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Abstract
Objective The Strategic Regional Plan of the Cree Board of Health and Social Services of James Bay (CBHSSJB), serving the Quebec Cree communities, mandates the objective of integrating oral health within primary healthcare. Emerging evidence suggests that the integration of oral health into primary healthcare can decrease oral health disparities. This research study aimed to answer the following research question: how and to what extent does the integration of oral health into primary healthcare address the oral health needs of the Cree communities?
Design We used a multiple-case study design within a qualitative approach and developmental evaluation methodology. The Discovery, Dream, Design and Destiny model of appreciative inquiry was selected as a study framework among existing frameworks of the developmental evaluation.
Setting Four purposefully selected Cree communities.
Participants Healthcare providers, administrators and patients at the community wellness centres and hospital.
Outcome measures Integration of oral health into primary healthcare.
Results A total of 36 interviews and 6 focus group discussions were conducted. We identified ten themes in discovery and dream phases. The Discovery phase identified the strengths of the organisation in facilitating enablers of integration including strategic planning, organisational structure, cultural integration, coordinated networks and colocation. In the Dream phase, participants’ oral healthcare stories expressed various dimensions of integration and their wish for strengthening integration via extending public oral healthcare programmes, increasing resources and improving organisational management. In the Design phase, recommendations were formulated for a future action plan within the CBHSSJB.
Conclusion This study results suggested that the CBHSSJB has been successful in implementing oral health integration into primary care following its strategic planning. At present, the organisation could extend the level of integration into full integration by following study recommendations derived from the perspective of local stakeholders.
- primary care
- public health
- qualitative research
- health services administration and management
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Footnotes
Contributors RS contributed to study conception, design, data collection, transcription, reviewing transcripts, coding, analysis, interpretation of data and manuscript writing. YC participated in study conception, data collection, data interpretation and critical revision of the manuscript. FG contributed to data collection, data interpretation and critical revision of the manuscript. CB and MEM were engaged in data interpretation and critical revision of the manuscript. JT contributed to study concept and design, data interpretation and critical revision of the manuscript. EE contributed to study concept and design, project administration, data collection, data analysis, data interpretation, manuscript drafting and critical revision of manuscript. All authors gave their final approval and agreed to be accountable for all aspects of the work.
Funding This study was supported by the funding from the Canadian Institutes of Health Research (grant number: GI1-145123). It has been cofunded by the Institut de recherche en santé publique de l’Université de Montréal, Quebec Population Health Research Network, the Network for Canadian Oral Health Research, the Network for Oral and Bone Health Research and Fondation de l’Ordre des dentistes du Québec. RS is a doctorate student funded by the merit scholarship programme for foreign students (PBEEE) by the Fonds de recherche du Québec – Nature et technologies.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The ethical approval for this study was obtained from the Institutional ethics review board of the Université de Montréal (15–130-CERES-P), McGill University (A10-B39-18A) and research committee of Cree Board of Health and Social Services of James Bay.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplementary information. The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.