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Shahid M, Tadakamadla SK, Kroon J, Peres MA. Do dental anxiety and satisfaction with dental professionals modify the association between affordability and dental service use? A population-based longitudinal study of Australian adults. J Public Health Dent 2024. [PMID: 38506129 DOI: 10.1111/jphd.12608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/06/2023] [Accepted: 12/23/2023] [Indexed: 03/21/2024]
Abstract
OBJECTIVES This study aimed to assess the association between affordability in terms of difficulty paying dental bills in Australian dollars and dental service use in the presence of sociodemographic confounders, and to assess the role of dental anxiety and satisfaction with dental professionals as mediators. The second aim was to investigate how dental anxiety and satisfaction with dental professionals modify the association between affordability and use of dental services in Australian adults. METHODS Longitudinal data from the Australian National Study of Adult Oral Health (2004-06 and 2017-18) was used. Poisson regression and path analysis were conducted to determine the association between affordability and frequency of use of dental services. Effect measure modification (EMM) analysis was performed by stratification of dental anxiety and satisfaction with dental professionals. RESULTS The study included 1698 Australian adults and identified that the prevalence of low frequency of dental visits was 20% more for those who had difficulty paying dental bills. Adults with dental anxiety (prevalence ratio [PR] = 1.14) and those who were dissatisfied with dental professionals (PR = 1.17) had a higher prevalence of low frequency of dental visits in the presence of difficulty paying dental bills. This indicated that dental anxiety and dissatisfaction with dental professionals were effect modifiers on this pathway. CONCLUSIONS Adults who experience dental anxiety and dissatisfaction with dental professionals are more likely to avoid dental visits when faced with difficulty paying dental bills. However, it is important to note that these associations do not necessarily imply a causal relationship.
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Affiliation(s)
- Mishel Shahid
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Santosh Kumar Tadakamadla
- Department of Rural Clinical Sciences, Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Jeroen Kroon
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Marco A Peres
- National Dental Research Institute, National Dental Centre, Singapore, Singapore
- Health Services and Systems Research Program, Duke-NUS Medical School, Singapore, Singapore
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Veginadu P, Gussy M, Calache H, Masood M. Factors associated with access to dental care among refugees: A systematic review of quantitative studies. Community Dent Oral Epidemiol 2023; 51:729-737. [PMID: 36575988 DOI: 10.1111/cdoe.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/19/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To identify, appraise and synthesize the published evidence from quantitative studies on the individual and contextual-level factors determining access to dental care among refugees worldwide. METHODS A systematic literature search was conducted until the last week of February 2022 in four electronic databases - MEDLINE, Embase, Web of Science (all databases) and APA PsycINFO - without any restrictions. Quantitative studies published in English language and meeting the a priori eligibility criteria were reviewed and data extracted. Quality assessment was conducted using the National Institutes of Health tool. The identified factors were stratified according to the framework of the Behavioural Model of Health Services Use, and the evidence related to each of these factors was summarized in tables. Narrative synthesis of the findings was conducted. RESULTS The search retrieved 6776 unique records, of which 69 were deemed eligible for full-text screening and nine studies were included in the final data analysis and synthesis. The studies were rated to be of 'fair' quality at best. Self-reported previous dental visits was the most commonly used measure of access. Associations between individual-level factors and dental care access were most frequently examined (predisposing [n = 6], need [n = 2] and enabling [n = 1]), while the contextual-level factors were rarely examined (predisposing and enabling [n = 1, each]). CONCLUSIONS Individual-level predisposing factors, such as English language proficiency, education, health and dental literacy and acculturation and integration, were shown to be significantly associated with refugees' access. There is limited evidence to determine the effect of individual enabling and need and contextual factors.
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Affiliation(s)
- Prabhakar Veginadu
- Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Menzies School of Health Research, Alice Springs, Northern Territory, Australia
| | - Mark Gussy
- Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
| | - Hanny Calache
- Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Mohd Masood
- Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
- Dental Institute, University of Turku, Turku, Finland
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Galvão MHR, Medeiros ADA, Roncalli AG. Using Andersen's behavioural model to examine individual and contextual factors associated with dental service utilization in Brazil. Community Dent Oral Epidemiol 2023; 51:746-754. [PMID: 35488515 DOI: 10.1111/cdoe.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study aimed to examine individual and contextual factors associated with the frequency of dental service utilization among adolescents, adults and older adults Brazilians. METHODS This cross-sectional study used secondary data from the Brazilian 2019 National Health Survey (94 114 individuals). The outcome 'when was your last dental appointment?' was categorized into three groups: up to 1 year, more than 1 year and never had a dental appointment. Andersen's behavioural model was used to select contextual and individual variables. Multinomial logistic regression analysis was performed to calculate the odds ratio (OR) and 95% confidence intervals (95% CI). RESULTS The following variables showed increased probability to the outcome had the last dental appointment more than 1 year ago: older adult, illiterate or incomplete primary school, and without private dental insurance. The outcome never had a dental appointment was significantly associated with illiterate (OR 26.65; 95% CI 17.63-40.29), male (OR 2.38; 95% CI 2.17-2.61), without private dental insurance (OR 5.20; 95% CI 3.48-7.76), self-rated oral health as bad or very bad (OR 2.67; 95% CI 2.31-3.09), household not enrolled in primary care teams (OR 1.29; 95% CI 1.11-1.49), household in a rural area (OR 1.86; 95% CI 1.69-2.05), high household crowding (OR 1.08; 95% CI 1.04-1.14) and low household income per capita (OR 0.99; 95% CI 0.99-0.99). CONCLUSIONS This study showed that contextual and individual factors induce inequity in dental appointments. Moreover, Andersen's behavioural model demonstrated inequitable access for dental services in Brazil, in which social structure and enabling characteristics, rather than the need for the service, determine who receives health care. Living in a household enrolled in primary care teams favoured regular dental appointments. Thus, these findings may help policymakers improve health access by expanding coverage of dental services in primary health care.
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Affiliation(s)
| | - Arthur de Almeida Medeiros
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
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Tu RY, Liang P, Tan AJM, Tran DHG, He AM, Je H, Kroon J. Factors associated with regular dental attendance by aged adults: A systematic review. Gerodontology 2023; 40:277-287. [PMID: 36271656 DOI: 10.1111/ger.12661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine factors influencing regular dental attendance in aged adults 65 and over according to Andersen's Behavioural Model. BACKGROUND Regular attendance for dental visits is vital to improve and maintain oral health, quality of life and general well-being. Aged adults 65 years and older experience barriers to regular dental attendance, which in turn leads to an increased risk for oral diseases. MATERIALS AND METHODS An electronic search was undertaken in April 2021 in Cochrane, Embase, Medline, Cinahl, Dentistry & Oral Science Source via EBSCOhost and Embase for papers on factors influencing the frequency of attendance by older people. Risk of bias was assessed according to the Newcastle-Ottawa Scale for cohort and case-control studies, and with modified version of this tool for cross-sectional studies. Frequency effect size was calculated for factors described in Andersen's Behavioural Model (predisposing, enabling and needs-related). RESULTS Twenty-one studies were eligible for inclusion. Factors frequently investigated affecting regular dental attendance included: age, gender, education (predisposing); income, and social support (enabling); and remaining teeth, pain, perceived health (needs-related). Income was the only factors with a 100% positive association with regular dental attendance. CONCLUSIONS This systematic review confirms the complex interconnectedness of several factors and dental attendance in older adults. A number of factors were identified which warrant further investigation to improve access to dental care to socio-economically vulnerable older populations.
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Affiliation(s)
- Raychel Yap Tu
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Phoebe Liang
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Alan Jia-Ming Tan
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Daniel Hien Gia Tran
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Antonio Menglong He
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Heidi Je
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Jeroen Kroon
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
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Galvão MHR, Roncalli AG. Explaining public dental service utilization: A theoretical model. PLoS One 2023; 18:e0290992. [PMID: 37656715 PMCID: PMC10473501 DOI: 10.1371/journal.pone.0290992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVES Constructing and validating a theoretical model of relationships between dental services use and socioeconomic characteristics, oral health status, primary care coverage, and public dental services. METHODS The first stage of the study consisted of developing a theoretical-conceptual model to demonstrate the expected relationships between variables based on the literature. In the second stage, we tested the proposed theoretical model using the Partial Least Squares Structural Equation Modeling (PLS-SEM) technique, using data from the Brazilian National Health Survey conducted in 2019 with a sample of 41,664 individuals aged 15 or older. RESULTS This study successfully defined a theoretical model that explains the systematic relationships involving public dental services utilization. Socioeconomic status was negatively associated with oral health status (β = -0.376), enrollment in primary care facilities (β = -0.254), and the use of public dental consultations (β = -0.251). Being black, indigenous, or living in a rural area was directly associated with lower socioeconomic status and greater use of public dental services. CONCLUSIONS The identified relationships, establishing a theoretical basis for further investigations, also provide evidence of a public access policy's effect on oral health services on equity, supporting the construction of more effective and equitable public policies.
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Affiliation(s)
- Maria Helena Rodrigues Galvão
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Academic Center of Vitória, Federal University of Pernambuco, Vitória de Santo Antão, Pernambuco, Brazil
| | - Angelo Giuseppe Roncalli
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Tebbutt JE. What factors affect the ability of refugees to access dental care services? Evid Based Dent 2023; 24:81-82. [PMID: 37188925 DOI: 10.1038/s41432-023-00897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 05/17/2023]
Abstract
DESIGN This was a systematic review of the quantitative evidence for which factors influence the ability of refugee populations to access dental care services. DATA SOURCES Searches were performed using broad search terms on the electronic databases MEDLINE (via Ovid), Embase (via Ovid), Web of Science (all databases) and American Psychology Association PsycINFO with no time, language, or regional restrictions. STUDY SELECTION Studies examining factors associated with access to dental care amongst refugees were eligible. Outcomes relating to any aspect of access were included. Quantitative observational or intervention studies including quantitative components of mixed method studies, were eligible for inclusion. Studies not published in English were excluded. DATA EXTRACTION AND SYNTHESIS Data extraction was performed by a single author, with a random sample of 10% reviewed by a second. Quality was assessed utilising the National institute for Health's Quality Assurance tool for observational studies and were identified as being either fair (n = 7) or poor (n = 2). Factors identified as influencing access were synthesised using the Behavioural Model of Health Services Use. RESULTS In total, 69 full-text articles were screened. Nine were included in the final narrative synthesis, including refugee populations across 10 countries (5 individual countries and one including multiple countries). Designs were cross sectional (n = 6) or retrospective (n = 3). Different populations were investigated, including children (n = 4) and adults (n = 5). Refugee populations included Somali (n = 2), Tibetan (n = 1), Palestinian (n = 1), Bhutanese (n = 1), Burmese (n = 1) and mixed groups (n = 4). Common measurements of access included self-reported past dental visits (n = 5), use of dental services (n = 1), perceived barriers to access (n = 1) and missed appointments (n = 1). Untreated decay was used as a proxy measure (n = 1). Common factors identified influencing access related to demography, socio-economic status, acculturation, health and dental literacy and oral health status of refugees. At an individual level, English language proficiency was associated with increased access to dental care. CONCLUSIONS There is limited evidence on the effects of various factors on influencing access to dental services for refugees. The authors suggest that on an individual level, English language proficiency, acculturation, health and dental literacy and oral health status of refugees may influence access to dental services.
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Affiliation(s)
- Jessie E Tebbutt
- Academic Clinical Fellow in Special Care Dentistry, School of Clinical Dentistry, University of Sheffield, Sheffield, UK.
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Velázquez-Cayón RT, Contreras-Madrid AI, Parra-Rojas S, Pérez-Jorge D. Oral Health and Pathologies in Migrants and Vulnerable Population and Their Social Impact: The Good Practices of the Intervention Model of a University Dental Clinic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:353. [PMID: 36612675 PMCID: PMC9819970 DOI: 10.3390/ijerph20010353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Numerous studies have shown the high incidence of diseases affecting oral health in vulnerable populations. The Canary Islands is a region particularly affected by the low income of its inhabitants and a high migration rate. Poor oral health habits and limited access to health care have turned these groups into risk groups. The role of the Fernando Pessoa Canarias University (CDUFPC) dental clinic in the health care of these groups has been an example of good professional practice and a fundamental resource in their health care. The present study aims to identify the profile of pathologies as well as the impact on the oral health of vulnerable population groups served by the CDUFPC. This study was developed between September 2019 and July 2022 with a sample of 878 patients, of whom 267 (30.4%) belonged to vulnerable groups referred by institutions and social organizations. The results identified the prevalence of dental caries as the main pathology and the lack of good oral habits and commitment to oral health and care.
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Affiliation(s)
- Rocío Trinidad Velázquez-Cayón
- Clinical Practice Unit, Department of Dentistry, Faculty of Health Sciences, University Fernando Pessoa Canarias, 35450 Las Palmas, Spain
| | - Ana Isabel Contreras-Madrid
- Clinical Practice Unit, Department of Dentistry, Faculty of Health Sciences, University Fernando Pessoa Canarias, 35450 Las Palmas, Spain
| | - Susell Parra-Rojas
- Clinical Practice Unit, Department of Dentistry, Faculty of Health Sciences, University Fernando Pessoa Canarias, 35450 Las Palmas, Spain
| | - David Pérez-Jorge
- Department of Didactics and Educational Research, Faculty of Education, University of La Laguna, 38200 La Laguna, Spain
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Toh JR, Wooi N, Tan SN, Wong K, Lopez-Silva C, Zafar S. Association between lack of dental service utilisation and caregiver-reported caries in Australian Indigenous children: A national survey. J Paediatr Child Health 2022; 58:2218-2224. [PMID: 36082587 PMCID: PMC10087467 DOI: 10.1111/jpc.16192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/06/2022] [Accepted: 08/18/2022] [Indexed: 11/30/2022]
Abstract
AIM To investigate the association between the lack of dental service utilisation and dental caries in Australian Indigenous children. METHODS Data from the Longitudinal Study of Indigenous Children, which is a longitudinal population-based cross-sectional study in Australia were analysed. A total of 1258 children were included, consisting of the baby cohort and the child cohort at Wave 7. Logistic regression analysis was conducted to examine the association between caregiver-reported child dental caries and dental service utilisation. Multiple imputation using the fully conditional specifications approach was used to account for missing data. RESULTS Around one tenth (12.3%) of Indigenous children did not see a dentist when required. Lack of dental service utilisation was associated with an increased likelihood of caregiver-reported dental caries (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.5-3.8) and teeth removed due to dental caries (OR 2.3; 95% CI 1.1-4.7). These associations remained after adjusting for confounders (caregiver-reported dental caries OR 2.3; 95% CI 1.3-3.8; teeth removed due to dental caries OR 2.1; 95% CI 1.0-4.4). The reasons reported for not utilising dental services when required were the lack of an available dentist (31.4%), difficulties with physical access (19.8%), long waiting times (13.9%), financial issues with cost (5.8%) and feeling that 'they could cope' (4.6%). CONCLUSIONS Lack of dental service utilisation was associated with dental caries and extraction due to caries in Australian Indigenous children.
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Affiliation(s)
- Jia R Toh
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Nadine Wooi
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Si N Tan
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Kingsley Wong
- Child Disability, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Claudia Lopez-Silva
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Sobia Zafar
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
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Beaven A, Boullin P, Penlington C. Do psychological attachment styles influence dental anxiety and dental attendance? Br Dent J 2022:10.1038/s41415-022-4353-0. [PMID: 35732911 DOI: 10.1038/s41415-022-4353-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/19/2022] [Indexed: 11/08/2022]
Abstract
Objectives Attachment style has been shown to influence patient engagement in medical settings but has been little explored in dentistry. The aim of our study was to identify whether there was a link between patients with insecure attachment styles and dental attendance and anxiety.Methods A survey was circulated and completed by 317 participants on social media. Respondents completed the revised Adult Attachment Scale and questions about the timing of their last dental visit, anxiety levels and the perceived reasons for these.Results Participants classed as having a secure attachment were most likely to have attended a dental appointment in the last two years (87%) and least likely to report dental anxiety (25%). Participants in the fearful attachment group had the highest levels of dental anxiety (75%) and lowest rates of attendance (63%). Both anxious attachment traits (M2.68, 2.09, z = 4.09; p <0.001) and avoidant attachment traits (M2.81, 2.51, z = -2.94; p <0.01) were associated with reduced dental attendance in the past two years. Common themes surrounding visiting the dentist included: unpleasant emotional experiences, previous psychological trauma and inaccurate beliefs about dentistry, resulting in mistrust.Conclusion Attachment styles are related to dental anxiety and attendance. Understanding the role of attachment in service planning and education of dentists could improve the care of patients.
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Affiliation(s)
- Anna Beaven
- South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW, UK.
| | - Pam Boullin
- School of Dental Sciences, Newcastle University, Framlington Place, NE2 4BW, UK
| | - Chris Penlington
- School of Dental Sciences, Newcastle University, Framlington Place, NE2 4BW, UK
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Ahmadyar M, Rai T, Daly B, Wong G. Improving access of young adults with experience of homelessness to primary care dental services in the UK: A realist synthesis. Community Dent Oral Epidemiol 2021; 50:437-444. [PMID: 34651327 DOI: 10.1111/cdoe.12695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/25/2021] [Accepted: 09/05/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To understand why, how and under what circumstances interventions lead to improved access of young adults with experience of homelessness (YAEH) to primary care dental services in the UK. METHODS We followed a realist, theory-driven methodology. It involved locating existing theories, searching for evidence, document selection, data extraction/appraisal and evidence synthesis. We searched scientific databases and grey literature sources. We used these data and relevant substantive theories to develop explanations of how, why and under what circumstances interventions lead to desired outcomes. We presented these explanations in the form of context-mechanism-outcome configurations (CMOCs). The CMOCs were incorporated in an overarching programme theory, which was iteratively developed and refined throughout the realist synthesis. RESULTS We used 106 scientific and 18 grey literature records to synthesize 61 CMOCs. Our revised programme theory highlights the importance of four main considerations: 'preparing a service', 'producing and disseminating information', 'outreach activities' and 'facilitating interactions'. When designing dental programmes for YAEH, we recommend considering the importance of prior service planning (including resourcing of emergency dental care, training staff and incorporating safety measures), creating positive experiences, flexibility, patient-centeredness, being informative and reassuring, creating an enabling environment (including strong communication, building rapport and avoiding negative judgements), having realistic expectations and designing services that empower patients. CONCLUSIONS Improving dental access of YAEH requires attention to multiple levels. Services can achieve positive outcomes by understanding the complexity of YAEH lives, and creating contextual circumstances that encourage their attendance.
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Affiliation(s)
- Maryam Ahmadyar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tanvi Rai
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Blanaid Daly
- Dublin Dental University Hospital, Trinity College Dublin, Dublin 2, Ireland
| | - Geoffrey Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Galvão MHR, Medeiros ADA, Roncalli AG. Contextual and individual factors associated with public dental services utilisation in Brazil: A multilevel analysis. PLoS One 2021; 16:e0254310. [PMID: 34242338 PMCID: PMC8270158 DOI: 10.1371/journal.pone.0254310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study verified the association between contextual and individual factors and public dental services utilisation in Brazil. METHODS The study was conducted based on a cross-sectional population-based household survey performed in Brazil (National Health Survey- 2019)). Data was collected between August 2019 and March 2020. Total sample included 43,167 individuals aged ≥15 years who had at least one dental appointment in the last 12 months before interview. Study outcome was 'public dental service utilisation', and Andersen's behavioral model was adopted for selecting independent variables. A multilevel analysis was performed using individual factors as first level and federation units as second level. RESULTS The highest prevalence of public dental service utilisation on an individual level was observed among unable to read or write people (PR: 3.31; p<0.001), indigenous (PR: 1.40; p<0.001), black or brown (PR: 1.16; p<0.001), with per capita household income of up to U$124 (PR: 2.40; p<0.001), living in the rural area (PR: 1.28; p<0.001), and who self-rated oral health as regular (PR: 1.15; p<0.001) or very bad/bad (PR: 1.26; p<0.001). On the contextual level, highest PR of public dental service utilisation was observed among those living in federal units with increased oral health coverage in primary health care. CONCLUSIONS Public dental service utilisation is associated with individual and contextual factors. These results can guide decision-making based on evidence from policymakers, demonstrating the potential for mitigating oral health inequalities and increasing service coverage in a public and universal health system.
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Affiliation(s)
- Maria Helena Rodrigues Galvão
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Arthur de Almeida Medeiros
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
- Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Angelo Giuseppe Roncalli
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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