Barriers and facilitators survivors of sexual abuse experience in oral healthcare and dental professionals’ perspectives

Aims: The aim of the current research is to explore the barriers and facilitators to oral healthcare as experienced by survivors of sexual abuse. An additional aim of the research is to explore dental professionals’ views on these barriers and facilitators and explore potential implications for professionals’ practice. Background: Current research concludes that physical healthcare is fraught with difficulties for survivors of sexual abuse accessing care and treatment. This is relevant in oral healthcare, where current research has highlighted broad psychological and social difficulties for survivors seeking care related to their oral health. At present, there is little research exploring dental professionals’ views of survivors’ experiences in the context of their clinical practice. Methodology: A Participatory Action Research approach was used throughout the research to involve survivors as co-researchers in designing the research and analysing the results. A critical realism approach was used to qualitatively explore the barriers and facilitators to oral healthcare from the perspective of survivors of sexual abuse. Purposive and snowball sampling recruited 8 survivors who participated in semi-structured interviews. Two focus groups with a total of 8 dental professionals was utilised as a methodology to explore their views of survivors’ experiences, which were presented for discussion in the focus groups. Results: Reflexive Thematic Analysis was used to interpret six themes from interviews with survivors: Dissociation from my Mouth, Commands to be Vulnerable, Avoidance of Routine Examinations and Unexpected Procedures, “Just Make it a Bit More Human” Relational Practice, Psychological Grounding and Stabilisation, A Sense of Community. The same approach was used to interpret three themes from focus groups with dental professionals: Competing Demands, Red Tape and Restrictions, “I’m Not Sure How That Would Work” Navigating Sexual Abuse is Difficult in Practice. Conclusion: Survivors indicated a multitude of factors related to systemic barriers, psychological safety and holistic care that supported or hindered their engagement in oral healthcare. The findings from dental professionals provides insight into the constraints on the profession and wider discourses that influence survivor’s experiences in oral healthcare. The themes suggest that the transformation of oral healthcare requires systemic progression to meet the needs of survivors. Trauma-informed care could offer a foundation to develop oral health services with the addition of nuanced recommendations to meet survivors’ needs and ensure dental professionals and services feel confident and supported in adopting these changes.