Electronic Theses and Dissertations (PhDs)

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Browsing Electronic Theses and Dissertations (PhDs) by Keyword "Autonomy"

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    Dental occupations in transition: Boundary contestation and curricula for Oral hygienists in South Africa
    (University of the Witwatersrand, Johannesburg, 2023-09) Vergotine, Glynnis; Allais, Stephanie; Shalem, Yael
    This study sought to understand how changes to the scope and autonomy of the oral hygiene occupation in South Africa have influenced relations among dental occupations. Over the past two decades, legislative advances in South Africa have sanctioned new possibilities for mid-level dental occupations such as oral hygienists, allowing them greater independence and additional procedures. The division of labour within the dental profession is that oral hygienists and dental therapists supplement the work that dentists do by offering some of the basic dental services. The changes to oral hygienists’ scope and independence have initiated boundary contestations around the work and training of dental professionals. The qualitative study involved analysing relevant regulatory documents and included semi-structured interviews with representatives of professional bodies and regulatory bodies as well as practitioners and lecturers representing the three dental occupations, and curriculum analyses. A key empirical finding is that the regulatory changes have not been implemented and this is so not only because of contestations by dentists. The study highlights boundary contestations between dentists and oral hygienists. These contestations are about specific procedures in the expanded scope of practice and the opportunity for hygienists to practice independently. The study found that boundaries have been established from outside of the oral hygiene occupation by dentists, to control their work and training. Dentists’ power is exhibited in the labour market and the education and training arena and provides justifications for why the official legislative changes in scope are not being implemented. Despite this, hygienists also place boundaries on themselves, so within the occupation, there are various ways in which hygienists limit their advancement. The hygienists are hesitant to perform certain procedures and have not opened independent practices. This suggests that pressure to narrow the scope and autonomy may not only come from outside of occupations but also from the inside of an occupation. The thesis shows a web of power relations between occupations and provides insights into a dominant occupation controlling the jurisdiction of subordinate occupations; but more unusually, it reveals the dynamics within the mid-level occupation that stifle its advancement.