Co-creating strategies and actions to tackle oral health-related stigma

Stigma is the greatest barrier faced by people experiencing social exclusion when accessing healthcare. Recent WHO framework for meaningful engagement of people living with noncommunicable diseases [1] builds on different types of evidence to acknowledge and empower people through participation in related health processes that address the systemic inequalities and inequities experienced around the globe. This framework sets up principles, enablers, and actions for the equitable inclusion of individuals in co-creating healthcare services and policy. Eliminating stigma is one of the core enablers for operationalizing this framework with one of the actions focused on reviewing and monitoring engagement work to prevent stigmatization and discrimination.
Oral health-related stigma has been identified and defined as a unique health stigma that harms people and groups with oral health that differs from the prevailing cultural norms [2, 3, 4]. Health-related stigmas affect individuals by discouraging access to services, impairing adherence to treatment, diminishing mental health and social resources, and impacting quality of life. Social signalling through the media, social networks, advertising, and other sources gives rise to Western cultural ideals of straight white teeth as synonymous with health, wealth and social status (5). Even minor irregularities such as mild spacing or normal racial pigmentation were cause for concern in the PPI group who have shared their insights on this topic. However, despite the ubiquity of oral health-related stigma in society, there is a paucity of research in the dental literature that explores the concept of oral health stigma and no published literature that explores attempts to destigmatise differences in oral health [2].
An increasing concern is stigma consciously and unconsciously perpetrated by dental health professionals and/or oral health researchers towards patients also highlighted in the paper by Doughty et al [2] and others [5]. This hands-on workshop will further expand on the ideas put forwards in this paper in an opening interactive segment that will use visual images to stimulate discussion and unpack clinicians’ and oral health researchers’ perspectives of oral health-related stigma. It will then use snapshot presentations by expert speakers to share patients’ perceptions of oral health related stigma. This will showcase research that has prioritised listening and learning from patients and people with lived experience of social exclusion across the globe. The group will then work together in the final segment of the session to identify and co-create strategies and actions to reduce professional and oral health perpetuated oral-health stigma.

3. Sponsorship : proposal submitted to Global Oral Health Inequalities Research Network (GOHIRN) and Behavioural, Epidemiologic and Health Services Research Group (BEHSR)
4.Learning Objectives
4.1.Increase knowledge on oral health-related stigma.
4.2.Critical understand of the effects and experiences of oral health-related stigma of vulnerable groups.
4.3.Critical reflect on strategies to tackle stigma in dental health services that prioritise involvement of patients and people with lived experience.
5.Participants
Corresponding organizer: Andrea Rodriguez
Organisers: Andrea Rodriguez (University of Dundee, UK); Janine Yazdi-Doughty (University of Liverpool, UK); Barry Gibson (University of Sheffield, UK); Vanessa Muirhead (Queen Mary University of London, UK)
Chair Moderator : Vanessa Muirhead (VM)

6.Speakers: Janine Yazdi-Doughty (JD); Barry Gibson (BG); Andrea Rodriguez (AR)
Speaker’s titles for short presentations:
-‘Conceptualizing Oral Health-related Stigma’ (JD)
-‘Life after tooth loss: efforts to preserve a sense of self’ (BG)
-‘Perspectives of vulnerable groups in Scotland and Brazil on the consequences of stigma’ (AR)
The Hands on Workshop will involve four moments:
Section ComponentsTiming Chair/speaker initials
Welcoming participantsIntroduction/background4 minutesVM
Breakout workshop 1Group discussion: Practitioners’ understanding of oral health-related stigma 15 - 20 minutesWhole group
Presenting consequences of stigma from the patient’s perspective (PPI members)5 minutesJD
Whole group feedback 10 minutesVM
Presentations Conceptualizing Oral Health-related Stigma7 minutesJD
Life after tooth loss: efforts to preserve a sense of self7 minutesBG
Perspectives of vulnerable groups in Scotland and Brazil on the consequences of stigma’7 minutes AR
Breakout workshop 2Strategies/actions for engagement work to tackle stigma15 minutes Whole group
Feedback from participants 10 minutesVM
Opportunity for questions 5 minutesVM, AR, JD

i.Welcoming participants (VM)
ii.20 min breakout workshop group discussion comprised as follows:
o1. ‘Practitioners’ understanding of oral health-related stigma’ and group discussion
o2. Presenting the Consequences of stigma from the patient’s perspective followed by group feedback.
iii.Speakers’ short presentations + Q&A with participants (JD, BG, and AR)
oConceptualizing Oral Health-related Stigma (JD)
oLife after tooth loss: efforts to preserve a sense of self (BG)
oPerspectives of vulnerable groups in Scotland and Brazil on the consequences of stigma’ (AR)
iv.30 min breakout workshop group discussion 3.
o20 mins discussion ‘Strategies/actions for engagement work to tackle stigma’
o10 min group feedback.
TOTAL Time: 90 minutes
Key words : Stigma, Inclusion Oral Health, Empowerment, Patient Engagement.
References
1.World Health Organization (2023). WHO framework for meaningful engagement of people living with noncommunicable diseases, and mental health and neurological conditions. Global Coordination Mechanism Secretariat for NCDs, 10 May 2023, 73p. https://www.who.int/publications/i/item/9789240073074
2.Doughty, J., M. E. Macdonald, V. Muirhead and R. Freeman (2023). "Oral health-related stigma: Describing and defining a ubiquitous phenomenon." Community Dentistry and Oral Epidemiology n/a(n/a).
3.Moore D, Keat R. Does dental appearance impact on employability in adults? A scoping review of quantitative and qualitative evi-dence. Br Dent J. 2020.
4.Seehra J, Newton JT, DiBiase AT. Bullying in schoolchildren – its relationship to dental appearance and psychosocial implications: an update for GDPs. Br Dent J. 2011;210:411- 415
5.Yuvaraj, A., V. S. Mahendra, V. Chakrapani, E. Yunihastuti, A. J. Santella, A. Ranauta and J. Doughty (2020). "HIV and stigma in the healthcare setting." Oral Diseases 26: 103-111.