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Objectives: To develop a patient's attitude questionnaire regarding prevention in oral health for use internationally., Methods: Using a mixed methods approach, a questionnaire was developed and refined as part of ADVOCATE (Added Value for Oral Care) study, involving partners in six countries: Netherlands, Hungary, Denmark, Ireland, Germany, and the UK. A literature review explored the history of oral healthcare delivery systems to develop a template for each of the six ADVOCATE countries. A systematic review identified the perceived barriers and facilitators to preventive oral healthcare and underpinned a topic guide and established the patient questionnaire domains. Focus groups in each ADVOCATE country developed the first version of the questionnaire. Patient and Public Involvement and Engagement (PPIE) in each ADVOCATE country tested the questionnaire and led to further refinement. The questionnaire was produced in five languages. Content validity and reproducibility used principal component analysis (PCA) and exploratory factor analysis (EFA) refined the questionnaire., Results: The literature review aided an understanding of each country's oral healthcare system, and the findings from the 25 studies identified in the systematic review found the main barriers/facilitators to preventive oral healthcare were cost, knowledge (preventive treatments and advice), and a patient awareness and adherence to preventive advice/treatments. Interviews and focus groups with 148 participants in the ADVOCATE study identified receiving the appropriate level of care/feeling valued, cost, level of motivation/priority, not feeling informed, knowledge, and skill mix as the main barriers/facilitators. Fifty-three PPIE members refined the questionnaire. The pilot questionnaire was tested with 160 participants. Non-essential or highly correlated variables were then removed, leaving 38 items, covering 6 domains (cost, advice received, advice wanted, message delivery, motivation, knowledge, and responsibility) within the questionnaire. A second pilot test-run was undertaken with 185 participants. The test-re-test reliability demonstrated strong consistency of responses between the two time points (kappa range 0.3-0.7, most p < .0011), which culminated with a final version of the Patient Attitudes to Prevention in Oral Health Questionnaire (PAPOH) questionnaire., Conclusions: This mixed-methods approach enabled the development of a multi-language attitudinal questionnaire for use with patients (PAPOH) to compare attitudes to oral disease prevention internationally., (© 2022 The Authors. Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Objective: To explore barriers and facilitators to oral disease prevention in Danish dental care from a multi-stakeholder perspective. Methods: Eleven semi-structured focus groups and interviews about Danish oral healthcare were conducted with 27 stakeholders (general public, dental teams, dental policy makers) in Copenhagen. Transcripts were analyzed using deductive thematic analysis independently by KR and HL, supervised by JC and KVC. Results: Seven broad themes were identified, including both barriers and facilitators: Knowledge and attitudes, Education and training, Regulation, Incentivization, Multidisciplinary approach, Access to care and the Dental professional-patient relationship. Whilst all themes were relevant to each group of stakeholders, the salient driver within each theme was different for each group. Conclusions: Stakeholder perspectives on the Danish Oral health care system suggest the following are important features for a preventively focused system: (a) Involving all stakeholders in oral healthcare planning. (b) Securing sufficient and ongoing briefing regarding disease prevention for all stakeholders. (c) Regulatory support and creation of incentives to promote and facilitate implementation of disease prevention. (d) Appropriate prevention for disadvantaged groups within society which may be possible to a higher degree by means of multidisciplinary collaboration. (e) Personal relations between the patient and the professional based on mutual trust.

Aim: To compare the provision and costs at the point of delivery of dental treatments in a sample of European Union (EU) Member States., Materials and Methods: A questionnaire with open-ended questions was sent to oral health policy-makers in Denmark, England, France, Germany, Hungary, Ireland, Italy, the Netherlands, Poland, Romania, Scotland and Spain. They were asked to answer questions on the probable costs and provision of treatment in their country for a vignette presented as a pre-defined case., Results: All respondents returned answers to all questions. Wide variations were reported in: who would deliver care, cost of items of care and total cost. For example, in France, only a dentist would provide the treatment. In Denmark, England, Germany, Ireland, Italy, the Netherlands and Scotland, it was likely that the treatment would be provided by a combination of dentist, dental hygienist and dental nurse. Fees ranged from €72 in England (if treated within the NHS) to €603 in Denmark. In Italy, Spain and for most patients in Romania, all treatment costs were paid by the patient. In the other nine countries, some subsidy from public funds was available. In terms of percentage of per capita Gross National Income, the cost to the patient ranged from 0.12% in France to 1.57% in Spain., Conclusions: It was apparent that there are wide variations between EU Member States in the manner in which oral healthcare is delivered, its cost and the extent to which the cost of treatment is subsidised from state funds or through private insurance., (© 2018 The Authors. International Dental Journal published by John Wiley & Sons Ltd on behalf of World Dental Federation.)