Father’s Experiences of Access to Oral Health Care Services for Children with Disabilities in the Kingdom of Saudi Arabia

Background: Children with disabilities experience poorer oral health and have higher oral health needs than their non-disabled peers. The poor oral health status of children with disabilities has been attributed to a variety of factors; from chronic diseases and conditions, to the varying knowledge and negative attitudes of oral health providers. Other barriers include accessibility and availability of oral health services, the skills of oral health professionals, and family support to maintain oral health. Access to oral health services would also appear to be an issue, but it has not explored in depth. This thesis employed a city in the Kingdom of Saudi Arabia as a case study to explore the ways that fathers of children with disabilities access oral health services. Methods: Ethnography was used as the methodology and this involved observation of 4 dental settings, interviews with 25 participants and 2 focus groups with 13 participants in total. All interviews were carried out in Arabic, recorded and transcribed where possible and then translated from Arabic to English. Thematic analysis was used to identify themes. Results: Parents, mainly fathers, of children with disabilities acted as gate-keepers for accessing oral health care services. Saudi culture played an active role in accessing oral health services because wasta (is a form of connection, contact, network and nepotism) and social networks were identified as means to ease the process. Affordability, availability, accessibility and geographical location of services were an issue within Al-Madinah and related to an inequitable distribution of services and resources. Conclusion: Overall, the findings of this thesis suggest that access to oral health care services for children with disabilities in Saudi Arabia exhibits some similarities to the evidence base, but there are also differences to access compared to those described in western countries. The differences could be attributed to lack of oral health policy and guidance for children with disabilities, cultural perspectives around oral health and service provision within the Saudi community and structural contrasts in commissioning and oral health service provision in the Kingdom of Saudi Arabia.