in improving access to oral healthcare for individuals with dental problems by addressing key barriers. However, its preventive objectives were not fully realised due to contextual factors. The study highlights that removing barriers is insufficient; interventions must address psychological readiness and build professionals’ trust in the project. Municipal initiatives are important, but sustainable preventive oral healthcare requires national commitment and collaboration with insurers.