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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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Harris RV, Pennington A, Whitehead M. Preventive dental visiting: a critical interpretive synthesis of theory explaining how inequalities arise. Community Dent Oral Epidemiol 2016; 45:120-134. [PMID: 27921329 DOI: 10.1111/cdoe.12268] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 10/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND In many countries, those with lower socioeconomic status are disproportionately affected by poor oral health. This can be attributed, at least in part, to differences in preventive dental visiting. While several theories have been applied to the area, they generally fail to capture the recursive nature of dental visiting behaviour, and fall short of informing the design of complex interventions to tackle inequalities. OBJECTIVE To undertake a systematic review and synthesis of theory in order to provide an overview of the pathways which bring about socioeconomic inequalities in early dental visiting, and identify possible intervention points. METHODS Electronic searching identified 8947 titles and abstracts. Paper screening and citation snowballing left 77 included papers. Drawing on the tenets of Critical Interpretive Synthesis, data extraction involved capturing concepts and relationships and translating these sometimes into synthetic constructs. RESULTS We theorize that at the individual (micro-level), dental visiting behaviour is influenced by: the 'Importance of obtaining care', 'Emotional response' and 'Perceived control', which feed into a balancing of 'Competing Demands' against 'Internal resources' (coping, self-identity), although attendance is tempered by the effective 'Affordability and Availability of services'. Positive Care experiences are theorized to lower the demands and increase internal resources associated with dental visiting. We also outline meso-level factors 'Social norms and sanctions', 'Obligations, expectations and trust', 'Information channels', 'Social structures' and theorize how these can exert an overwhelming influence in deprived areas. CONCLUSIONS Socioeconomic inequalities in early dental visiting emerge from several stages in the care-seeking process. Dental visiting behaviour should be viewed not just as a one-off event, but extending over time and social space. Since there is recursivity in peoples' most recent dental experience any future visits we identify that interventions which make care a positive experience for low socioeconomic patients may be particularly beneficial in reducing inequalities.
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Affiliation(s)
- Rebecca V Harris
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Andrew Pennington
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Margaret Whitehead
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
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Coles E, Freeman R. Exploring the oral health experiences of homeless people: a deconstruction-reconstruction formulation. Community Dent Oral Epidemiol 2015. [PMID: 26202302 DOI: 10.1111/cdoe.12190] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore qualitatively, using a grounded theory approach, homeless people's awareness of their oral health needs and how they access dental services using a deconstruction-reconstruction formulation, and provide recommendations for service designers and dental professionals who work with people experiencing homelessness. METHODS A qualitative study using grounded theory methodology was conducted. A purposive sample of homeless people was recruited from health facilities and organizations serving homeless populations in four Scottish cities and towns. Participants were interviewed about their oral health within the wider context of their experiences of homelessness. Initial research questions were open and focused on social processes such as oral health practices and interaction with dental services. Data collection and analysis were carried out simultaneously and iteratively, with emerging findings informing subsequent cycles. Data analysis was guided by Glaser and Strauss's grounded theory methodology and involved constant comparison, coding of transcripts and detailed memo-writing. RESULTS Thirty-four homeless people took part. Participant experiences were conceptualized as a journey into and through the stages of homelessness, towards 'reclaiming life'. Oral health experiences were mapped as a parallel 3-stage journey from the deconstruction of self-care, to the construction and maintenance of the neglected dentine, and finally to the reclamation of oral health resulting in a reconstructed functioning dentition. CONCLUSIONS This qualitative exploration using a deconstruction-reconstruction formulation has added to the understanding of homeless people's oral health awareness and dental treatment access while permitting an examination of the wider socioeconomic and psychosocial issues that disrupt their intentions to attend for treatment. These findings provide service designers and dental professionals with recommendations for the provision of responsive, acceptable and appropriate dental health services for those experiencing homelessness.
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Affiliation(s)
- Emma Coles
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
| | - Ruth Freeman
- Dental Health Services Research Unit, University of Dundee, Dundee, UK
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Masood M, Thaliath ET, Bower EJ, Newton JT. An appraisal of the quality of published qualitative dental research. Community Dent Oral Epidemiol 2010; 39:193-203. [DOI: 10.1111/j.1600-0528.2010.00584.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Exley C. Bridging a gap: the (lack of a) sociology of oral health and healthcare. SOCIOLOGY OF HEALTH & ILLNESS 2009; 31:1093-1108. [PMID: 19659738 DOI: 10.1111/j.1467-9566.2009.01173.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This article provides an historical review of international research related to sociology and oral health and healthcare. I begin by considering the relevance of the mouth and oral health to social interactions and physical health, and outline existing inequalities in oral health and healthcare experiences. The paper examines critically some of the existing published research in the field - considering both what might be described as sociology of oral health and healthcare and sociology in oral healthcare - and demonstrates the dearth of sociological research related to this subject compared to other areas of interest within the field of sociology of health and illness. I conclude by suggesting some ways in which this area could be expanded and developed further. I suggest that sociological analyses of how individuals experience, understand and manage their mouth and oral health, can add to and enhance the broader field of the sociology of health and illness. Further, examining experiences and provision of oral healthcare may provide sociology with a new opportunity to explore the neglected field of private healthcare, but also to engage with health policy makers who seek to address oral healthcare needs.
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Affiliation(s)
- Catherine Exley
- Institute of Health and Society, Newcastle University, 21 Claremont Road, Newcastle upon Tyne, NE2 4AA.
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Methods of data collection in qualitative research: interviews and focus groups. Br Dent J 2008; 204:291-5. [PMID: 18356873 DOI: 10.1038/bdj.2008.192] [Citation(s) in RCA: 608] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper explores the most common methods of data collection used in qualitative research: interviews and focus groups. The paper examines each method in detail, focusing on how they work in practice, when their use is appropriate and what they can offer dentistry. Examples of empirical studies that have used interviews or focus groups are also provided.
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Cohen LA, Harris SL, Bonito AJ, Manski RJ, Macek MD, Edwards RR, Cornelius LJ. Coping with toothache pain: a qualitative study of low-income persons and minorities. J Public Health Dent 2007; 67:28-35. [PMID: 17436976 DOI: 10.1111/j.1752-7325.2007.00005.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES This study examined the behavioral impact of toothache pain as well as self-care strategies for pain relief among minority and low-income individuals. METHODS Eight focus group sessions were conducted with 66 participants drawn from low-income non-Hispanic White, non-Hispanic Black, and Hispanic adults over the age of 20 who had experienced a toothache during the previous 12-month period and who had utilized self-care or care from a nondentist. RESULTS Toothache pain was described as intense, throbbing, miserable, or unbearable. Focus group participants indicated that toothache pain affected their ability to perform normal activities, such as their job, housework, social activities, sleeping, talking, and eating, as well as making them depressed and affecting their social interactions. Numerous prescription and nonprescription medications as well as home remedies and self-care strategies were used for pain relief, although these were generally of limited and uncertain benefit. While receiving care at a dental office was the most preferable option for care, most participants reported multiple barriers, including the cost of dental care that resulted in long delays in seeking dental care. The main reason for eventually seeking dental care was the severity of the pain. CONCLUSIONS Although removing financial barriers alone may not lead to preventive dental visits, it would facilitate more timely visits to dentists to treat toothache pain.
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Affiliation(s)
- Leonard A Cohen
- Department of Health Promotion and Policy, University of Maryland Dental School, 650 West Baltimore Street, Baltimore, MD 21201, USA.
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Gregory J, Gibson B, Robinson PG. The relevance of oral health for attenders and non-attenders: a qualitative study. Br Dent J 2007; 202:E18; discussion 406-7. [PMID: 17308534 DOI: 10.1038/bdj.2007.150] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2006] [Indexed: 11/08/2022]
Abstract
BACKGROUND Low expectations of health mean that oral health becomes a low priority for some people, an appreciation of which would help dentists when a non-attender does come to the surgery. OBJECTIVE To provide an insight into why oral health is not important to some people and how this attitude might hinder access to dental care. METHOD In this qualitative study, purposive sampling was used to recruit two groups of participants with sociably visible missing, decayed or broken teeth but apparently differing responses to that status. The data analysis used social systems theory as operationalised by grounded theory techniques. RESULTS The core category that emerged from the data was that people constructed their own 'margins of the relevance' of oral health. For some people oral health was highly relevant whilst for others it was not very relevant. The degree of relevance of oral health was organised along seven dimensions: the perceived 'normal' state of oral health, the perceived causes of oral health and disease, the degree of trust held in dentistry, perceptions of oral 'health' as a commodity, perceptions of the accessibility of oral health care, perceptions of 'natural' oral health and judgements of character. CONCLUSIONS If certain aspects of oral health are not relevant, little that is said about those aspects will be meaningful to people. The key is to either emphasize or gently challenge those ideas and beliefs that allow or hinder the margins of relevance.
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Affiliation(s)
- J Gregory
- Unit of Oral Health Services Research and Dental Public Health, Guy's, King's and St Thomas' Dental Institute, King's College London, Denmark Hill, London, UK
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De Palma P, Nordenram G. The perceptions of homeless people in Stockholm concerning oral health and consequences of dental treatment: a qualitative study. SPECIAL CARE IN DENTISTRY 2006; 25:289-95. [PMID: 16463601 DOI: 10.1111/j.1754-4505.2005.tb01403.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study investigated the perceptions of Swedish homeless people concerning their oral health and perceived consequences of dental treatment. Candid, tape-recorded interviews were conducted in a conversational style. A phenomenological-hermeneutical method was used to analyze the subjects' stories. New participants were recruited into the study, until the interviews provided no additional new information, which occurred after eight interviews. All narratives revealed expressions of loss as well as recovery in the informants' life. Both aspects highlighted the fact that homelessness equated to "loss" not only of a permanent residence but also of many values. Similarly, oral health was described and interpreted in terms of loss and recovery. During periods of drug abuse, study participants ranked oral health as a low priority and generally received only emergency dental attention. In more rehabilitative phases of life, however, they perceived oral health and dental treatment as a function to restore their human dignity and as a key to their holistic recovery of total body health.
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Macek MD, Wagner ML, Goodman HS, Manz MC, Marrazzo ID. Dental visits and access to dental care among Maryland schoolchildren. J Am Dent Assoc 2005; 136:524-33. [PMID: 15884324 DOI: 10.14219/jada.archive.2005.0210] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Regular dental visits afford an opportunity for dentists to provide preventive services and to diagnose and treat disease. Not all children, however, have equal access to these services. METHODS The authors conducted this study to describe access to and utilization of oral health care services for Maryland schoolchildren in kindergarten and third grade. They obtained data from a questionnaire filled out by parents or guardians participating in the Survey of the Oral Health Status of Maryland School Children, 2000-2001 (N = 2,642). Outcome variables included having a dental visit in the last year, prophylaxis in the last year, usual source of medical care and usual source of dental care. Descriptor variables included region, grade, race/ethnicity, eligibility for free or reduced-fee meals, parents' or guardians' education and dental insurance status. RESULTS Overall, general dental visit and dental prophylaxis visit rates were similar (74.1 and 71.3 percent, respectively). Schoolchildren, however, were more likely to have had a usual source of medical care than of dental care (96.0 and 82.9 percent, respectively). Third graders, those ineligible for free or reduced-fee meals and those with some dental insurance coverage were more likely to have received a prophylaxis in the last year and were more likely to have a usual source of dental care. Non-Hispanic white and non-Hispanic black schoolchildren also were more likely to have had a usual source of dental care than were Hispanics. CONCLUSIONS Schoolchildren most likely to have received regular preventive dental care were those who had parents or guardians with financial resources. Medicaid and State Children's Health Insurance Program (SCHIP) provide safety nets, but these programs could be improved. PRACTICE IMPLICATIONS Dentistry's challenge is to determine which characteristics are unique to those who visit the dentist regularly and use this information to help meet the needs of the underserved.
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Affiliation(s)
- Mark D Macek
- Department of Health Promotion and Policy, Baltimore College of Dental Surgery Dental School, University of Maryland, 21201-1586, USA
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Gregory J, Gibson B, Robinson PG. Variation and change in the meaning of oral health related quality of life: a ‘grounded’ systems approach. Soc Sci Med 2005; 60:1859-68. [PMID: 15686816 DOI: 10.1016/j.socscimed.2004.08.039] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Changes in concepts of health and disease have led to increased interest in health related quality of life in medicine. Quality of life measures tend to treat quality of life as a stable construct that can be measured externally. They do not consider people's differing expectations and assume that what quality of life means to people is stable over time. This paper reports on a study which aimed to find out how measures of oral health related quality of life (OHRQoL) vary between and change within individuals. Longitudinal semi-structured open-ended interviews were carried out with twenty people with socially noticeable broken, decayed or missing teeth who were or were not seeking dental treatment. The data were collected and analysed using the iterative processes of grounded systems theory based on Glaserian (Theoretical Sensitivity, The Sociology Press, Mill Valley, CA, 1978) grounded theory and Luhmann's (Social Systems, Stanford University, Stanford, 1984) social systems theory. During the data analysis it emerged that participants' were adopting positions on seven dimensions of oral health relating to the positions that people would adopt with respect norm, attribution, trust, accessibility, commodity, authenticity, and character. The core distinction that accommodated people's varying positions was that people constructed their own margins of relevance of oral health. The margins of relevance indicated a variable from a hypothetical extreme of 'super-relevant' to the other extreme of 'not relevant'. The margins of relevance could shift, meaning that assessments of quality of life would vary. Oral health related quality of life is therefore defined as the cyclical and self-renewing interaction between the relevance and impact of oral health in everyday life.
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Affiliation(s)
- Jane Gregory
- Unit of Oral Health Services Research and Dental Public Health, Guy's Kings and St Thomas' Dental Institute, Room 202, Denmark Hill Campus, Caldecot Road, Denmark Hill, London, SE5 9RW, UK
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Chattopadhyay A, Kumar JV, Green EL. The New York State Minority Health Survey: determinants of oral health care utilization. J Public Health Dent 2003; 63:158-65. [PMID: 12962469 DOI: 10.1111/j.1752-7325.2003.tb03494.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the factors associated with visits to a dentist and more specifically the role of dental insurance coverage and to explore the reasons for not visiting a dentist among minorities in New York State. METHODS The Minority Health Survey was a one-time, statewide, random digit-dialed telephone survey. We drew a directed acyclic graph (DAG) of the potential determinants of oral health care utilization for our population of interest and modeled the independent variables as determinants of oral health care utilization. The data for this study were analyzed in SUDAAN using appropriate weights and variance adjustments that accounted for the complex sampling design. Hence, this report is generalizable to the New York State adult "minority" population. RESULTS About 63 percent respondents had visited a dentist in the past one year. Having dental insurance (adjusted odds ratio [adj OR]=2.5), having more than high school education (adj OR=1.9), being younger (adj OR=2.3 for 18-25 years vs age 40 years or older), being married (adj OR=1.7), being dentate (adj OR=0.3 for edentulousness), and having higher income (adj OR=0.5 for middle vs high income) were significantly associated with having visited a dentist in the past year. Cost and awareness-related factors were the most common reasons for not visiting a dentist. Most of the year 2000 oral health objectives measurable in this survey were not met. CONCLUSION Increasing dental insurance coverage and increasing awareness about oral health care would be the two biggest factors in meeting the goals of year 2010.
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Affiliation(s)
- Amit Chattopadhyay
- Department of Dental Ecology, University of North Carolina at Chapel Hill, USA.
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Siriphant P. Response to the JPHD's guest editorial: qualitative research--does it have a place in dental public health? J Public Health Dent 2001; 61:68-9. [PMID: 11474916 DOI: 10.1111/j.1752-7325.2001.tb03367.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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