Vulnerable populations and health: A call for social literacy in primary care

As outlined in the scientific literature, poverty have important consequences for the health of individuals and populations and their access to care. Althought we know that medical and dental practitionners encounter difficulties in the delivery of care for the underprivileged people, we know little on how healthcare professionals can contribute positively to better access to care for the poor. Study background: A previous qualitative research project conducted by Loignon and colleagues suggest that healthcare professionnals should be more aware of the impact life conditions and poverty have on health and on health behaviour among underserved patients with chronic illness. Objective: To describe and understand experience of oral health practitionners who work in a deprived area with patients on social welfare benefits and those who could be described as working poor. Methods: We conduct a qualitative research using semi-structured interviews and ethnographic observations of dentists working in private offices. Data analysis of transcribed interviews and ethnographic field notes support the development and validation of interpretations. Results: Preliminary results obtained in this study reveal that «empathic» dentists address social barriers that exists between them and their poor patients. Long time experience with the poor enable dentists to understand in a broader way the life conditions of the vulnerable patients and to understand how this could influence negatively their experience of oral health and health care. Some of the dentists develop complex perceptions of poverty and try to understand the impact living in poverty has on the health behavior of their patients. We also identified that dentists who work with the poor address more effectively unpreventive self-care practices and low compliance with dental treatments. Furthermore, they adopt multiple strategies in order to adapt their clinical practice to the needs and capabilities of poor patients. For example, they adapt their care setting organization (reduction of expenses, appointment flexibility, and clinic near public transportation) and use empathy in their clinical practice. Practice Implications: Training and continuing education should include a comprehensive health care course that focus on the consequences poverty has on the health behavior and health care seeking. Conclusion: Our findings highlight key elements that are fundamental to the improvement of access to oral health care for under-served patients