Barriers and enablers to skill-mix in the oral health workforce: A systematic review

Introduction: In dentistry, the term “skill-mix” is used to describe the combinations of dentists and dental care professionals in delivering activities that are commonly established by their level of education, training and scope of practice. However, the literature has indicated an under-utilisation of skill-mix in the oral health care team. Further work is required to understand the poor uptake of skill-mix in oral health care and what could be done to address this issue. Objective: To identify and synthesise the available evidence on the barriers and enablers to skill-mix in the oral health workforce using a macro-, meso- and micro-level framework. Materials and methods: The databases MEDLINE, CINAHL and Scopus between January 2010 to April 2020 were searched. Primary research studies published in English were included. Results: Thirty-two articles were included. Key barriers and enablers at each level of analysis were identified. Macro-level barriers and enablers included structural, regulatory and policy conditions and dental health care needs of populations. Meso-level barriers and enablers defined the parameters of service delivery and included workplace characteristics, referral systems and patterns, and workplace productivity and efficiency. Micro-level barriers and enablers pertained to the perceptions, attitudes, and social acceptability of stakeholders that affected the delivery of services. Conclusion: Understanding the barriers and enablers from a multi-level framework requires further high-quality research to fully appreciate its importance in addressing health care needs within populations and increase generalisability to oral health settings.