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Azañedo D, Visconti-Lopez FJ, Hernández-Vásquez A. Oral Health Service Use in Older Peruvians Before and During the COVID-19 Pandemic. Int Dent J 2024; 74:473-481. [PMID: 38225185 PMCID: PMC11123544 DOI: 10.1016/j.identj.2023.12.003] [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: 05/09/2023] [Revised: 11/14/2023] [Accepted: 12/09/2023] [Indexed: 01/17/2024] Open
Abstract
OBJECTIVES The aim of this work was to analyse inequalities in oral health services utilisation (OHSU) in older Peruvian adults through comparative analysis of the years 2019 and 2021. METHODS We conducted a secondary analysis of data from the 2019 and 2021 Demographic and Health Survey (ENDES). The outcome variable was OHSU by older Peruvian adults in the past year. We used Poisson generalised linear models adjusted for age and sex to assess changes in OHSU by sociodemographic characteristics. The Erreygers concentration index was used to describe the socioeconomic inequalities in OHSU. The contribution of each variable to inequalities was estimated by a decomposition analysis. RESULTS In 2021, OHSU probability amongst older Peruvian adults decreased by 37% compared to 2019. The decline was greatest in those aged 80 or older (51%), the lowest wealth quintile (47%), those with functional limitations (53%), and those whose native language is Quechua or other indigenous languages (47%). Surprisingly, we observed a reduction in OHSU inequalities (difference: -0.1074; P = .003) during the COVID-19 pandemic, particularly amongst rural residents (difference: -0.0771; P = .030), the lowest wealth quintile (difference: -0.0764; P = .020), and those with functional limitations (difference: -0.3665; P < .001). Poverty accounted for 73% of the inequality in 2021. CONCLUSIONS The probability of OHSU has significantly decreased likely due to the COVID-19 pandemic. Paradoxically, we observed a reduction in OHSU inequalities during the pandemic, despite the known socioeconomic impact. However, further research is required to gain deeper understanding of this phenomenon.
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Affiliation(s)
| | | | - Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.
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Sidharthan S, Ramanarayanan V, Karuveettil V, Ravindran GC. Utilization of dental health services and its associated factors among adult population in Ernakulam district, Kerala, India: A mixed-method analysis. J Oral Biol Craniofac Res 2024; 14:133-142. [PMID: 38352196 PMCID: PMC10862006 DOI: 10.1016/j.jobcr.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 12/11/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
Background There exists a high burden of oral diseases. Yet, the utilization of oral health care remains low. Understanding how, when, and why/why not individuals utilize dental healthcare resources is essential for planning health services and developing policies as it reflects the population's oral health needs, helps allocate resources efficiently, and formulate policies that are tailored to address their needs. Objectives To assess the utilization of dental health services and its associated factors along with barriers and facilitators among adults residing in Ernakulam district, Kerala, using the Anderson healthcare model for healthcare utilization. Methods A mixed-method study was conducted among adults aged 18 years and above in urban and rural wards of Ernakulam district using the cluster sampling method. Univariate and multivariate analysis were used for the quantitative part, and thematic analysis was used for the qualitative aspect. The total sample size was 544. Results The dental healthcare utilization was 15.4 ± 2.9 % among the study participants. Age and education were associated with dental healthcare utilization. The level of education, pain, and self-consciousness of oral diseases were independent predictors. Barriers identified were negative attitudes, financial restraints, and difficulty in access, while facilitators were trust in service providers, availability of services, and a positive attitude. Conclusion Utilization was poor despite the perceived need for oral health care. This was affected by several personal and system-level facilitators and barriers.
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Affiliation(s)
- Saanu Sidharthan
- Department of Community Medicine and Public Health, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Venkitachalam Ramanarayanan
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Vineetha Karuveettil
- Department of Public Health Dentistry, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Greeshma C. Ravindran
- Department of Biostatistics, Amrita School of Medicine, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Erwin J, Horrell J, Wheat H, Axford N, Burns L, Booth J, Witton R, Shawe J, Doughty J, Kaddour S, Boswell S, Devalia U, Nelder A, Paisi M. Access to Dental Care for Children and Young People in Care and Care Leavers: A Global Scoping Review. Dent J (Basel) 2024; 12:37. [PMID: 38392241 PMCID: PMC10887801 DOI: 10.3390/dj12020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/22/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
AIMS This scoping review aimed to explore three research questions: 1. What is the dental care access for children and young people (CYP) in care and care leavers? 2. What factors influence CYP in care and care leavers' access to dental care? 3. What pathways have been developed to improve access to oral health care for CYP in care and care leavers? METHODS Five databases (Ovid MEDLINE, Ovid Embase, CINAHL, SocINDEX and Dentistry and Oral Sciences Source) and grey literature sources were systematically searched. Articles relating to CYP in care or care leavers aged 0-25 years old, published up to January 2023 were included. Abstracts, posters and publications not in the English language were excluded. The data relating to dental care access were analysed using thematic analysis. RESULTS The search identified 942 articles, of which 247 were excluded as duplicates. A review of the titles and abstracts yielded 149 studies. Thirty-eight were eligible for inclusion in the review: thirty-three peer-reviewed articles, one PhD thesis and four grey literature sources. All papers were published from very high or medium Human Development Index countries. The studies indicate that despite having higher treatment needs, CYP in care and care leavers experience greater difficulty in accessing dental services than those not care-experienced. Organisational, psycho-social and logistical factors influence their access to dental care. Their experience of dental care may be impacted by adverse childhood events. Pathways to dental care have been developed, but little is known of their impact on access. There are very few studies that include care leavers. The voices of care-experienced CYP are missing from dental access research. CONCLUSIONS care-experienced CYP are disadvantaged in their access to dental care, and there are significant barriers to their treatment needs being met.
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Affiliation(s)
- Jo Erwin
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Jane Horrell
- Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Hannah Wheat
- Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Nick Axford
- Peninsula Medical School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Lorna Burns
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Joelle Booth
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
- Centre for Dental Public Health and Primary Care, Queen Mary University of London, Turner Street, London E1 2AD, UK
| | - Robert Witton
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
- Peninsula Dental Social Enterprise, Plymouth PL6 8BT, UK
| | - Jill Shawe
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
| | - Janine Doughty
- School of Dentistry, Royal Liverpool University Dental Hospital, Pembroke Place, Liverpool L3 5PS, UK
| | - Sarah Kaddour
- Pathway Oral Health Fellow, Pathway, 250 Euston Road, London NW1 2PG, UK
| | - Skye Boswell
- Patient and Public Involvement Member, Plymouth County Council, Plymouth PL1 3BJ, UK
| | - Urshla Devalia
- Royal National ENT and Eastman Dental Hospitals, University College London Hospitals, London NW1 2BU, UK
| | - Abigail Nelder
- Peninsula Dental Social Enterprise, Plymouth PL6 8BT, UK
| | - Martha Paisi
- Peninsula Dental School, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
- School of Nursing and Midwifery, University of Plymouth, Drake Circus, Plymouth PL4 8AA, UK
- Patient and Public Involvement Member, Plymouth County Council, Plymouth PL1 3BJ, UK
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Marcus K, Balasubramanian M, Short SD, Sohn W. Quantitative analysis on dental utilisation in culturally and linguistically diverse mothers. Aust J Prim Health 2024; 30:NULL. [PMID: 38056884 DOI: 10.1071/py23136] [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: 07/25/2023] [Accepted: 10/27/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Culturally and linguistically diverse (CALD) mothers are influential in children's behaviours, yet little is known about this population. Furthermore, insufficient quantitative and context-based studies are available with CALD mothers and their access to oral health care. To address this gap, the study investigates oral health behaviours, psychological factors and remoteness area with dental utilisation in CALD mothers, within the NSW context. METHODS Informed by middle-range theory and a CALD-specific rainbow model, the 2013 and 2015 NSW Adult Population Health Survey was analysed. Variables for CALD mothers included household structure, age and language spoken. Multivariable analysis was conducted with oral health behaviours, psychological and remoteness variables, with dental utilisation as the outcome. RESULTS The sample was weighted (n =190,283). In total, 39.8% did not have a dental visit, and older mothers (aged 36-55 years) sought more dental services than younger mothers (aged 18-35 years). Higher odds for treatment dental care (aOR 2.21, 95% CI 1.12-4.37) than prevention-oriented care were found. Mothers experiencing moderate levels of psychological distress (aOR 0.49, 95% CI 0.31-0.77), or residing in outer regional and remote regions (aOR 0.19, 95% CI 0.04-0.85) were less likely to utilise dental care. CONCLUSION Findings underline geographical issues in dental care utilisationand the need for integrated care for CALD mothers experiencing psychological distress, and to encourage uptake of preventive oral health care. Addressing cost barriers necessitates for universal health coverage. Multidisciplinary integration of healthcare services with improved primary sector collaboration between governments and healthcare providers, and the expansion to regional services are required for equity in CALD communities.
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Affiliation(s)
- Kanchan Marcus
- The University of Sydney, Faculty of Medicine and Health, Menzies Centre for Health Policy and Economics, Charles Perkins Centre, Sydney, NSW 2006, Australia
| | - Madhan Balasubramanian
- Flinders University, Health Care Management, College of Business, Government and Law, Adelaide, SA, Australia; and The University of Sydney, School of Dentistry, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Stephanie D Short
- The University of Sydney, School of Health Sciences, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Woosung Sohn
- The University of Sydney, Faculty of Medicine and Health, Menzies Centre for Health Policy and Economics, Charles Perkins Centre, Sydney, NSW 2006, Australia; and The University of Sydney, School of Dentistry, Faculty of Medicine and Health, Sydney, NSW, Australia
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Raskin SE, Thakkar-Samtani M, Santoro M, Fleming EB, Heaton LJ, Tranby EP. Discrimination and Dignity Experiences in Prior Oral Care Visits Predict Racialized Oral Health Inequities Among Nationally Representative US Adults. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01821-0. [PMID: 37848669 DOI: 10.1007/s40615-023-01821-0] [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: 07/18/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/19/2023]
Abstract
Racism, an oppressive and fallacious sociopolitical hierarchy, is a fundamental cause of oral health inequities worldwide. Everyday discrimination is associated with worse self-rated oral health, toothache and adult tooth loss, and lower oral care utilization. Few studies examine discrimination or microaggressions within oral care settings or their effects on oral health outcomes. We adapted the seven-item Everyday Discrimination Scale to the oral care setting (EDSOC); developed a four-item Dignity in Oral Care Scale (DOCS); fielded them to a probability-based nationally representative sample of US households as part of the 2022 State of Oral Health Equity in America survey (SOHEA, n = 5682); and examined associations between EDSOC and DOCS scores and three outcomes: self-rated oral health, duration since last oral care visit, and planning for future preventive/routine oral care. Nearly, all EDSCOC and DOCS measures were significantly associated with oral health outcomes. Discrimination experience in dental settings had an additive effect on reporting fair/poor oral health and a suppressive effect on planning a future dental visit. Indignity experience doubled-to-quadrupled the likelihood of reporting fair/poor oral health, not having visited a dentist in 2 years, and not planning a future oral care visit. Racio-ethnically minoritized patients may experience the unjust double bind of resolving urgent dental or completing preventive services needs amidst being treated in a discriminatory manner or without dignity. Oral health stakeholders should invest more effort to understand relationships between racism and oral health outcomes and introduce evidence-based interventions to ultimately abolish this societal harm.
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Affiliation(s)
- Sarah E Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, 1001 W. Franklin Street, Richmond, VA, 23284, USA.
| | | | - Morgan Santoro
- Analytics and Data Insights, CareQuest Institute for Oral Health, Boston, MA, USA
| | | | - Lisa J Heaton
- Analytics and Data Insights, CareQuest Institute for Oral Health, Boston, MA, USA
| | - Eric P Tranby
- Analytics and Data Insights, CareQuest Institute for Oral Health, Boston, MA, USA
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Marcus K, Balasubramanian M, Short SD, Sohn W. Dental hesitancy: a qualitative study of culturally and linguistically diverse mothers. BMC Public Health 2022; 22:2199. [PMID: 36443774 PMCID: PMC9703727 DOI: 10.1186/s12889-022-14513-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/01/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Oral healthcare is paramount and inextricably linked to well-being. Yet, the evidence indicates that culturally and linguistically diverse (CALD) migrant communities have unequal access to mainstream dental services due to several barriers. The purpose of this study was to investigate the oral healthcare experiences, attitudes and barriers to oral healthcare utilisation in CALD mothers. METHODS A qualitative study with semi-structured interviews was conducted within a social constructivism epistemology. CALD mothers who identified as non-English speaking, foreign country born, with a child under 12, were recruited though purposive snowball sampling. Questions probed oral healthcare experiences, barriers, enablers, and attitudes. Verbatim typed transcripts were thematically analysed using grounded methodology. RESULTS Thirty-three CALD mothers participated; twenty from India, five from Fiji, four from China, two from Nepal and one each from Israel and Macedonia. Languages included Cantonese, Fiji-Hindi, Gujrati, Hebrew, Hindi, Kannada, Mandarin, Maharashtrian, Macedonian, Nepalese, Punjabi, Sanskrit, Telegu and Urdu. Cost was the foremost barrier to oral healthcare services, followed by Confidence in quality care for the provision of services and treatment. Confusion in navigating a public and private healthcare system was highlighted and Competing priorities took precedence. Complacency referred to 'no need' or lack of urgency in dental care. Subsequently, dental hesitancy (superordinate theme) described the patterning of data as comprising the five 'C' factors and was theorised as the dental hesitancy phenomenon to explain the occurrence of delay or avoidance in utilising dental care. CONCLUSION Findings highlight the utility of the dental hesitancy phenomenon unearthed within this study. CALD mothers explained five 'C' dimensions: cost, confidence, confusion, competing priorities and complacency as barriers to accessing timely dental care. Multisectoral collaboration between healthcare systems, universal health coverage and primary sector support is required to address dental hesitancy in CALD mothers. Further, this study contributes to the field of behavioural and social sciences in oral health and augments the literature on dental avoidance.
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Affiliation(s)
- Kanchan Marcus
- grid.1013.30000 0004 1936 834XPopulation Oral Health, Faculty of Medicine and Health, The University of Sydney School of Dentistry, Surry Hills, NSW Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Madhan Balasubramanian
- grid.1014.40000 0004 0367 2697Health Care Management, College of Business, Government and Law, Flinders University, Adelaide, Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Stephanie D. Short
- grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Woosung Sohn
- grid.1013.30000 0004 1936 834XPopulation Oral Health, Faculty of Medicine and Health, The University of Sydney School of Dentistry, Surry Hills, NSW Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
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Marcus K, Balasubramanian M, Short SD, Sohn W. Dental diaspora: oral health care attitudes and experiences in culturally and linguistically diverse mothers in Australia. BMC Health Serv Res 2022; 22:1314. [PMID: 36329526 PMCID: PMC9632598 DOI: 10.1186/s12913-022-08708-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Background Globally oral health care is unequally accessible or utilised within culturally and linguistically diverse (CALD) migrant communities. Yet much remains unknown about CALD mothers and their oral healthcare experiences in Australia. Hence, this paper explores the oral health care attitudes and experiences of CALD mothers within the Australian context with the broader objective to reduce oral health inequalities. Methods Qualitative semi-structured interviews were conducted from a social constructivism paradigm. Participants were foreign country born, spoke language/s other than English and have a child. Purposive snowball sampling and recruitment was conducted through CALD organisations and social media. Participants were interviewed for their attitudes and experiences to dental care and frequency of utilisation in Australia and the home country. Interviews were transcribed verbatim and grounded analysis (Strauss and Corbin) performed. Researcher bias was reduced through reflexivity and triangulation. Results The participants (n = 33) included 20 CALD mothers born in India and 13 from either China, Fiji, Nepal, Macedonia and Israel. The theme, experiences with health workforce personnel revealed positive attitudes toward CALD providers from similar cultural and/or linguistic backgrounds. We coin these CALD providers as the ‘dental diaspora’. The dental diaspora facilitated CALD mothers through culture and/or language factors, alleviating cost barriers and flexibility in appointments. Dental travel to the home country was affirmed, however family visitation was the foremost reason for travel. Conclusion The findings suggest that the dental diaspora plays a significant role in promoting oral health care utilisation for first generation CALD mothers in Australia. This paper brings to light the phenomenon of the ‘dental diaspora’ as an essential health workforce that contributes to addressing inequities in oral healthcare utilisation within CALD migrant communities. Universal health coverage in oral health is further affirmed, as aligned to the WHO policy context.
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Affiliation(s)
- Kanchan Marcus
- grid.1013.30000 0004 1936 834XPopulation Oral Health, Faculty of Medicine and Health, The University of Sydney Dental School, Surry Hills, NSW Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Madhan Balasubramanian
- grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia ,grid.1014.40000 0004 0367 2697Health Care Management, College of Business, Government and Law, Flinders University, Bedford Park, SA Australia
| | - Stephanie D Short
- grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
| | - Woosung Sohn
- grid.1013.30000 0004 1936 834XPopulation Oral Health, Faculty of Medicine and Health, The University of Sydney Dental School, Surry Hills, NSW Australia ,grid.1013.30000 0004 1936 834XMenzies Centre for Health Policy and Economics, School of Public Health, The University of Sydney, Camperdown, NSW Australia
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