Title: Barriers and facilitators to dental care adherence during pregnancy: An intervention study in a primary health care service
The low use of dental services during pregnancy is worrisome due to increased susceptibility to oral disorders in this period and to the possibility of some negative effects on the baby. The objective of this study was to highlight barriers and facilitators to adherence to dental care by pregnant women, when guaranteeing full access at a Primary Health Care (PHC) service. The study had an exploratory intervention design, with a qualitative approach. Over one year, a researcher carried out dental care for the pregnant women enrolled in a PHC facility in a big city in Southern Brazil. Dental care was performed under a protocol developed to improve oral health outcomes, with emphasis on education, preventive care and minimal intervention. When necessary, curative treatment were carried out. Throughout the study's duration, 69 pregnant women enrolled in the prenatal at the facility, 67 were referred for dental care by the health team, 59 attended the first consultation and 25 completed the entire dental care plan under the protocol. At the end of the year of intervention, we invited some of the pregnant women to take part of a household interview. There were two possible inclusion criteria for this qualitative stage: women who completed the dental care plan or women who did not adhere to the dental prenatal protocol. A sample of five pregnant women who attended all the appointments and completed the protocol and eight who did not adhere were interviewed under a semi-structured script in order to clarify the barriers or facilitators experienced by them. All the interviews were recorded, transcribed and have undergone thematic content analysis. The categories that emerged were: a) predisposing factors: knowledge about the importance and benefits of prenatal dental care, feelings about going to the dentist, distance/ transport availability, number of children, and systemic health condition; b) perceived need factors: oral health condition before and after consultations, c) enabling factors: medical and family support to dental attendance; d) health practices: change of habits, e) service evaluation: satisfaction with received care; f) health system: organization of health services. We concluded that psychosocial factors strongly influence the access and adherence to dental care in the gestational period. Some of the barriers are culture related, such as beliefs and myths regarding the oral health condition and the safety of the receipt of dental care during pregnancy. These barriers can be overcome with oriented health service organization, good treatment and prevention protocols and permanent education of the PHC teams.