Volunteer-student experiences and patient access to an inner-city dental clinic

Background: Low-income Canadians face multi-faceted physical and social barriers to dental care including but not limited to cost and stigma. Recognising the barriers to care, the Student-Health Initiative for the Needs of Edmonton (SHINE) dental clinic was created in 2004. SHINE is a student-volunteer operated clinic that aims to reduce inequalities in access to oral health care by offering free dental care to low-income individuals. However, as SHINE is a volunteer initiative independent from the undergraduate dentistry and dental hygiene programs at the University of Alberta, there has been limited investigation into the clinic and how it aligns with patient needs and contributes to student learning. Purpose: The purpose of this dissertation was to explore the accessibility to SHINE for oral health care, and how students perceive volunteering at SHINE contributes to their learning. Methods: The dissertation consists of three related papers: (1) interviews with health brokers were held to explore access to SHINE for the intended patient population to understand SHINE’s alignment to the populations needs; (2) student focus groups explored how the volunteer experience at SHINE contributed to student learning; (3) patient surveys and field notes investigated patient satisfaction with access, patient oral health concerns, and alternative dental care options outside of SHINE. Results: Interviews with health brokers revealed lack of awareness of the SHINE clinic. Further, English language translation support was an identified need, and there was concern for clients who fear discrimination in health care settings. From the student focused groups, data showed that students gained both clinical and cultural competence by volunteering at SHINE. Three themes were derived from the data which captured how SHINE benefitted student learning: learning environment, learning enhancements, and learning from patients. Patient surveys revealed that patients primarily present to SHINE for pain (52%) or broken teeth. However, desire for preventative care was indicated by 25.2% seeking dental hygiene services. Patients were generally satisfied with SHINE although the least satisfaction was seen in time spent waiting to attain care and patient ability to attain dental care when needed. Dissatisfaction was correlated with attending SHINE without receiving treatment. Field notes revealed physical accessibility barriers not captured within the survey. If SHINE was not an option for receiving dental care, 32% would seek care through an emergency department or physician and 27% would not attain care at all. Conclusion: Health brokers identified preliminary barriers to dental care at SHINE. However, further investigation was required to understand SHINE’s accessibility. Through patient surveys and field notes, remaining barriers were identified to be wait times and capacity for SHINE to provide all dental services required. Although patients were generally satisfied with access to SHINE, suggestions were made to alleviate barriers. Access to care at SHINE may reduce the utilization of emergency departments. Students’ experiences volunteering with SHINE had beneficial learning outcomes and brought to light three considerations for undergraduate dentistry and dental hygiene education; need for further cultural competence education, student desire for “real-life” clinical experiences, and a reduction in evaluations once clinical competency was achieved.

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