184 Chapter 6 Results Participants and Outcome Focus Groups: Step 1 Step 1a took place in September 2023. For this first design session, we included four professionals and five specialists (n = 9). The total group consisted of seven women and two men; their ages ranged between 25 and 53 years (mean age: 40.5 years). Participant characteristics (profession, gender, age, educational level, and years of working experience) are given in Table 1. The pressure cooker session for focus groups 1 and 2 had a duration of 100 min (or 200 min in total). The following key themes were mentioned in both focus groups: patients and MHNs in practice regarding oral health; preferred oral health tools, particularly for MHNs working with patients with psychotic disorders; and intended outcomes of tools. It is important to note that themes were interlinked (e.g., context was related to tools; tools were related to context and outcomes). Key theme 1: Patients and MHNs in practice regarding oral health Participants in both focus groups indicated that patients frequently experience dental issues. The expert by experience stated that many patients with psychosis do not pay much attention to oral health at all. Patients do not contemplate oral care (or self-care) and are genuinely focused on other matters. The expert by experience indicated that when patients have oral problems (e.g., bad breath), nobody comments on them. “A patient is not aware of it himself; patients live in their own reality and if patients are ill, they simply are not always aware of it. MHNs need to bring this up for discussion.” (Participant 9, MHN) MHNs indicated that many patients with psychosis use medication. The influence of medication on oral health is known by some MHNs, but this is not always communicated to patients, suggesting that this should be considered when developing a tool. Participants stated that when patients need to visit the dentist, it incurs a significant cost, and they often do not have dental insurance. Consequently, patients are left with expensive bills, and they often do not have the necessary funds available.
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