ACCESS TO DENTAL CARE FOR BRISTOL STUDENTS Healthwatch engaged with students studying at Bristol University to find out students experiences of using local dental services. The questionnaire aimed to identify the barriers students experience in accessing dental care and make recommendations to the Bristol University Students Health Service to reduce these barriers.
1 ACCESS TO DENTAL CARE FOR BRISTOL STUDENTS PURPOSE This questionnaire has been created to better understand Bristol university students experiences of using local dental services. It aimed to find out what students think about dental hygiene, how often they use dentists and what barriers stop them accessing dental care. Where do students go for checkups? Where do students go if they have dental problems? METHODOLOGY Data was gathered from Bristol University students using an online questionnaire. The questionnaire was shared and promoted using social media. 36 students completed the questionnaire. Of these, 69 % were in their 3 rd year of study and 84 % were international students. 19 % were dental students. Please see appendices for a blank copy of the questionnaire, as well as a full list of findings. FINDINGS Public opinion of oral hygiene On average, students agreed with the following statements: - Having healthy teeth is important to me (81 % agreed) - You cannot be healthy if you have tooth decay (61 % agreed) - An attractive person has healthy teeth (72 % agreed) - I know how to look after my own teeth (67 % agreed) What would make it easier for students to go to a Bristol dentist? Teach or inform students about it (dental care) during Fresher s week - Anonymous student (I would like) an easier more transparent way of finding a new dentist in the immediate area - Anonymous student
2 On average, students disagreed with the following statement: - It s normal to get tooth decay sometimes (33 % agreed) Dental attendance Students access to dental services increased when they started university, however many students chose to visit dental surgeries in their home town rather than in Bristol. Before starting university: - 50 % of students regularly visited the dentist for checkups - 44 % of students only visited the dentist when they noticed problems with their teeth - 3 % of students had never visited the dentist. After starting university: 68% of students who responded said they had visited a dentist for a checkup since they started university. Of these: - 4 % visited a dentist in Bristol (50 % of these specified that they were dental students being seen by fellow dental students.) - 96 % visited a dentist in their home town - (85% of these were international students). Of the 42% of students who had experienced problems with their teeth: - 21 % visited a dentist in Bristol (60 % of these were UK students) - 57 % visited a dentist in their home town (88 % of these were international students*) - 21 % did not visit a dentist. *One non-eu international student commented that they had visited a private clinic back in Malaysia to address their dental problem. Barriers to access: Students were asked what barriers they face in terms of accessing dental care. They rated the severity of the following factors: Barrier (in order of severity) Average severity rating (1 = not a problem, 5 = huge problem ) Cost 3.59 62 % (21/34) Do not know how to find a 3.18 47 % (16/34) dentist Opening times do not suit 2.82 38 % (13/34) Travelling to the dentist 2.71 35 % (12/34) Proportion of student respondents who considered this barrier a problem
3 Do not know how to book 2.65 35 % (12/34) an appointment Bad past experiences of 2.18 18 % (5/34) dentists Social anxiety 1.85 18 % (5/34) Language barriers 1.76 18 % (5/34) Fear of being judged 1.94 12 % (4/34) Dentist is of the opposite sex 1.44 6 % (2/34) On average, cost was the highest barrier for students who responded. The second highest barrier was not knowing how to find a dentist. Unsuitable opening times and travelling to the dentist were also seen as barriers to a significant amount of Bristol students who responded. One student commented that it was difficult to find dentists within walking distance that were taking in new patients, as well as dentists with fees accessible to students. On average, students disagreed with the following statement: - I know how to get emergency dental care in Bristol (33 % agreed, a third of whom were dental students. This means 67 % of students who responded did not know where they could find emergency dental care in Bristol.) When asked to suggest changes that would increase access to local dental care whilst studying in Bristol, the following comments were received from students: (full list) - Contact details on the student website. - A dentist service for students or at least help with fees, and an easier more transparent way of finding a new dentist in the immediate area. - Provide more information to the students about clinic locations and the price. - Include free dental services in the students' health services provided by the university. - Teach or inform students about it during Freshers week. - Quicker appointment times and online availabilities. - More aid in registering. - Information in one place. - The Uni should advertise dental services as much as they do for student health services. - Having a dentist in the student health office? - University to supply it (as) part of the student health service. - Providing information about dental services on the student health service leaflets. - List of dentists with openings provided by school.
4 Students agreed, on the whole, that more information about local dentist locations and costs would increase students use of dental surgeries in Bristol. SUMMARY OF FINDINGS Most students agreed that maintaining healthy teeth is important to them. Students reported an increase in visiting their dentists since starting university, but most students chose to visit a dentist in their own home towns rather than in Bristol. It is a concern that most international students who responded said they were much more likely to visit a dentist in their home country. Nearly half (42 %) of the students surveyed experienced problems with their teeth since starting university. The highest barriers to dental care access for students were cost (identified as an issue by 62 % of students) followed by not knowing how to find a dentist (identified as an issue by 47 % of students). 38 % of students who responded also said that dentist opening hours did not suit them, and 35 % found travelling to the dentist a barrier. 35 % of students who responded did not know how to book an appointment. 67% of students did not know how to access emergency dental care in Bristol. 78% of the 42% who said they had experienced problems with their teeth whilst studying in Bristol either visited a dentist in their home town or did not see a dentist at all. RECOMMENDATIONS Based on findings and feedback from students, we would like to make the following recommendations: 1. Reducing cost: The biggest barrier to dental care was cost, with 2 students suggesting that a free or reducedcost dental service be introduced within The University of Bristol. As the NHS does not sponsor free dental treatment except for certain cases, and the Students Health Service is unlikely to have enough money to run a dental service, it is unlikely that free treatment can be offered by the university. 2. Making information about costs more easy for students to find: Findings suggested that a significant proportion of students who responded do not have a clear understanding of how much NHS dental treatment costs, or who can be eligible for free treatment.
5 The University of Bristol Students Health Service has its own section of the university s main website. A few short lines are given on one of its web pages on dental care. As no information is given on the website about the cost of dental care or eligibility for free treatment, links could be given to the following NHS choices web pages, which give clear information on these subjects: http://www.nhs.uk/chq/pages/1781.aspx?categoryid=74: for information on NHS dental charges. http://www.nhs.uk/chq/pages/1786.aspx?categoryid=74&subcategoryid=742: for information on eligibility for free treatment. 3. Helping students find a dentist: The second biggest barrier was students not knowing how to find a dentist. 10 students surveyed have expressed the need for more information and guidance to be given to students about how to register with a dentist from the university, with websites and leaflets suggested as an effective medium of distributing this information. On the Dentists section of the Students Health Service website, a link is given to the NHS choices website (nhs.uk/pages/home.aspx) to locate a dental practice. This information needs to be bolder so students can find it more easily. This leaflet is widely distributed across most university buildings. The Students Health Service s website is given in the bottom right hand corner on the back of the leaflet. There is a lot of blank space and we recommend that a few lines about dental treatment be added before the leaflet next goes to print. In addition, staff who hold the Students Health Service stand at the Freshers Fair and other university events could make a point of informing students that information on finding a dentist is available on the Health Service s website. A simple flyer about the importance of registering with a local dentist and what to do in a dental emergency could be added to Freshers packs. 4. Helping students find emergency dental care: Many students did not know how to access emergency dental care in Bristol. Information is given on the Students Health Service s website to call a Bristol dentist during opening hours if the student is registered, or call 111 if unregistered.
6 In addition, the people operating the Students Health Service stand at the Welcome Fair and other university events could make a point of informing students that a free, walk-in emergency service is available at the Bristol Dental Hospital for students who are not registered at a dentist in Bristol. Summary of recommendations: The following recommendations for the Bristol Students Health Service have been selected as the most feasible and cost-efficient: 1. Provide the following 3 links on the Dentists section of the Students Health Services website: http://www.nhs.uk/chq/pages/1781.aspx?categoryid=74 for information on NHS dental costs. The Students Health Service s web page could also direct students in need of emergency dental care to the Bristol Dental Hospital, which provides free emergency dental care for people who do not have a regular dentist. We recommend the following information about the hospital s walk-in service is given on the Students Health Service website: http://www.uhbristol.nhs.uk/patients-and-visitors/your-hospitals/university-of-bristol-dentalhospital/ http://www.nhs.uk/nhsengland/healthcosts/pages/nhs-low-incomescheme.aspx for information on eligibility for free NHS dental care. http://www.uhbristol.nhs.uk/patients-and-visitors/your-hospitals/university-ofbristol-dental-hospital/ for information on a free walk-in emergency dental care service for students who do not have a Bristol dentist. 2. Ensure that the people operating the Students Health Services stand at the Welcome Fair and Welcome Week inform students of the following: that although the university cannot provide dental services, information on registering with a local dentist is available on the Students Health Services website that the Bristol Dental Hospital offers a free walk-in emergency service for people who are not registered with a Bristol dentist. 3. That the Your Guide: Where to go when you re unwell university leaflet is updated with a few lines about dental treatment before it next goes to print. Disclaimer This report relates to students consulted at a specific point in time. This report is not representative of all students (only those who contributed their views).
Appendix 1 Blank Questionnaire 7
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10 Appendix 2 Full List of Findings 1. Which gender do you identify as? Answer choice No. of respondents /36 Male 15 Female 21 Transgender 0 Other 0 Prefer not to say 0 2. What year of study are you in? Answer choice No. of respondents /36 1 st 4 2 nd 2 3 rd 25 4 th 3 5 th or above 2 3. Which faculty do you belong to? Answer choice No. of respondents /36 Arts 0 Biomedical sciences 3 Engineering 7 Health Sciences (not including 9 dentistry) Science 2 Social Sciences and Law 8 I am a dental student 7 4. Before studying at university in Bristol, where did you live? Answer choice No. of respondents /36 Bristol 0 Somewhere in England (not including 5
11 Bristol) Scotland, Northern Ireland or Wales 1 An EU country (not including the UK) 2 A non-eu country 28 5. Before you started university, which sentence best describes why you visited the dentist? Answer choice No. of respondents /36 I have never visited the dentist 1 I only visited the dentist when I noticed 15 problems with my teeth I regularly visited the dentist for checkups, 17 even if I had not noticed any problems with my teeth Other (please specify) 1 Comment: maintaining condition of retainer Unanswered 2 6. Have you visited the dentist for checkups since starting university? Answer choice No. of respondents /36 Yes, in Bristol 1 Comment: at the dental hospital done by friends Yes, in my home town (I am not from Bristol) 22 Comment: It s a private clinic back in Malaysia No 11 Unanswered 2 7. Since starting university, have you visited a dentist about problems with your teeth? Answer choice No. of respondents /36 Yes in Bristol 3 Yes in my home town (if you are not from Bristol) No I have had problems, but did not see a dentist No I have not had any problems 20 Unanswered 2 8 Comment: It s a private clinic back in Malaysia 3 8. How strongly do you agree with the following opinions?
12 Having healthy teeth is important You cannot be healthy if you have tooth decay An attractive person has healthy teeth It's normal to get tooth decay sometimes I know how to look after my teeth well I know how to get emergency dental care in Bristol I strongly disagree Disagree Neutral Agree I strongly agree Total Weighted Average 3 2 0 3 26 34 4.38 2 5 5 11 11 34 3.71 2 4 2 10 16 34 4.00 2 8 12 10 2 34 3.06 1 2 7 15 9 34 3.85 11 9 1 4 8 33 2.67 9. How strongly do you feel the following make you less likely to go to the dentist? Not a problem for me Mostly not a problem Neutral Noticeable problem A huge problem for me Total Weighted Average Cost 1 7 5 13 8 34 3.59 Don't know how to find a dentist Opening times do not suit me Travelling to the dentist Don't know how to book an appointment Bad past experiences of dentists 9 2 7 6 10 34 3.18 8 6 7 10 3 34 2.82 10 3 9 11 1 34 2.71 13 4 5 6 6 34 2.65 12 10 7 4 1 34 2.18 Fear of being judged 16 9 5 3 1 34 1.94 Social anxiety 22 2 5 3 2 34 1.85 Language barriers 23 2 4 4 1 34 1.76 Dentist is of the opposite sex 26 4 2 1 1 34 1.44 9a. Please tell us what, if anything, was difficult about going to the dentist in more detail below: - Finding a dentist with fees accessible to students, as well as dentists in walking distance that are taking new patients
13 10. If there was one thing you could change to make it easier to find a dentist whilst studying in Bristol, what would it be? Do you have anything else you would like to share about getting dental care in Bristol? Please find full list of responses on Page 3.