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The purpose of this paper is to help authors to think about ways to present qualitative research papers in the American Journal of Pharmaceutical Education . It also discusses methods for reviewers to assess the rigour, quality, and usefulness of qualitative research. Examples of different ways to present data from interviews, observations, and focus groups are included. The paper concludes with guidance for publishing qualitative research and a checklist for authors and reviewers.
Policy and practice decisions, including those in education, increasingly are informed by findings from qualitative as well as quantitative research. Qualitative research is useful to policymakers because it often describes the settings in which policies will be implemented. Qualitative research is also useful to both pharmacy practitioners and pharmacy academics who are involved in researching educational issues in both universities and practice and in developing teaching and learning.
Qualitative research involves the collection, analysis, and interpretation of data that are not easily reduced to numbers. These data relate to the social world and the concepts and behaviors of people within it. Qualitative research can be found in all social sciences and in the applied fields that derive from them, for example, research in health services, nursing, and pharmacy. 1 It looks at X in terms of how X varies in different circumstances rather than how big is X or how many Xs are there? 2 Textbooks often subdivide research into qualitative and quantitative approaches, furthering the common assumption that there are fundamental differences between the 2 approaches. With pharmacy educators who have been trained in the natural and clinical sciences, there is often a tendency to embrace quantitative research, perhaps due to familiarity. A growing consensus is emerging that sees both qualitative and quantitative approaches as useful to answering research questions and understanding the world. Increasingly mixed methods research is being carried out where the researcher explicitly combines the quantitative and qualitative aspects of the study. 3 , 4
Like healthcare, education involves complex human interactions that can rarely be studied or explained in simple terms. Complex educational situations demand complex understanding; thus, the scope of educational research can be extended by the use of qualitative methods. Qualitative research can sometimes provide a better understanding of the nature of educational problems and thus add to insights into teaching and learning in a number of contexts. For example, at the University of Nottingham, we conducted in-depth interviews with pharmacists to determine their perceptions of continuing professional development and who had influenced their learning. We also have used a case study approach using observation of practice and in-depth interviews to explore physiotherapists' views of influences on their leaning in practice. We have conducted in-depth interviews with a variety of stakeholders in Malawi, Africa, to explore the issues surrounding pharmacy academic capacity building. A colleague has interviewed and conducted focus groups with students to explore cultural issues as part of a joint Nottingham-Malaysia pharmacy degree program. Another colleague has interviewed pharmacists and patients regarding their expectations before and after clinic appointments and then observed pharmacist-patient communication in clinics and assessed it using the Calgary Cambridge model in order to develop recommendations for communication skills training. 5 We have also performed documentary analysis on curriculum data to compare pharmacist and nurse supplementary prescribing courses in the United Kingdom.
It is important to choose the most appropriate methods for what is being investigated. Qualitative research is not appropriate to answer every research question and researchers need to think carefully about their objectives. Do they wish to study a particular phenomenon in depth (eg, students' perceptions of studying in a different culture)? Or are they more interested in making standardized comparisons and accounting for variance (eg, examining differences in examination grades after changing the way the content of a module is taught). Clearly a quantitative approach would be more appropriate in the last example. As with any research project, a clear research objective has to be identified to know which methods should be applied.
Types of qualitative data include:
Qualitative research is often criticized as biased, small scale, anecdotal, and/or lacking rigor; however, when it is carried out properly it is unbiased, in depth, valid, reliable, credible and rigorous. In qualitative research, there needs to be a way of assessing the “extent to which claims are supported by convincing evidence.” 1 Although the terms reliability and validity traditionally have been associated with quantitative research, increasingly they are being seen as important concepts in qualitative research as well. Examining the data for reliability and validity assesses both the objectivity and credibility of the research. Validity relates to the honesty and genuineness of the research data, while reliability relates to the reproducibility and stability of the data.
The validity of research findings refers to the extent to which the findings are an accurate representation of the phenomena they are intended to represent. The reliability of a study refers to the reproducibility of the findings. Validity can be substantiated by a number of techniques including triangulation use of contradictory evidence, respondent validation, and constant comparison. Triangulation is using 2 or more methods to study the same phenomenon. Contradictory evidence, often known as deviant cases, must be sought out, examined, and accounted for in the analysis to ensure that researcher bias does not interfere with or alter their perception of the data and any insights offered. Respondent validation, which is allowing participants to read through the data and analyses and provide feedback on the researchers' interpretations of their responses, provides researchers with a method of checking for inconsistencies, challenges the researchers' assumptions, and provides them with an opportunity to re-analyze their data. The use of constant comparison means that one piece of data (for example, an interview) is compared with previous data and not considered on its own, enabling researchers to treat the data as a whole rather than fragmenting it. Constant comparison also enables the researcher to identify emerging/unanticipated themes within the research project.
Qualitative researchers have been criticized for overusing interviews and focus groups at the expense of other methods such as ethnography, observation, documentary analysis, case studies, and conversational analysis. Qualitative research has numerous strengths when properly conducted.
The following extracts are examples of how qualitative data might be presented:
The following is an example of how to present and discuss a quote from an interview.
The researcher should select quotes that are poignant and/or most representative of the research findings. Including large portions of an interview in a research paper is not necessary and often tedious for the reader. The setting and speakers should be established in the text at the end of the quote.
The student describes how he had used deep learning in a dispensing module. He was able to draw on learning from a previous module, “I found that while using the e learning programme I was able to apply the knowledge and skills that I had gained in last year's diseases and goals of treatment module.” (interviewee 22, male)
This is an excerpt from an article on curriculum reform that used interviews 5 :
The first question was, “Without the accreditation mandate, how much of this curriculum reform would have been attempted?” According to respondents, accreditation played a significant role in prompting the broad-based curricular change, and their comments revealed a nuanced view. Most indicated that the change would likely have occurred even without the mandate from the accreditation process: “It reflects where the profession wants to be … training a professional who wants to take on more responsibility.” However, they also commented that “if it were not mandated, it could have been a very difficult road.” Or it “would have happened, but much later.” The change would more likely have been incremental, “evolutionary,” or far more limited in its scope. “Accreditation tipped the balance” was the way one person phrased it. “Nobody got serious until the accrediting body said it would no longer accredit programs that did not change.”
The following example is some data taken from observation of pharmacist patient consultations using the Calgary Cambridge guide. 6 , 7 The data are first presented and a discussion follows:
Pharmacist: We will soon be starting a stop smoking clinic. Patient: Is the interview over now? Pharmacist: No this is part of it. (Laughs) You can't tell me to bog off (sic) yet. (pause) We will be starting a stop smoking service here, Patient: Yes. Pharmacist: with one-to-one and we will be able to help you or try to help you. If you want it. In this example, the pharmacist has picked up from the patient's reaction to the stop smoking clinic that she is not receptive to advice about giving up smoking at this time; in fact she would rather end the consultation. The pharmacist draws on his prior relationship with the patient and makes use of a joke to lighten the tone. He feels his message is important enough to persevere but he presents the information in a succinct and non-pressurised way. His final comment of “If you want it” is important as this makes it clear that he is not putting any pressure on the patient to take up this offer. This extract shows that some patient cues were picked up, and appropriately dealt with, but this was not the case in all examples.
This excerpt from a study involving 11 focus groups illustrates how findings are presented using representative quotes from focus group participants. 8
Those pharmacists who were initially familiar with CPD endorsed the model for their peers, and suggested it had made a meaningful difference in the way they viewed their own practice. In virtually all focus groups sessions, pharmacists familiar with and supportive of the CPD paradigm had worked in collaborative practice environments such as hospital pharmacy practice. For these pharmacists, the major advantage of CPD was the linking of workplace learning with continuous education. One pharmacist stated, “It's amazing how much I have to learn every day, when I work as a pharmacist. With [the learning portfolio] it helps to show how much learning we all do, every day. It's kind of satisfying to look it over and see how much you accomplish.” Within many of the learning portfolio-sharing sessions, debates emerged regarding the true value of traditional continuing education and its outcome in changing an individual's practice. While participants appreciated the opportunity for social and professional networking inherent in some forms of traditional CE, most eventually conceded that the academic value of most CE programming was limited by the lack of a systematic process for following-up and implementing new learning in the workplace. “Well it's nice to go to these [continuing education] events, but really, I don't know how useful they are. You go, you sit, you listen, but then, well I at least forget.”
The following is an extract from a focus group (conducted by the author) with first-year pharmacy students about community placements. It illustrates how focus groups provide a chance for participants to discuss issues on which they might disagree.
Interviewer: So you are saying that you would prefer health related placements? Student 1: Not exactly so long as I could be developing my communication skill. Student 2: Yes but I still think the more health related the placement is the more I'll gain from it. Student 3: I disagree because other people related skills are useful and you may learn those from taking part in a community project like building a garden. Interviewer: So would you prefer a mixture of health and non health related community placements?
Qualitative research is becoming increasingly accepted and published in pharmacy and medical journals. Some journals and publishers have guidelines for presenting qualitative research, for example, the British Medical Journal 9 and Biomedcentral . 10 Medical Education published a useful series of articles on qualitative research. 11 Some of the important issues that should be considered by authors, reviewers and editors when publishing qualitative research are discussed below.
A good introduction provides a brief overview of the manuscript, including the research question and a statement justifying the research question and the reasons for using qualitative research methods. This section also should provide background information, including relevant literature from pharmacy, medicine, and other health professions, as well as literature from the field of education that addresses similar issues. Any specific educational or research terminology used in the manuscript should be defined in the introduction.
The methods section should clearly state and justify why the particular method, for example, face to face semistructured interviews, was chosen. The method should be outlined and illustrated with examples such as the interview questions, focusing exercises, observation criteria, etc. The criteria for selecting the study participants should then be explained and justified. The way in which the participants were recruited and by whom also must be stated. A brief explanation/description should be included of those who were invited to participate but chose not to. It is important to consider “fair dealing,” ie, whether the research design explicitly incorporates a wide range of different perspectives so that the viewpoint of 1 group is never presented as if it represents the sole truth about any situation. The process by which ethical and or research/institutional governance approval was obtained should be described and cited.
The study sample and the research setting should be described. Sampling differs between qualitative and quantitative studies. In quantitative survey studies, it is important to select probability samples so that statistics can be used to provide generalizations to the population from which the sample was drawn. Qualitative research necessitates having a small sample because of the detailed and intensive work required for the study. So sample sizes are not calculated using mathematical rules and probability statistics are not applied. Instead qualitative researchers should describe their sample in terms of characteristics and relevance to the wider population. Purposive sampling is common in qualitative research. Particular individuals are chosen with characteristics relevant to the study who are thought will be most informative. Purposive sampling also may be used to produce maximum variation within a sample. Participants being chosen based for example, on year of study, gender, place of work, etc. Representative samples also may be used, for example, 20 students from each of 6 schools of pharmacy. Convenience samples involve the researcher choosing those who are either most accessible or most willing to take part. This may be fine for exploratory studies; however, this form of sampling may be biased and unrepresentative of the population in question. Theoretical sampling uses insights gained from previous research to inform sample selection for a new study. The method for gaining informed consent from the participants should be described, as well as how anonymity and confidentiality of subjects were guaranteed. The method of recording, eg, audio or video recording, should be noted, along with procedures used for transcribing the data.
A description of how the data were analyzed also should be included. Was computer-aided qualitative data analysis software such as NVivo (QSR International, Cambridge, MA) used? Arrival at “data saturation” or the end of data collection should then be described and justified. A good rule when considering how much information to include is that readers should have been given enough information to be able to carry out similar research themselves.
One of the strengths of qualitative research is the recognition that data must always be understood in relation to the context of their production. 1 The analytical approach taken should be described in detail and theoretically justified in light of the research question. If the analysis was repeated by more than 1 researcher to ensure reliability or trustworthiness, this should be stated and methods of resolving any disagreements clearly described. Some researchers ask participants to check the data. If this was done, it should be fully discussed in the paper.
An adequate account of how the findings were produced should be included A description of how the themes and concepts were derived from the data also should be included. Was an inductive or deductive process used? The analysis should not be limited to just those issues that the researcher thinks are important, anticipated themes, but also consider issues that participants raised, ie, emergent themes. Qualitative researchers must be open regarding the data analysis and provide evidence of their thinking, for example, were alternative explanations for the data considered and dismissed, and if so, why were they dismissed? It also is important to present outlying or negative/deviant cases that did not fit with the central interpretation.
The interpretation should usually be grounded in interviewees or respondents' contributions and may be semi-quantified, if this is possible or appropriate, for example, “Half of the respondents said …” “The majority said …” “Three said…” Readers should be presented with data that enable them to “see what the researcher is talking about.” 1 Sufficient data should be presented to allow the reader to clearly see the relationship between the data and the interpretation of the data. Qualitative data conventionally are presented by using illustrative quotes. Quotes are “raw data” and should be compiled and analyzed, not just listed. There should be an explanation of how the quotes were chosen and how they are labeled. For example, have pseudonyms been given to each respondent or are the respondents identified using codes, and if so, how? It is important for the reader to be able to see that a range of participants have contributed to the data and that not all the quotes are drawn from 1 or 2 individuals. There is a tendency for authors to overuse quotes and for papers to be dominated by a series of long quotes with little analysis or discussion. This should be avoided.
Participants do not always state the truth and may say what they think the interviewer wishes to hear. A good qualitative researcher should not only examine what people say but also consider how they structured their responses and how they talked about the subject being discussed, for example, the person's emotions, tone, nonverbal communication, etc. If the research was triangulated with other qualitative or quantitative data, this should be discussed.
The findings should be presented in the context of any similar previous research and or theories. A discussion of the existing literature and how this present research contributes to the area should be included. A consideration must also be made about how transferrable the research would be to other settings. Any particular strengths and limitations of the research also should be discussed. It is common practice to include some discussion within the results section of qualitative research and follow with a concluding discussion.
The author also should reflect on their own influence on the data, including a consideration of how the researcher(s) may have introduced bias to the results. The researcher should critically examine their own influence on the design and development of the research, as well as on data collection and interpretation of the data, eg, were they an experienced teacher who researched teaching methods? If so, they should discuss how this might have influenced their interpretation of the results.
The conclusion should summarize the main findings from the study and emphasize what the study adds to knowledge in the area being studied. Mays and Pope suggest the researcher ask the following 3 questions to determine whether the conclusions of a qualitative study are valid 12 : How well does this analysis explain why people behave in the way they do? How comprehensible would this explanation be to a thoughtful participant in the setting? How well does the explanation cohere with what we already know?
This paper establishes criteria for judging the quality of qualitative research. It provides guidance for authors and reviewers to prepare and review qualitative research papers for the American Journal of Pharmaceutical Education . A checklist is provided in Appendix 1 to assist both authors and reviewers of qualitative data.
Thank you to the 3 reviewers whose ideas helped me to shape this paper.
Introduction
Conclusions
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On time: a qualitative study of swedish students’, parents’ and teachers’ views on school attendance, with a focus on tardiness.
1.1. absenteeism, 1.2. specific on tardiness, 1.3. the swedish school system, 2. materials and methods, 2.1. participants and procedures, 2.2. analysis, 2.3. research ethics.
Yes, that they are in place, at the lessons. And on breaks and lunches too, of course. So, they are in place on school days, that’s what I think. (Mother 1)
Yes, that they are on time and are here (in school) when they should be. (Mother 2)
Yes and have what they need to bring to school, like books, clothes for physical education, bags, or whatever it is. (Mother 1)
A time is usually to be held to for a reason. So if you do not show up or do not bother being on time, then you do not show respect for it. Everything I think is about consideration, respect, and cooperation. We are numerous at the school; it should work for everyone. And then slipping in when you feel like it or not showing up at all, this affects oneself first and foremost but affects others as well. You get into it, there just has to be a routine...In our family, we are useless at being on time, but…you have to try. And then there are surely families who, ‘but my goodness, come on time, it is well a worldly thing, there are worse problems in life’. But somehow, the school must uphold routines. If you don’t have a routine in school...and do not have one at home, where do you have it, if you are a youth? You have these two platforms and then perhaps a hobby. And then there must be security in this. (Mother 1)
So that you...And that you get in contact directly, so... (to the Guardian), if a student does not come to school, for example, and you have not received an illness report or any other absences, then you must call immediately, of course.
They begin arriving a little bit late from breaks, linger, don’t take things seriously, or the student left home a little bit late. And of course, it affects others too, those who are always there on time [laughter]. So, of course, that is part of the reason why we have tried to work on it.
Some teachers, they do this... If you are a little late, you cannot get in; then, you get marked even more absent than you really were… So, you really were earlier than the report shows because the teacher didn’t let you in. And then you want to be on time. You do not want to get an unnecessarily long absence. The teachers lock the door, not just close it.
4. discussion, 4.1. signals, 4.2. reactions, 4.3. responses, 4.4. it depends on…, 4.5. methodological discussion, 5. conclusions, author contributions, conflicts of interest.
Warne, M.; Svensson, Å.; Tirén, L.; Wall, E. On Time: A Qualitative Study of Swedish Students’, Parents’ and Teachers’ Views on School Attendance, with a Focus on Tardiness. Int. J. Environ. Res. Public Health 2020 , 17 , 1430. https://doi.org/10.3390/ijerph17041430
Warne M, Svensson Å, Tirén L, Wall E. On Time: A Qualitative Study of Swedish Students’, Parents’ and Teachers’ Views on School Attendance, with a Focus on Tardiness. International Journal of Environmental Research and Public Health . 2020; 17(4):1430. https://doi.org/10.3390/ijerph17041430
Warne, Maria, Åsa Svensson, Lina Tirén, and Erika Wall. 2020. "On Time: A Qualitative Study of Swedish Students’, Parents’ and Teachers’ Views on School Attendance, with a Focus on Tardiness" International Journal of Environmental Research and Public Health 17, no. 4: 1430. https://doi.org/10.3390/ijerph17041430
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“removing the home court advantage”: a qualitative evaluation of lego® as an interprofessional simulation icebreaker for midwifery and medical students.
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Polish your papers with one click, avoid unintentional plagiarism, reliability vs validity | examples and differences.
Published on September 27, 2024 by Emily Heffernan, PhD .
When choosing how to measure something, you must ensure that your method is both reliable and valid . Reliability concerns how consistent a test is, and validity (or test validity) concerns its accuracy.
Reliability and validity are especially important in research areas like psychology that study constructs . A construct is a variable that cannot be directly measured, such as happiness or anxiety.
Researchers must carefully operationalize , or define how they will measure, constructs and design instruments to properly capture them. Ensuring the reliability and validity of these instruments is a necessary component of meaningful and reproducible research.
Reliability | Validity | |
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Whether a test yields the same results when repeated. | How well a test actually measures what it’s supposed to. | |
Is this measurement consistent? | Is this measurement accurate? | |
A test can be reliable but not valid; you might get consistent results but be measuring the wrong thing. | A valid test must be reliable; if you are measuring something accurately, your results should be consistent. | |
A bathroom scale produces a different result each time you step on it, even though your weight hasn’t changed. The scale is not reliable or valid. | A bathroom scale gives consistent readings (it’s reliable) but all measurements are off by 5 pounds (it’s not valid). |
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Understanding reliability and validity, reliability vs validity in research, validity vs reliability examples, frequently asked questions about reliability vs validity.
Reliability and validity are closely related but distinct concepts.
Reliability is how consistent a measure is. A test should provide the same results if it’s administered under the same circumstances using the same methods. Different types of reliability assess different ways in which a test should be consistent.
Type of reliability | What it assesses | Example |
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Does a test yield the same results each time it’s administered (i.e., is it consistent)? | Personality is considered a stable trait. A questionnaire that measures introversion should yield the same results if the same person repeats it several days or months apart. | |
Are test results consistent across different raters or observers? If two people administer the same test, will they get the same results? | Two teaching assistants grade assignments using a rubric. If they each give the same paper a very different score, the rubric lacks interrater reliability. | |
Do parts of a test designed to measure the same thing produce the same results? | Seven questions on a math test are designed to test a student’s knowledge of fractions. If these questions all measure the same skill, students should perform similarly on them, supporting the test’s internal consistency. |
Validity (more specifically, test validity ) concerns the accuracy of a test or measure—whether it actually measures the thing it’s supposed to. You provide evidence of a measure’s test validity by assessing different types of validity .
Type of test validity | What it assesses | Example |
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Does a test actually measure the thing it’s supposed to? Construct validity is considered the overarching concern of test validity; other types of validity provide evidence of construct validity. | A researcher designs a game to test young children’s self-control. However, the game involves a joystick controller and is actually measuring motor coordination. It lacks construct validity. | |
Does a test measure all aspects of the construct it’s been designed for? | A survey on insomnia probes whether the respondent has difficulty falling asleep but not whether they have trouble staying asleep. It thus lacks content validity. | |
Does a test seem to measure what it’s supposed to? | A scale that measures test anxiety includes questions about how often students feel stressed when taking exams. It has face validity because it clearly evaluates test-related stress. | |
Does a test match a “gold-standard” measure (a criterion) of the same thing? The criterion measure can be taken at the same time ( ) or in the future ( ). | A questionnaire designed to measure academic success in freshmen is compared to their SAT scores (concurrent validity) and their GPA at the end of the academic year (predictive validity). A strong correlation with either of these measures indicates criterion validity. | |
Does a test produce results that are close to other tests of related concepts? | A new measure of empathy correlates strongly with performance on a behavioral task where participants donate money to help others in need. The new test demonstrates convergent validity. | |
Does a test produce results that differ from other tests of unrelated concepts? | A test has been designed to measure spatial reasoning. However, its results strongly correlate with a measure of verbal comprehension skills, which should be unrelated. The test lacks discriminant validity. |
Test validity concerns the accuracy of a specific measure or test. When conducting experimental research , it is also important to consider experimental validity —whether a true cause-and-effect relationship exists between your dependent and independent variables ( internal validity ) and how well your results generalize to the real world ( external validity ).
In experimental research, you test a hypothesis by manipulating an independent variable and measuring changes in a dependent variabl e. Different forms of experimental validity concern how well-designed an experiment is. Mitigating threats to internal validity and threats to external validity can help yield results that are meaningful and reproducible.
Type of experimental validity | What it measures | Example |
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Does a true cause-and-effect relationship exist between the independent and dependent variables? | A researcher evaluates a program to treat anxiety. They compare changes in anxiety for a treatment group that completes the program and a control group that does not. However, some people in the treatment group start taking anti-anxiety medication during the study. It is unclear whether the program or the medication caused decreases in anxiety. Internal validity is low. | |
Can findings be generalized to other populations, situations, and contexts? | A survey on smartphone use is administered to a large, randomly selected sample of people from various demographic backgrounds. The survey results have high external validity. | |
Does the experiment design mimic real-world settings? This is often considered a subset of external validity. | A research team studies conflict by having couples come into a lab and discuss a scripted conflict scenario while an experimenter takes notes on a clipboard. This design does not mimic the conditions of conflict in relationships and lacks ecological validity. |
Though reliability and validity are theoretically distinct, in practice both concepts are intertwined.
Reliability is a necessary condition of validity: a measure that is valid must also be reliable. An instrument that is properly measuring a construct of interest should yield consistent results.
However, a measure can be reliable but not valid. Consider a clock that’s set 5 minutes fast. If checked at noon every day, it will consistently read “12:05.” Though the clock yields reliable results, it is not valid: it does not accurately reflect reality.
Because reliability is a necessary condition of validity, it makes sense to evaluate the reliability of a measure before assessing its validity. In research, validity is more important but harder to measure than reliability. It is relatively straightforward to assess whether a measurement yields consistent results across different contexts, but how can you be certain a measurement of a construct like “happiness” actually measures what you want it to?
Reliability and validity should be considered throughout the research process. Validity is especially important during study design, when you are determining how to measure relevant constructs. Reliability should be considered both when designing your study and when collecting data—careful planning and consistent execution are key.
Reliability and validity are both important when conducting research. Consider the following examples of how a measure may or may not be reliable and valid.
Casey can choose a different measure in an attempt to improve the reliability and validity of her study.
Even though the measure in the previous example is reliable, it lacks validity. Casey must try a different approach.
Psychology and other social sciences often involve the study of constructs —phenomena that cannot be directly measured—such as happiness or stress.
Because we cannot directly measure a construct, we must instead operationalize it, or define how we will approximate it using observable variables. These variables could include behaviors, survey responses, or physiological measures.
Validity is the extent to which a test or instrument actually captures the construct it’s been designed to measure. Researchers must demonstrate that their operationalization properly captures a construct by providing evidence of multiple types of validity , such as face validity , content validity , criterion validity , convergent validity , and discriminant validity .
When you find evidence of different types of validity for an instrument, you’re proving its construct validity —you can be fairly confident it’s measuring the thing it’s supposed to.
In short, validity helps researchers ensure that they’re measuring what they intended to, which is especially important when studying constructs that cannot be directly measured and instead must be operationally defined.
A construct is a phenomenon that cannot be directly measured, such as intelligence, anxiety, or happiness. Researchers must instead approximate constructs using related, measurable variables.
The process of defining how a construct will be measured is called operationalization. Constructs are common in psychology and other social sciences.
To evaluate how well a construct measures what it’s supposed to, researchers determine construct validity . Face validity , content validity , criterion validity , convergent validity , and discriminant validity all provide evidence of construct validity.
Test validity refers to whether a test or measure actually measures the thing it’s supposed to. Construct validity is considered the overarching concern of test validity; other types of validity provide evidence of construct validity and thus the overall test validity of a measure.
Experimental validity concerns whether a true cause-and-effect relationship exists in an experimental design ( internal validity ) and how well findings generalize to the real world ( external validity and ecological validity ).
Verifying that an experiment has both test and experimental validity is imperative to ensuring meaningful and generalizable results.
An experiment is a study that attempts to establish a cause-and-effect relationship between two variables.
In experimental design , the researcher first forms a hypothesis . They then test this hypothesis by manipulating an independent variable while controlling for potential confounds that could influence results. Changes in the dependent variable are recorded, and data are analyzed to determine if the results support the hypothesis.
Nonexperimental research does not involve the manipulation of an independent variable. Nonexperimental studies therefore cannot establish a cause-and-effect relationship. Nonexperimental studies include correlational designs and observational research.
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BMC Oral Health volume 24 , Article number: 1130 ( 2024 ) Cite this article
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Many patients consult general practitioners instead of dentists for their oral and dental problems every year. This study aims to find the reasons why patients consult general practitioners when they have dental problems.
The sample consisted of patients visiting dentists and general practitioners in Kerman, Iran. A thematic interview guide, semi-structured questions, and a mind map that allowed for structured and open-ended questions were prepared and used for the interviews. All interviews were recorded and transcribed verbatim by a final-year student. Data collection, transcription, and analysis were conducted simultaneously to allow for new topics to be raised and theoretical saturation to be reached. When researchers determined that sufficient information was available for analysis and understanding of patient opinions and beliefs, the interview process was stopped. As all audio conversations were recorded with the participant’s permission, no note-taking was done during the interviews, which allowed for greater focus on the participants’ conversation. The obtained data was analyzed using the content analysis.
A total of 52 patients were included in this study. The codes related to patients participating in this research, along with the number of respondent groups related to each code were as follows: patient’s perceptions of general practitioner(GP) and dental practitioner’s scope of work [ 21 ], flawed dental system (34), dental anxiety [ 28 ], financial considerations [ 25 ], and more accessibility to GPs (31). Dental abscesses and dental pain were reported as the most common reasons for consulting GPs.
Most participants agreed that dental problems are more effectively treated by dentists. Reasons for visiting a general practitioner included lack of a specific dentist, dissatisfaction with dental treatments, lack of a dentist nearby, absence of emergency dental care, and familiarity with a physician. The most common reasons for visits were toothache and dental abscesses. Patients also sought treatment for TMJ pain, referred nerve pain, wisdom tooth pain, numbness and tingling in the jaw, gum inflammation, oral lesions, and ulcers. Furthermore, other factors such as opening hours, appointment systems and waiting time can also affect patient’s consult behaviors regarding dental problems.
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Although a large number of patients consult a dentist when they have dental problems, other patients consult a general practitioner. Nearly 380,000 visits are made to general practitioners per year due to dental problems in the United Kingdom [ 1 ]. The overall rate of consultations related to dental issues with general practitioners in the UK has decreased between 2008 and 2013. However, reported statistics vary widely. For example, in some practices, as many as 8.29 dental consultations per 1,000 patients have been reported [ 2 , 3 ].
This may be due to issues with access to dental services, the patient’s perception of the scope of practice of physicians and dentists, poorly differentiated pain, the need for antibiotics, or financial concerns about the cost of dental treatment [ 2 , 3 ]. Evidence-based guidelines for the management of acute dental conditions recommend that patients (except those with critical conditions) be referred to dentists who have the skills and resources necessary to stabilize conditions and prevent the worsening of patient status. In many cases, acute dental conditions require dental surgical treatments such as extractions or root canal treatments. It seems unlikely that general practitioners have the necessary skills or tools to diagnose and treat such cases, which can justify the high rate of prescribing antibiotics for dental problems. Since in most cases prescribing antibiotics for acute dental problems rarely leads to a definitive cure, the use of antibiotics in these consultations has become a concern. There are also direct, indirect, and opportunity costs associated with dental consultations those are imposed on general practitioners [ 4 ].
Most dental problems cannot be managed entirely by physicians [ 4 ], but unfortunately, general practitioners who lack the knowledge, specialized skills, and necessary facilities to perform appropriate treatment still visit such patients. Systemic antibiotic prescribing for those consulting general practitioners regarding dental problems is more likely than those who visit dentists. Antibiotics have no clinical benefit for many acute dental diseases [ 5 ], and their indiscriminate use could lead to the emergence of antibiotic-resistant bacterial strains and harmful side effects [ 6 ].
The use of general practitioners for dental problems is usually ineffective and insufficient, making it a waste of resources. Patients rarely receive the best care for their dental condition, which can lead to concern about the worsening of their condition due to untreated dental problems and increase the emergence of antibiotic-resistant bacterial strains from improper antibiotic prescribing. The reasons for patients consulting with general practitioners regarding dental problems are not only influenced by the symptoms of the disease and the difference between dentist and general practitioner consultations in terms of access and scheduling convenience but also by background factors such as previous experiences with dental visits and patients’ perceptions of the scope of practice of physicians [ 1 ].
Evidence has been discussed for decades on the relationship between oral and dental health and systemic diseases, especially the interactions between periodontitis or remaining teeth and chronic and non-communicable diseases (diabetes, coronary heart disease, atherosclerosis, and dementia) [ 5 , 6 , 7 ]. Collaborating between general practitioners and dentists is crucial for providing high-quality health services to patients. Recently, it was reported that the convenience of scheduling a visit and its availability can be effective in choosing a general practitioner for dental symptoms. In a study of patients referred to the maxillofacial surgery department in the UK, 26% of patients referred by their treating physician believed that the cost of visiting a dentist instead of a physician was effective in choosing a treating physician for dental and jaw problems. Although the findings of this study may not be generalized to a larger population of patients with dental problems who visit general practitioners, only a small proportion of these patients are referred to another physician [ 8 , 9 , 10 , 11 ]. Therefore, this study aims to find out the reasons why patients consult with a general practitioner for dental or gum problems.
The sample population was comprised of patients who went to dentists and general practitioners in Kerman. In this comprehensive study, both individual and group interviews were conducted with several patients in Kerman. Focus groups and individual interviews are both excellent means of collecting data and information to support monitoring and evaluation work. Both collect qualitative information directly from participants and should provide detailed and rich data. A Focus Group is a structured discussion group, which aims to gather critical information about beneficiaries. A focus group is a small, but representative, sample of people who are asked about their opinions on a particular topic. The responses are then used to generate insights and understanding about that topic. The Focus groups can be an effective way to gather information because they provide a forum for open discussion and allow for the exploration of different viewpoints. They also offer the opportunity to build rapport and relationships with participants [ 11 , 12 ].
Before the interviews, verbal consent was obtained from the patients, and those who were willing to participate were included in the study. A purposive sample with maximum diversity was used to ensure diversity in occupation, gender, and age. All participants volunteered and participated without compensation, and were informed of their right to withdraw from the study without giving a reason until the publication of the study.
Semi-structured individual interviews were conducted in locations requested by the patients. The interviews were conducted by an experienced interviewer (a final-year student who had been trained by the oral medicine professor). A thematic interview guide, semi-structured questions, and a mind map that allowed for structured and open-ended questions were prepared and used for the interviews [ 11 , 12 ].
All interviews were recorded and transcribed verbatim by a final-year student (female). After each interview, field notes were reviewed and reminders were documented. Field notes consisting the context of the conversation, how the information was presented by the patients, the interview atmosphere, and reactions during the interview. Transcripts were compared with recordings and adjusted if necessary [ 11 , 12 ].
The timing and schedule for participants were not uniform, and because each participant may have had different ethical and behavioral characteristics, some conversations may not have required further questioning during the interview, while others may have prompted more questions from the interviewer. The interviews were conducted informally to allow for more detailed and nuanced opinions and discussions by the participants [ 11 , 12 ].
Data collection, transcription, and analysis were conducted simultaneously to allow for new topics to be raised and theoretical saturation to be reached. Theoretical saturation refers to when no new interviews add additional information required for a specific topic. When researchers determined that sufficient information was available for analysis and understanding of patient opinions and beliefs, the interview process was stopped [ 11 , 12 ].
Immediately after the first interview, individuals’ opinions were reviewed and coded separately by a researcher and continued until data saturation was reached (Fig. 1 ). Additionally, to increase the scientific accuracy and validity of the study, the cod es obtained from each interview were given back to the participants to ensure that the researchers’ interpretation of their opinions was accurate.
Saturation of data was reached after conducting six focus groups
Furthermore, individuals were allowed to fully express their opinions, experiences, and perspectives in this area, and their experiences and attitudes were evaluated (face-to-face). As all audio conversations were recorded with the participant’s permission, no note-taking was done during the interviews, which allowed for greater focus on the participants’ conversation [ 11 , 12 ].
Also, the following methods were used to minimize bias: start with building a diverse shortlist, standardize our interview process, make records of the interviews, involve multiple people in the interview process, and acknowledge bias in virtual interviews.
Data was analyzed using content analysis, and the analyzed data was classified and the number of respondents for each category was determined.
This study included 52 patients, all of whom participated in focus group interviews. There were 38 female and 14 male patients, with a mean age of 27.32 ± 1.4 years. All interviews were conducted in a private space and lasted between 20 and 30 min (Mean ± SD = 24.12 ± 4.78). Also, there was no repetition of interviews. Table 1 .
The codes related to participating patients in this study, along with the number of respondent groups for each code, was as follows:
Lack of understanding of the scope of work of physicians (21 codes).
Problems in the patient admission system in dentistry (34 codes).
Anxiety and fear of dentistry (28 codes).
Expensive dental services and inability to pay for dental expenses (25 codes).
Easier access to physicians (31 codes).
Dissatisfaction with previous dental care (17 codes).
Willingness and ability to pay for dental care (21codes).
A great number of participants (39 individuals) agreed that dental problems are more effectively treated by dentists. However, some (13 individuals) had doubts about who was the most appropriate person to consult for gum or other oral problems. For example, some of the patients went to ear, nose, and throat specialists, surgery, or even cosmetic dentistry for this purpose. Some participants (12 individuals) expressed a border between the situations treated by general practitioners and those requiring a dentist. Additionally, some (15 individuals) believed that general practitioners should treat oral problems such as jaw pain or gum sores, while dentists focus on teeth. In this regard, some patients reported reasons such as unusual pain or symptoms that did not match dental problems to justify their choice.
Some patients stated that general practitioners can easily treat dental problems caused by the infection. Additionally, a few participants were unaware that their condition was dental-related until they consulted a general practitioner.
“I didn’t have any toothache at all. My problem started with facial swelling. Then I had swelling under my jaw. I should see a general practitioner.”
“One of my relatives was a physician. I explained my problem over the phone and the infection was resolved with medication.”
Some patients (34 individuals) visited a general practitioner for reasons such as not having a specific dentist, dissatisfaction with dental treatments, not having a dentist near their place of residence, no emergency dental care, and familiarity with general practitioners.
Waiting in line for a dental appointment was a common reason for visiting a general practitioner. Among participants who were unable to access a dentist, only a few attempted to go to emergency dental care. From the patients’ point of view, the timing of appointments with general practitioners was much wider than that of dentists. For a patient who has their own business, being able to access a dentist only during working hours means incurring financial losses. Additionally, another reason for visiting a general practitioner was the proximity and stronger relationship between patients and their general practitioner.
“Emergency dental care is not near our place of residence. Besides, students usually work in emergencies. At least there is a physician in clinics.”
“I tried several times to schedule an appointment with a dentist, but they told that it takes several days to get an appointment with a dentist. So, I decided to see a general practitioner.”
More than half of the patients (28 individuals) reported fear of dentistry or unpleasant experiences from previous dental treatments. This issue has contributed to non-participation in regular dental care over many years. In five cases, fear of dentistry was the main reason for patients to visit a general practitioner instead of a dentist. Some patients reported not having access to their dentist or not being given an appointment by their dentist as reasons for fear of visiting other dentists and visiting general practitioners instead.
“Instead of enduring dental stress, a toothache can be relieved with painkillers and antibiotics.”
Patient dissatisfaction with prior dental care was notably evident in the patients’ statements, revealing a sequence of events that led them to seek treatment from a general practitioner. It seems that experiences in the first few dental visits are crucial, and dissatisfaction during these meetings more often leads to a reluctance to return for further treatments. Failures in dental treatments, unsightly dental restorations, and post-surgical complications all contribute to this feeling. Undertaking unnecessary treatments, the lack of a clear treatment plan, and prolonged waiting times despite severe dental pain were also the other reasons for consulting a general practitioner.
Other reasons included missing appointments or changing addresses, which made these individuals feel abandoned by their previously trusted dentists and unsure about where to seek dental care.
The inability to afford dental expenses was a significant reason for patients to consult a general practitioner. The extent of patients’ demand for treatment may be influenced by their values and willingness to pay for dental care. Some patients reported that they did not any visit a dentist due to unpaid bills from previous treatments and, therefore, consulted a general practitioner.
“If I have a dental problem at the end of the month, I always consult a general practitioner because I can’t afford the cost.”
“If I visit a dentist, I have to pay at least half the cost, and I don’t have a definite plan for dental maintenance. That’s why I turned to a general practitioner so I can decide later.”
“I don’t have the necessary funds for dental treatments.”
This study verifies and examines the reasons for patients consult general practitioners when experiencing dental problems. The obtained findings reveal that lack of individual understanding of the scope of medical professionals, issues within the dental care system, fear and anxiety about dentistry, inability to afford dental expenses, easier access to physicians, patients’ previous experiences with dental care, and dissatisfaction with prior treatments are among the reasons for these consultations.
A study conducted in the United Kingdom revealed that between 30 and 48 patients with dental problems consult regular general practitioners out of 7,000 registered patients annually [ 3 ]. In Australia, general practitioners manage and control oral problems in approximately 19.1 out of 100 individuals [ 3 ].
A research work by Verma et al. (67) revealed that 94% of patients with dental issues visited the emergency department of Royal Hobart Hospital, which is similar to statistics reported in other hospital emergency departments (1.8-3%) [ 8 , 9 ].
The findings by Cope et al. [ 3 ] are similar to another study that shows that although the presence of patients with dental issues in general practitioner offices is relatively low, they receive various treatments [ 1 ]. Consultations and the need for dental problem treatment may be less frequent than other infections, but it still poses a dilemma for some general practitioners [ 1 , 3 ].
Dental problems sometimes manifest with atypical features such as acute sinusitis [ 10 ] or orbital and auricular symptoms [ 11 ]. Recent research has recognized referred pains or pains that are difficult to distinguish as one of the reasons why patients consult general practitioners instead of dentists during dental problems [ 12 ]. However, it is currently not possible to estimate the ratio of patients who are influenced by misconceptions about their condition compared to those who are aware that their problem is related to their teeth or gums [ 13 ].
According to the study by Cope et al. [ 14 ], some patients believe that physicians receive more extensive training for managing facial and jaw problems than dentists. This perspective may be more common, especially in individuals who consult general practitioners with jaw or dental problems. This aligns with the findings of a study conducted in the United States, where 21% of participants who consulted a physician for dental pain believed that the physician could treat them [ 15 ].
In the study conducted by Cope et al. [ 12 ], the choice of oral health care provider for dental problems was influenced by patient characteristics, such as their understanding of the scope of practice and their willingness and ability to pay for dental care, as well as the characteristics of the healthcare providers. This study is in line with Levesque et al. [ 16 ], who proposed a framework in which access to healthcare is the result of dynamic interaction between the healthcare system and the population they serve. One of the main reasons participants without a specific dentist chose to consult a general practitioner was the lack of timely access to dental care.
Another reason for patients seeking general practitioners was anxiety and fear of dental procedures, which is consistent with the research by Cope et al. [ 12 ] and Levesque et al. [ 16 ]. Dental anxiety is a well-known significant factor affecting access to dental care and is a significant barrier that leads patients to consult general practitioners instead of dentists.
This study revealed that participants sought a general practitioner because of their inability or unwillingness to pay for dental care expenses. The cost of dental treatment had been described previously as a barrier to accessing dental care and a factor that might drive patients toward general practitioners. Reluctance to pay was also recognized as a known barrier to access.
In a study conducted in Wales, UK in 2015, the prescription of antibiotics for managing dental problems significantly varied among samples. Some general practitioners reported that they might not prescribe antibiotics for all patients with dental problems, but most patients receive antibiotics. In comparison, other general practitioners were highly resistant to prescribing antibiotics and only provided pain relief medications or advised patients to consult a dentist [ 14 ].
In the research conducted by Cope et al. [ 14 ], most general practitioners expressed that they have limited or no formal education in diagnosing and managing dental conditions. Therefore, most of their dental knowledge is informally gained through socializing with friends who are dentists, occasionally working alongside dentists to acquire knowledge, or sometimes being patients of dentists themselves, which helps them acquire knowledge. One problem with this type of learning is that it can lead to confusion among general practitioners when they receive mixed information about managing dental problems, especially regarding the use of antibiotics.
In the study by Cope and colleagues [ 14 ], a general practitioner expressed that the rate of antibiotic prescription for dental problems had decreased since the improvement in access to local emergency dental services. This means that doctors can guide patients to places with better dental care and have less commitment to making efforts and managing conditions.
In the research work by Cope et al. [ 14 ], one general practitioner similarly stated that antibiotic prescriptions for dental problems have decreased since access to local emergency dental services has improved. This means that doctors can refer patients to a place with better care and feel less of an obligation to try and manage the condition. In Cope et al. research [ 14 ], many doctors, especially those who did not routinely prescribe antibiotics for dental problems rejected the patient’s request for antibiotics; which caused patient dissatisfaction.
In Cope et al. [ 17 ] study, more than half of the treatments led to antibiotic prescriptions for dental problems. The widespread prescription of antibiotics for dental problems is concerning. Antibiotics may not resolve the issue in the long term, and they may interact with other medications and create antibiotic resistance. Furthermore, evidence suggests that prescribing antibiotics for dental problems may encourage future visits to general practitioners and reinforce the incorrect behavior of patients not seeking dental care for dental issues.
A study by Verma and colleagues [ 7 ] showed that the management of dental caries and infections primarily occurs through drugs such as pain relievers and antibiotics, which can be ineffective and, at best, provide short-term relief without addressing the patient’s need for definitive treatment by a dentist. Despite the increase in awareness of the importance of surgical treatments for managing dental problems among doctors, general practitioners are still considered unsuitable professionals for controlling dental problems. Therefore, there is a need for more effort to encourage people to seek appropriate dental care when they have dental problems, possibly through proper awareness by dental care providers or campaigns to educate people about healthcare professionals in this field for addressing dental issues.
In this study, the number of visits ranged from 1 to 20 per month, with most cases occurring during the night. The reported sequence by general practitioners for dental consultations varies. While some general practitioners visit patients with dental problems weekly, others report that dental consultations during their practice are much less frequent.
In the Cope et al. study [ 14 ], the reported number of dental consultations varied from once a week to once every few months. While some doctors stated that the number of dental consultations remains relatively stable, other doctors stated that the number of patients presenting with dental problems increases or decreases during their time in the office. The reduction in these referrals is related to improved access to dentistry or patient awareness of where they can access appropriate dental care.
Attitudes towards the management of dental problems can be much different. In the study by Cope et al. [ 14 ], some doctors stated that some of their colleagues stubbornly refuse to visit patients with dental problems, although they always do so with good manners. In comparison, general practitioners who strongly opposed the management of dental problems in medical practice expressed different degrees of consternation than those who willingly treated such patients. The doctors explained that in their experience, this will lead to an increase in the probability of patients coming back during the next period of toothache.
Despite the general negative attitude towards dental problems in medical practice, general practitioners sympathize with patients who experience dental problems. Doctors are aware of the debilitating effects of toothache as well as the complexities of accessing emergency dental services. This issue shows that many of the contradictions shown by general practitioners towards dental consultations are related to system defects that lead to insufficient access to emergency dental care. The exception in this case were the patients who were thought to do this to avoid the costs of dental services [ 14 ].
The attitude of general practitioners towards dental consultations is influenced by the burden and pressure of dental problems, the general pressure of the workload of medicine, and the perceptions of the patient’s motivation to request care. Cost concerns may be the main reason for avoiding dental care [ 7 ].
In the Cheng et al. study [ 18 ], problems related to oral and dental mucosa were reported as the most common problems. These findings are consistent with a study conducted by physicians in Ontario, Canada [ 19 ]. This study identified dental problems and supporting structures, hard tissue diseases, and soft tissue diseases of the mouth, except for gum and tongue lesions, as the most common oral conditions visited by physicians.
In Cope et al.‘s study [ 3 ], women visited more than men, which is similar to findings from other articles [ 19 , 20 , 21 ]. The highest number of visits was for the age group of 20 to 29 years, and the reason was due to problems related to wisdom teeth and toothache.
In the study by Verma et al. [ 17 ], most patients were male. In South Korea and Ohio, 7.62% and 59% of emergency department visits were made by men, respectively [ 10 , 20 ].
In the investigation by Verma et al. [ 7 ] it was revealed that despite the wide age range of emergency department patients at Royal Hobart Hospital (from 0 to 88 years), the majority of patients are under 30 years old. 68% of patients visit the hospital during non-working hours when general dentists may not be available, which can lead to the need for dental services to be provided at Hobart Hospital during non-working hours.
Cheng et al. study [ 22 ] showed that the rate of individuals aged 70 and above visiting general practitioners for dental problems is significantly lower than those aged 54 and younger. These findings are consistent with the National Dental Health Survey of Australian adults in 2017–2018, which reported a decreasing trend in delaying or avoiding dental care due to cost in older age groups [ 23 ].
In Bell et al. study [ 5 ], the majority of patients preferred to consult with a medical practitioner rather than a dentist for non-dental jaw and facial problems. This result is similar to a survey of patients attending a rapid access clinic for suspected cancer cases, where 59% of patients presented to their general practitioner with a complaint of oral problems [ 24 ]. Another study on patient preference for oral ulcer therapy showed that 69% of patients preferred to consult with a general practitioner rather than a dentist for specific dental problems [ 25 ]. The results of the Bell et al. study [ 5 ] suggest that most patients perceive medical practitioners to have more training and therefore greater ability to deal with non-dental jaw and facial complaints. Additionally, most patients reported that their general practitioner is more accessible than their dentist.
In the Anderson et al. study [ 1 ], dental problems were seen in 44% of visits to dental clinics or 0.13% of all visits. However, nearly one-fifth of these visits were for non-dental problems that were also presented to family physicians. Many patients may also visit their physician without realizing that their symptoms have a dental origin. Although the presence of patients in general practitioner clinics is often seen as a major problem, this study found that only 0.3% of visits were for oral and dental health problems.
Similarly, the Office of Population Censuses and Surveys/Royal College of General Practitioners study showed a low prevalence of oral and dental problems among family physician patients (185 consultations per 10,000 people) [ 26 ]. In Anderson et al.‘s study [ 1 ], patients with dental problems were generally in the age groups of 0–4 years and 16–44 years. A disproportionate number of weekend visits were shown for dental problems compared to all visits. Patients who met with their general practitioner more regularly had a stronger relationship with them and were therefore more likely to request help from them than from a dentist, with whom they have less frequent contact.
It was revealed by Bell et al. [ 5 ] that most participants find medical practitioners more accessible than dentists when scheduling appointments. This suggests that factors such as working hours, appointment systems, and waiting times can influence a patient’s decision to seek advice for dental problems [ 27 , 28 ]. The direct cost associated with dental treatments can be an effective factor in choosing a healthcare provider.
Since there is no single reason why patients with dental problems visit their general practitioner, it seems that there will be no single solution to ensure that patients seek the most professional individuals capable of managing their dental conditions. However, there is a need to overcome barriers that prevent access to dental care. It may also be necessary to take action to increase access to emergency dental care for patients who do not have a specific dentist and to ensure that dentists have timely access to emergency care for their patients so that they do not have to wait long periods during which they may seek care from a general practitioner. These findings also indicate a need for information on where to seek care for oral diseases, especially the role that dentists can play in managing non-dental oral problems. This information should be tailored to reflect local dental service providers along with treatment costs. General practice teams should also be able to guide patients with dental problems to local emergency dental services or other care resources if necessary. The limitations of this study were non-cooperation of some patients and the lengthening of several interviews.
Most participants agreed that dental problems are more effectively treated by dentists, because of the lack of a specific dentist, dissatisfaction with dental treatments, lack of a dentist nearby, absence of emergency dental care, and familiarity with a family physician. The most common reasons for visits were toothache and dental abscesses. Patients also sought treatment for TMJ pain, referred nerve pain, wisdom tooth pain, numbness and tingling in the jaw, gum inflammation, oral lesions, and ulcers. Furthermore, other factors such as opening hours, appointment systems and waiting time can also effects on patient’s consult behaviors regarding dental problems.
This in turn should facilitate the design of interventions to reduce consultation rates for dental problems in general medical practice in Iran. This could be approached using qualitative methods, in order to capture the richness and complexity of influences on patients’ care-seeking behavior. Alternatively, a cross-sectional design could be employed, in which dominant influences on consultation behavior are quantified amongst a representative sample of the Iranian population who have sought care from a general medical practitioner for a dental problem. There is therefore a need for further high-quality studies exploring the reasons why patients in Iran may seek care from a general medical practitioner general medical practitioner when experiencing dental problems.
Availability of data and materials: The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.
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The authors would like to express their gratitude to the Vice Deputy of Research at Kerman University of Medical Sciences for their financial support (Reg. No. 401000594). This project was approved by the Ethics Committee of the university with the code IR.KMU.REC.1401.477.
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Authors and affiliations.
Kerman Social Determinants on Oral Health Research Center, Kerman University of Medical Sciences, Kerman, Iran
Raziyehsadat Rezvaninejad
Department of Oral Medicine, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
Maryam Alsadat Hashemipour & Mina Mirzaei
Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
Haleh Rajaeinia
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Raziyehsadat Rezvaninejad: wrote the main manuscript text Maryam Alsadat Hashemipour: wrote the main manuscript text Mina Mirzaei : data collectionHaleh Rajaeinia: data collection.
Correspondence to Maryam Alsadat Hashemipour .
Ethics approval and consent to participate.
The study was approved by the ethics committee of Kerman University of Medical Sciences by the research deputy of Kerman University of Medical Sciences. A statement to confirm that all experimental protocols were approved by the research deputy of Kerman University of Medical Sciences. Informed verbal consent was obtained from the participants for examinations and participation in the study following the provision of the needed explanations by the research deputy of Kerman University of Medical Sciences. All the information on the subjects will remain confidential. The authors would like to express their gratitude to the Vice Deputy of Research at Kerman University of Medical Sciences for their financial support (Reg. No. 401000594). This project was approved by the Ethics Committee of the university with the code IR.KMU.REC.1401.477. All experiments were performed according to relevant guidelines and regulations.
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Coreq (consolidated criteria for reporting qualitative research) checklist: 32-item checklist.
Developed from:
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007. Volume 19, Number 6: pp. 349–357. (Ref:26)
Item No | Guide Questions/Description | Reported on Page # |
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1. Interviewer/ facilitator | Which author/s conducted the interview or focus group? | Page# 4,5 |
2. Credentials | What were the researcher’s credentials? E.g., PhD, MD | Page# 4,5 |
3. Occupation | What was their occupation at the time of the study? | Page# 4,5 |
4. Gender | Was the researcher male or female? | Page#4 |
5. Experience and training | What experience or training did the researcher have? | Page#4 |
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6. Relationship established | Was a relationship established prior to study commencement? | Page#4 |
7. Participant knowledge of the interviewer | What did the participants know about the researcher? e.g. personal goals, reasons for doing the research? | Page#4 |
8. Interviewer characteristics | What characteristics were reported about the interviewer/facilitator? e.g. Bias, assumptions, reasons and interests in the research topic | Page#5 |
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9. Methodological orientation and Theory | What methodological orientation was stated to underpin the study? e.g. grounded theory, discourse analysis, ethnography, phenomenology, content analysis | Page# 4,5 |
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10. Sampling | How were participants selected? e.g., purposive, convenience, consecutive, snowball | Page# 4,5 |
11. Method of approach | How were participants approached? e.g., face-to-face, telephone, mail, email | Page# 4 |
12. Sample size | How many participants were in the study? | Page# 4 |
13. Non-participation Setting | How many people refused to participate or dropped out? Reasons? | Page# N/A |
14. Setting of data collection | Where was the data collected? e.g., home, clinic, workplace | Page# 4 |
15.Presence of nonparticipants | Was anyone else present besides the participants and researchers? | N/A |
16. Description of sample | What are the important characteristics of the sample? e.g. demographic data, date | Page# 4 |
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17. Interview guide | Were questions, prompts, and guides provided by the authors? Was it pilot tested? | Page# 4 |
18. Repeat interviews | Were repeat interviews carried out? If yes, how many? | N/A |
19. Audio/visual recording | Did the research use audio or visual recording to collect the data? | Page# 4,5 |
20. Field notes | Were field notes made during and/or after the interview or focus group? | Page#4,5 |
21. Duration | What was the duration of the interviews or focus group? | Page# 4 |
22. Data saturation | Was data saturation discussed? | Page# 4,5 |
23. Transcripts returned | Were transcripts returned to participants for comment and/or correction? | Page# 4,5 |
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24. Number of data coders | How many data coders coded the data? | Page#5 |
25. Description of the coding tree | Did the authors provide a description of the coding tree? | N/A |
26. Derivation of themes | Were themes identified in advance or derived from the data? | Page# 5 |
27. Software | What software, if applicable, was used to manage the data? | N/A |
28. Participant checking | Did participants provide feedback on the findings? | N/A |
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29. Quotations presented | Were participant quotations presented to illustrate the themes/findings? Was each quotation identified? e.g., participant number | Page#6,7 |
30. Data and findings consistent | Was there consistency between the data presented and the findings? | Page#6–9 |
31. Clarity of major themes | Were major themes clearly presented in the findings? | Page#6,7 |
32. Clarity of minor themes | Is there a description of diverse cases or a discussion of minor themes? | Page#6–9 |
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Rezvaninejad, R., Hashemipour, M.A., Mirzaei, M. et al. Patients’ reasons for consulting a general practitioner at the time of having dental problems: a qualitative study. BMC Oral Health 24 , 1130 (2024). https://doi.org/10.1186/s12903-024-04899-y
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Introduction Many patients consult general practitioners instead of dentists for their oral and dental problems every year. This study aims to find the reasons why patients consult general practitioners when they have dental problems. Methods The sample consisted of patients visiting dentists and general practitioners in Kerman, Iran. A thematic interview guide, semi-structured questions, and ...