title: Evaluation of a community dental service for homeless and 'hard to reach' people.
abstract: OBJECTIVE
  Since 2013, Revive Dental Care has been operating a community outreach dental service for homeless and 'hard-to-reach' patients. This research aimed to (a) explore the dental care experienced by people accessing the service, (b) examine barriers and facilitators to using a dental service, (c) examine the impact of the service and (d) identify good practice in providing dental services for homeless people.
  
  
  METHODS
  Semi-structured interviews with 20 patients, nine members of the dental staff and four staff members from the community centres providing services for homeless people.
  
  
  RESULTS
  Findings suggest that homeless patients have overall poor daily dental care and experience significant dental problems due to a range of lifestyle factors. Most participants had not seen a dentist for many years and previous experiences of seeing a dentist were often unpleasant. Barriers to care included fear, embarrassment, lack of money, living chaotic lifestyles, not prioritising dental care and difficulties finding an NHS dentist that would take on homeless people. Service provision for homeless and/or hard-to-reach patients needs to be proactive with dental staff going to community settings and making personal contact.
  
  
  CONCLUSIONS
  Crucially, providers must acknowledge that the patients are vulnerable. A successful service needs to be informal, adapt to patient needs and accommodates chaotic lives.
authors.affiliation: Research Institute for Health and Social Change, Manchester Metropolitan University.
authors.forename: S
authors.initials: S
authors.lastname: Caton
authors.affiliation: Revive Dental Care.
authors.forename: F
authors.initials: F
authors.lastname: Greenhalgh
authors.affiliation: NHS R&D NW.
authors.forename: L
authors.initials: L
authors.lastname: Goodacre
mesh_terms: D003149:Community Dentistry / Q000379:methods / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000379:methods / Q000458:organization & administration; D006703:Ill-Housed Persons; D006801:Humans; D015397:Program Evaluation; D006113:United Kingdom; D035862:Vulnerable Populations