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研究生:RAKESH MARLECHA BHARATH MARLECHA
研究生(外文):RAKESH MARLECHA BHARATH MARLECHA
論文名稱:Attitude and barriers to integrate oral health care in patients with diabetes from the perspectives of general practitioners in India - A qualitative study
論文名稱(外文):Attitude and barriers to integrate oral health care in patients with diabetes from the perspectives of general practitioners in India - A qualitative study
指導教授:Chiu, Chiung-HsuanChiu, Chiung-Hsuan引用關係
指導教授(外文):Chiu, Chiung-Hsuan
口試委員:Shih, Chung-LiangSheu, Mei-LingChiu, Chiung-Hsuan
口試委員(外文):Shih, Chung-LiangSheu, Mei-LingChiu, Chiung-Hsuan
口試日期:2024-06-03
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫務管理學系碩士班
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2024
畢業學年度:112
語文別:英文
論文頁數:103
中文關鍵詞:Diabetic PatientsOral Health CareMedical-Dental IntegrationBarriers to Health Care IntegrationOral Health in Diabetes
外文關鍵詞:Diabetic PatientsOral Health CareMedical-Dental IntegrationBarriers to Health Care IntegrationOral Health in Diabetes
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Background: Oral health is crucial for overall well-being, particularly in patients with diabetes, who are at higher risk for periodontal disease which results in permanent tooth loss, if left unaddressed. Integrating oral health care into the management of diabetes can enhance patient outcomes. However, the perspectives of general practitioners (GPs) on this integration, particularly in India, remain underexplored.

Objective: This study aims to explore the attitudes of general practitioners in India towards integrating oral health care for diabetic patients and to identify the barriers they face in this integration.

Method: A qualitative study design was employed, utilizing semi-structured interviews with 8 general practitioners from southern part of India. Participants were selected through purposive sampling to ensure a diverse representation. The interviews were audio-recorded, transcribed verbatim. Grounded theory was used to analyze the data.

Results: The analysis revealed a predominantly negative attitude and practice among GPs towards integrating oral health care in diabetic management. GPs demonstrated limited knowledge regarding the relationship between oral health and diabetes. Significant barriers included a lack of training and awareness about the interconnection between diabetes and oral health, insufficient interprofessional collaboration between medical and dental professionals, and several patient-related factors such as dental fear, the high cost of dental care, and inadequate awareness of oral health complications associated with diabetes. Additionally, systemic issues such as the absence of a robust national oral health policy and specific national guidelines for oral-diabetes care further compounded these barriers.

Conclusion: While general practitioners in India recognize the importance of integrating oral health care into diabetes management, several barriers hinder its implementation. Addressing these barriers through targeted training programs, improved interprofessional collaboration, and systemic changes in healthcare delivery could facilitate better integration of oral health care for diabetic patients, ultimately enhancing their overall health outcomes.
Background: Oral health is crucial for overall well-being, particularly in patients with diabetes, who are at higher risk for periodontal disease which results in permanent tooth loss, if left unaddressed. Integrating oral health care into the management of diabetes can enhance patient outcomes. However, the perspectives of general practitioners (GPs) on this integration, particularly in India, remain underexplored.

Objective: This study aims to explore the attitudes of general practitioners in India towards integrating oral health care for diabetic patients and to identify the barriers they face in this integration.

Method: A qualitative study design was employed, utilizing semi-structured interviews with 8 general practitioners from southern part of India. Participants were selected through purposive sampling to ensure a diverse representation. The interviews were audio-recorded, transcribed verbatim. Grounded theory was used to analyze the data.

Results: The analysis revealed a predominantly negative attitude and practice among GPs towards integrating oral health care in diabetic management. GPs demonstrated limited knowledge regarding the relationship between oral health and diabetes. Significant barriers included a lack of training and awareness about the interconnection between diabetes and oral health, insufficient interprofessional collaboration between medical and dental professionals, and several patient-related factors such as dental fear, the high cost of dental care, and inadequate awareness of oral health complications associated with diabetes. Additionally, systemic issues such as the absence of a robust national oral health policy and specific national guidelines for oral-diabetes care further compounded these barriers.

Conclusion: While general practitioners in India recognize the importance of integrating oral health care into diabetes management, several barriers hinder its implementation. Addressing these barriers through targeted training programs, improved interprofessional collaboration, and systemic changes in healthcare delivery could facilitate better integration of oral health care for diabetic patients, ultimately enhancing their overall health outcomes.
Acknowldegement………………………………………………………………….. Ⅰ
Abstract ……………………………………………………………………………… Ⅱ
List of tables………………………………………………………………………….. Ⅵ
List of Figures………………………………………………………………………... Ⅶ
Chapter 1 – Introduction
1.1 Background………………………………………………………………….. 1
1.2 Statement of the Problem……………………………………………………. 2
1.3 Significance of the study…………………………………………………….. 3
1.4 Research objectives………………………………………………………….. 3

Chapter 2 - Literature Review
2.1 Healthcare in India…………………………………………………………... 4
2.2 Oral complications of Diabetes……………………………………………… 7
2.2.1 Prevalence of periodontitis in DM patients………………………………... 7
2.2.2 Periodontitis & its treatment benefits in diabetes patients………………… 8
2.3 Diabetes Oral health care guidelines………………………………………… 11
2.4 Knowledge, attitude and practice among GPs towards oral health promotion in diabetes patients……………………………………………………… 13
2.5 Knowledge on oral health and practice of dental visists among diabetes patients…………………………………………………………………………………... 20

2.6 Qualitative studies on practices of dental referrals and barriers among GPs on integrating oral care in diabetic patients………………………………………………… 24



Chapter 3 – Methods
3.1 Study design……………………………………………………………………. 31
3.2 Conceptual design for Interview Guide………………………………………… 31
3.3 Meanings of dimensions…………………………………………………….. 32
3.4 Interview Process……………………………………………………………….. 36
3.5 Study Participants………………………………………………………………. 40
3.6 Data Analysis……………………………………………………………………. 40
3.7 Ethical considerations……………………………………………………………. 40

Chapter 4 – Results
4.1 Characteristics of participants…………………………………………………… 41
4.2 Study results…………………………………………………………………….. 41
4.3 Themes and subthemes ………………………………………………………….. 46
4.3.1 Theme 1: Oral healthcare in diabetes……………………………………….. 46
4.3.2 Theme 2: Barriers to promote oral healthcare………………………………. 49
4.3.3 Theme 3: Attitude and practices for oral care prevention and management…………………………………………………………………………….. 56

Chapter 5 – Discussion
5.1 Perceptions of GPs towards oral healthcare…………………………………… 61
5.2 System factors………………………………………………………………….. 63
5.3 Personnel factors……………………………………………………………….. 66
5.4 Patient factors…………………………………………………………………... 72
5.5 Attitude and practices related to oral care prevention and management……….. 76
5.6 Opportunities for improvement (recommendations from GPs)………………... 79
5.7 Study Limitations………………………………………………………………. 80

Chapter 6 – Conclusion……………………………………………………………… 81

References…………………………………………………………………………….. 83-97

Appendixes……………………………………………………………………………. 98-103

Appendix 1 Detailed characteristics of participants………………… 98


Appendix 2 TMU-JIRB Certificate (Mandarin & English)……………………… 102

List of Tables

Table 1 Randomized control studies in India on diabetic patients…………………… 9
Table 2 Meta-analysis reports on periodontal treatment effects on diabetes patients... 10
Table 3 Knowledge and practice among GPs towards oral health promotion in diabetic patients……………………………………………………………... 15
Table 4 Cross-sectional studies on knowledge of oral health and practice of dental visits in diabetic patients……………………………………………………. 22
Table 5 Qualitative studies on perceptions of general practitioners on providing oral health care to diabetic patients………………………………………………. 25
Table 6 Interview guide of previous studies…………………………………………. 27
Table 7 Overall participant details…………………………………………………... 42
Table 8 Themes and subthemes……………………………………………………… 43

List of Figures

Figure 1 3-tier public health system in India………………………………………... 4
Figure 2 GPs role in integrating oral health in diabetes care: A model……………… 44
Figure 3 Hierarchy of factors to enhance GPs role in active oral health management (bottom to top)……………………………………………………………… 45


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