1) Central phenomenon

The central phenomenon among platform-based mobile workers was ‘repeated experiences of unmet dental needs.’

Despite planning or making appointments to visit the dentist, they often failed to actually go, experienced delays or postponements in treatment due to not visiting on time even during ongoing dental care, and endured oral symptoms without seeking treatment, resulting in necessary dental care not being adequately met at the appropriate time. “I know I need to go to the dentist, but I keep putting it off. I only go when I really can’t bear it anymore.” (Participant 3) “Even when I made appointments, I often ended up not going. So, I kept missing out on treatment.” (Participant 8) “I’ve had toothaches many times, but I just endured them.” (Participant 11)

2) Causal conditions

The causal conditions were ‘work environment hindering dental visits’ and ‘financial burden of dental visits.’ Regarding ‘work environment hindering dental visits,’ participants stated that due to the nature of their work, it was ‘hard to schedule dental appointments’ and ‘not easy to secure time to visit the dentist.’ They also mentioned that during work hours, it was ‘difficult to access dental care,’ and after long working hours, they lacked ‘the leisure and energy to visit the dentist.’ Some participants perceived that ‘visiting the dentist while wearing work clothes itself was burdensome.’ “Even if I make a dental appointment, it’s hard to go at the scheduled time. So I keep postponing it.” (Participant 4) “After work, I’m so exhausted that I can’t even think about going to the dentist.” (Participant 14) “I can’t go to the dentist wearing my work clothes…” (Participant 15)

Regarding ‘financial burden of dental visits,’ participants stated that they often postponed or gave up dental visits due to the ‘burden of treatment costs.’ In particular, dental treatment was perceived as a medical service with a high cost burden, so when symptoms were not severe, they tended to delay treatment as a lower priority. “Dentist visits cost a lot of money at once, so I can’t go. I endure it until the pain gets worse.” (Participant 6) “I need to go to the dentist, but the cost of treatment right now is too burdensome.” (Participant 10) “When I think about the cost, it’s hard to go to the dentist right away. So I think I keep postponing it.” (Participant 13)

3) Contextual conditions

The causal conditions were reinforced by six contextual conditions: uncertainty of platform-based mobile work, poor working conditions and high physical fatigue, psychological stress and low occupational recognition, socioeconomic vulnerability and monetization of time, insufficient social and institutional protection, and low oral health awareness. Together, these conditions contributed to repeated experiences of unmet dental needs. Regarding ‘uncertainty of platform-based mobile work,’ participants described real-time changes in work locations, difficulty predicting the content and duration of tasks in advance, and irregular working hours. “I have to keep moving, so I can’t go to the dental clinic I usually visit.” (Participant 2) “Since I don’t know what jobs will come up today or how long they will take, I can’t even make an appointment.” (Participant 7)

Regarding ‘poor working conditions and high physical fatigue,’ participants performed long hours of high-intensity labor while being continuously exposed to various external environments such as vehicle vibrations, fine dust, exhaust fumes, and noise. At the same time, they reported high levels of fatigue due to a lack of sufficient space for rest or changing clothes. “I keep getting vibrations, so my back hurts a lot. It puts a lot of strain on my musculoskeletal system.” (Participant 11) “Working outside all day means dust sticks to my clothes and they smell. It’s a bit awkward to go to the dentist like that.” (Participant 12) “There’s nowhere to change clothes in the middle of the day… For us, standing on the street is what counts as resting.” (Participant 15)

Regarding ‘psychological stress and low occupational recognition,’ participants continuously experienced psychological pressure from the platform system, the burden of customer evaluations, and conflicts with customers. They also perceived that their occupation was not sufficiently respected by society and stated that even visiting the dentist while wearing their work uniform was burdensome. “When a call comes in, I have to pick it up quickly, so I’m constantly on edge.” (Participant 1) “They keep saying ‘delivery guy, delivery guy.’ Even among ourselves, we ignore it, so…” (Participant 6) “You have to get good ratings too. So even when you meet difficult customers, it’s not easy to speak up.” (Participant 9) “When I went to the dentist wearing my work uniform, I felt the way people looked at me was different.” (Participant 15)

Regarding ‘socioeconomic vulnerability and monetization of time,’ participants were placed in a situation of low work rates and unstable income structures due to a lack of social, cultural, and economic capital. They also perceived that since their earnings were based on the amount of work done, any time not working directly resulted in income loss. This led to viewing even dental visits as an economic loss, showing a tendency to prioritize livelihood maintenance over health care. “Break time itself is time when I can’t earn money, so going to the hospital is a burden.” (Participant 6) “If I can’t work while I’m at the dentist, my income for that day immediately decreases, so I can’t go easily.” (Participant 12) “I have debts and have to support my family, so even if my body is tired, I have no choice but to keep working.” (Participant 15)

Regarding ‘insufficient social and institutional protection,’ participants stated that unlike regular workers, they were not sufficiently guaranteed health checkups or welfare benefits, and there was no coverage for accidents or injuries. Therefore, even if an accident or illness occurred during work, it was difficult to receive institutional protection. This absence of institutional protection also served as another background factor preventing them from accessing necessary dental care at the appropriate time. “When I got into a traffic accident, my income for the next month immediately dropped to zero.” (Participant 3) “You can’t take sick leave like at a company when you’re sick, and if you take a day off, you lose that day’s income right away.” (Participant 2) “Quick service workers don’t get any support for dental care or health check-ups.” (Participant 14)

Regarding ‘low oral health awareness,’ participants did not perceive oral symptoms as serious health issues, and there was a strong perception that the dentist was a place to visit only when the pain became severe. Additionally, due to prioritizing making a living, there was a tendency to postpone oral health care or endure symptoms. “I thought the dentist was a place you go only when the pain is really unbearable.” (Participant 3) “Since making a living comes first, dental care keeps getting pushed back.” (Participant 8) “Even if my teeth felt a little uncomfortable, I just thought it was because I was tired and ignored it.” (Participant 14)

4) Intervening conditions

The intervening conditions identified were ‘expanded institutional support for workers in special types of employment,’ ‘platform-linked dental care support,’ and ‘rest and recovery support.’ Participants recognized, based on their experiences with oral health screening programs, that such support could help alleviate barriers to accessing dental care caused by time constraints and financial burdens.

Regarding ‘expanded institutional support for workers in special types of employment,’ participants perceived that institutional support tailored to the characteristics of platform-based mobile work should be established. In particular, they emphasized the need for public oral health screening programs for platform-based mobile workers and the inclusion of oral health examination items in health checkups for workers in special types of employment. They also suggested that time spent receiving health screenings or dental treatment should be recognized as working time or compensated for as income loss. Some participants further noted that social safety nets, such as a basic income or minimum income guarantee, could reduce financial pressures and allow them to seek dental care when needed. “If I could receive regular oral health screenings like office workers do, it would feel much less burdensome.” (Participant 4) “If dental examinations were included in routine health checkups, I would not need to set aside additional time for them.” (Participant 8) “If the time spent receiving health screenings were recognized as working time, I could attend much more comfortably.” (Participant 14)

Regarding ‘platform-linked dental care support,’ participants reported that the nature of platform-based mobile work makes it difficult to access dental services during regular weekday clinic hours. Therefore, they emphasized the need for expanded evening and weekend dental services as well as platform-linked dental support systems. For example, they suggested recommendation services that identify available dental clinics based on workers’ locations or travel routes, appointment systems integrated within platform applications, and partnerships with affiliated dental clinics. Participants believed that such measures would improve access to dental care. They also highlighted the importance of oral health screenings and counseling services provided through shelters for platform-based mobile workers, as well as expanded evening and weekend services tailored to their work schedules. “Because I work throughout the day, I need to be able to visit a dentist conveniently at night or on weekends.” (Participant 5) “If appointments could be made directly through the platform, it would reduce the burden of searching and making phone calls during work.” (Participant 6) “Since it is difficult to visit a local dental clinic anyway, it would be much more convenient if only clinics near my usual route were shown.” (Participant 10)

Regarding ‘rest and recovery support,’ participants reported that long working hours and inadequate rest environments made it difficult to utilize dental care services. Therefore, they emphasized the need to expand shelters for platform-based mobile workers and provide sufficient rest facilities during work. Participants viewed shelters not only as places for rest but also as potential hubs for oral health screenings and health counseling. They further perceived that ensuring adequate rest time would facilitate their ability to seek dental care. “Because we spend most of our time working outdoors, having a proper place to rest is extremely important.” (Participant 4) “If there were more shelters, it would be easier to take breaks, brush our teeth, and even change work clothes.” (Participant 15)

5) Action–interaction strategies

The action–interaction strategies identified were ‘attempts to use dental care under constrained conditions’ and ‘intention to use dental care with available support.’

Regarding ‘attempts to use dental care under constrained conditions,’ participants reported making efforts to access dental care and maintain oral health within the limitations imposed by their work environments. Because it was difficult to visit dental clinics during weekday daytime hours, they sought clinics providing evening and weekend services or prioritized dental facilities located along their work routes. Some participants took advantage of oral health screenings offered at shelters for platform-based mobile workers and perceived these services as more accessible than arranging separate dental visits. When immediate dental care was not feasible, participants attempted to minimize deterioration in oral health through daily self-care practices such as tooth brushing and the use of oral hygiene products. In addition, some reported regulating their working and resting hours or utilizing shelters to reduce physical fatigue caused by excessive workloads. “Since I work continuously during weekday daytime hours, I tend to look for clinics that provide weekend or evening services.” (Participant 10) “Because it is difficult to visit a neighborhood dental clinic, I have already identified clinics that I can access along my usual work route.” (Participant 3) “I came because I heard that oral health screenings were being offered at the shelter.” (Participant 12) “Since I cannot immediately visit the dentist, I try to pay extra attention to brushing my teeth before work and before going to bed.” (Participant 6) “I set my own work schedule and limit my hours. Otherwise, the physical strain becomes too great.” (Participant 5)

Regarding ‘intention to use dental care with available support,’ participants stated that although it is currently difficult to visit dental clinics because of their working conditions, they would be willing to seek dental care if institutional and environmental support were provided. “If the time spent receiving health screenings were officially recognized, like it is for regular employees, and some kind of protection were provided, I would definitely participate.” (Participant 3) “If information about hospitals and appointment services were connected through the platform, I think it would be much easier to use.” (Participant 14) “If shelters continued to offer screenings and counseling, I think many more people would participate.” (Participant 6)

6) Consequences

The consequence identified in the paradigm model was ‘improved access to dental care.’

Participants reported that the oral health screenings provided at shelters for platform-based mobile workers motivated them to visit dental clinics in practice. They perceived that institutional and environmental support designed to accommodate the characteristics of platform-based mobile work would reduce barriers to dental care utilization and increase participation in both oral health screenings and dental treatment. Furthermore, they believed that such support would encourage better oral health management practices and enable workers to receive necessary dental care at appropriate times. Consequently, they expected that repeated experiences of unmet dental needs would be alleviated.