230 Chapter 7 Our research (chapter 2 and 3) has demonstrated that patients with psychotic disorders exhibit numerous risk factors for decreased oral health care. Our case– control comparison (chapter 3) indicated that nearly 15% of FEP patients reported a negative impact on their oral health-related quality of life (OHRQoL) due to risk factors, versus 2% in the general population [7]. The possession of dental insurance and the financial capacity to afford treatment are closely connected to the quality of life related to oral health. Patients after FEP state that they significantly lack the financial means to cover dental expenses [30,31], and moreover, face more risk factors than a comparable group within society [7]. In the Netherlands, beyond the standard basic health insurance, supplementary dental insurance is necessary for oral healthcare. Vulnerable individuals, particularly those with mental health issues, may not always have such coverage [1,32,33]. This dissertation highlights the importance of preventing oral health issues and argues for the inclusion of preventive interventions in dental insurance packages. This is not the case in current practice. However, there are arrangements for users of the Long-Term Care Act (In Dutch: Wet Langdurige Zorg), but therefore patients must reside in a psychiatric hospital for treatment for more than three years; from that point onward, the responsibility for their care shifts to this act. From 2024, it has been arranged that dental care should be reimbursed for these people. For patients with FEP who have regular health insurance without dental coverage, the situation is more complex. The basic health insurance does not cover routine dental care, such as check-ups, fillings, or preventative treatments. Early dental care is crucial to prevent worsening conditions. The Integral Healthcare Agreement lays the foundation for making healthcare universally accessible. Therefore, the accessibility of oral care should be improved, e.g. through an additional insurance or through an expansion of existing dental insurance. Methodological considerations Design-oriented research: using a human-centered design In this dissertation, we used different study designs, such as qualitative, quantitative, and a design-oriented approach, and noted the potential strengths of applying design-oriented research within mental health nursing (chapter 5 and 6). The co-creative, iterative, and creative approach with non-linear steps can be used to solve problems and to provide tailor-made solutions for severe issues [34]. We found
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