A Conceptual Framework for Improving the Oral Health of Children with Disabilities
Abstract Title: A Conceptual Framework for Improving the Oral Health of Children with Disabilities Shiamaa Shihab Al-Mashhadani Introduction: The effect of good oral health contributes to improving general health, well-being, and quality of life. Children with disabilities are more likely to develop oral diseases than the general population. They are disproportionately affected by dental diseases such as high dental caries, periodontal disease prevalence, missing teeth, and malocclusion. There are many challenges that children with disabilities and their carers experience regarding oral health, including access to dental care, availability of preventive interventions, oral health literacy, and education. This study aims to understand the personal experiences and views of stakeholders involved in the child’s life and/or care, to gain an in-depth understanding of the barriers and enablers of oral health for children with disabilities, and to guide policy by creating a framework for policymakers and stakeholders to address the problems of oral health for children with disabilities. Methods: A systematic review was conducted to understand the existing body of evidence on barriers, facilitators, and the involvement of stakeholders (parents, caregivers, dental and non-dental health providers, health systems, and policies) in the oral healthcare of children with disabilities. This led to the identification of knowledge gaps and provided a clearer understanding of the literature related to the research objectives. A qualitative approach was used, with 31 semi-structured in-depth interviews conducted with parents (using purposive sampling) and dental/non-dental health providers (using snowball sampling). The main findings of the interviews were transcribed and coded using the six steps of thematic analysis, following an inductive approach as outlined by Braun and Clarke. An interpretive approach was adopted to pursue an answer to the research question while considering the primary aims and objectives of the study. Results This study identified five core themes and 29 sub themes of barriers and facilitators shaping oral healthcare for children with disabilities: 1) Infrastructure and health system limitations, 2) Financial barriers, 3) Gaps in training and caregiver knowledge, 4) Accessibility and availability of services and 5) Stigma and caregiver perceptions. These empirical findings informed a conceptual framework structured around three interrelated dimensions of socioeconomic and governance, social stigma, and healthcare systems. The framework is underpinned by the social model of disability and the socio-ecological approach, offering both a practical and theoretical tool for system reform. An accompanying implementation tool outlines actionable strategies for health authorities, including stakeholder training, service integration, policy alignment, and inclusive community outreach. Conclusion This study examined the barriers and facilitators influencing oral healthcare access for children with disabilities in the UAE. Qualitative analysis identified five key themes. These findings informed a conceptual framework that captures the multi-level influences on oral health. The framework supports policy development and service redesign in the UAE. Its utility lies in mapping the interaction between governance, healthcare systems, and lived experience. An implementation tool, developed directly from stakeholder insights, helps stakeholders identify actionable points of intervention. While developed in the UAE context, the framework also offers potential for adaptation and piloting in comparable settings. By anchoring the analysis in stakeholder experiences and drawing on socio-ecological and rights-based perspectives, the study contributes pragmatic, evidence-informed tools for addressing oral health inequities both locally and as a basis for future adaptation and intervention research.
Oral healthcare access; Children with disabilities; United Arab Emirates (UAE); Stakeholder perspectives; Barriers and facilitators; People of Determination; Qualitative thematic analysis; Conceptual framework.
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