|Year : 2016 | Volume
| Issue : 4 | Page : 451-455
Utilization of dental health-care services and its barriers among the patients visiting community health centers in Nellore District, Andhra Pradesh: A cross-sectional, questionnaire study
P Nagarjuna, V Chandra Sekhara Reddy, KM Sudhir, R. V. S. Krishna Kumar, Srinivasulu Gomasani
Department of Public Health Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
|Date of Web Publication||15-Dec-2016|
Post Graduate, Department of Public Health Dentistry, Narayana Dental College and Hospital, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: The primary health centers and community health centers (CHCs) offer an opportunity for early diagnosis and treatment, dental health education, and institution of preventive measures in the remote areas. Aim: To assess the level of utilization of dental health care services and to determine barriers that prevent utilization of dental health-care services among the patients visiting CHCs in Nellore District, Andhra Pradesh. Materials and Methods: A cross-sectional study was carried out among 600 patients aged 20 years and above visiting the randomly selected 10 CHCs during May 2015 in Nellore District. A multistage sampling method was followed. The source of data was primary in nature and it was obtained through self-administered questionnaire. Data was entered and analyzed using a software program IBM SPSS Statistics version 22 (Armonk, NY: IBM Corp) (P < 0.05). Results: Only 36% of patients had visited the dentist in the last 12 months. Males (54%) visited dentist more frequently than females (46%). The most common reported reasons for the last dental visit were pain or a dental emergency (71%), followed by restorative treatment (17%) and other reasons (12%). The most commonly reported reasons for not seeking dental care were “Not needed unless having pain” by 360 (60%), “I do not think dental diseases are very serious” by 304 (51%), “I have fear of dental procedures” by 290 (48.6%),“Lack of time” by 235 (45.6%), “Dental treatment is expensive” by 200 (33.3%), and “The dentist is at a long distance” by 158 (26.8%). Conclusions: Our findings suggest that only a small portion of population visited a dentist in previous year. Most of them believe that visiting dentist is necessary only for pain relief.
Keywords: Communication barriers, community health services, dental health services, utilization
|How to cite this article:|
Nagarjuna P, Reddy V C, Sudhir K M, Kumar RK, Gomasani S. Utilization of dental health-care services and its barriers among the patients visiting community health centers in Nellore District, Andhra Pradesh: A cross-sectional, questionnaire study. J Indian Assoc Public Health Dent 2016;14:451-5
|How to cite this URL:|
Nagarjuna P, Reddy V C, Sudhir K M, Kumar RK, Gomasani S. Utilization of dental health-care services and its barriers among the patients visiting community health centers in Nellore District, Andhra Pradesh: A cross-sectional, questionnaire study. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Oct 23];14:451-5. Available from: http://www.jiaphd.org/text.asp?2016/14/4/451/195844
| Introduction|| |
Health has been considered as a basic human right and it is also a wider social goal. Oral health is critical but an overlooked component of overall health and well-being among children and adults. According to WHO, oral health means more than just good teeth: It is a state of being free from chronic mouth and facial pain, oral and throat cancer, oral sores, birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay and tooth loss, and other diseases and disorders that affect the oral cavity.
Dental diseases are generally not self-limiting. If untreated, dental conditions may affect the person's well-being and overall quality of life. Regular home oral care and a yearly dental checkup are the best means for saving one's own teeth. Dental service use can be defined as an annual number of dental visits per person or the proportion of persons visiting a dentist within a year or reported first dental visit within a series of visits or lack of dental visits within a specific period or aggregated expenditures for dental visits or routine versus emergency care. This information will help in planning and implementation of oral health services in a community.
Oral health problems are emerging as a major public health problem in developing countries such as India. The community health centers (CHCs) constitute the secondary level of health care and are designed to provide referral as well as specialist healthcare to the rural population. According to the 11-year plan, there are about 4809 CHCs in India. Among them, only a few of them provide dental services. There are limited studies on the utilization of dental health-care services and its barriers among patients visiting CHCs in India. Hence, the present study was carried out to assess the utilization of dental health-care services and its barriers among the patients visiting CHCs in Nellore District, Andhra Pradesh.
| Materials and Methods|| |
A cross-sectional study was done among patients visiting the CHCs in Nellore during May 2015. The study was approved by the Institutional Ethics Committee. The permission was obtained from the administrative medical officer of CHCs before the start of the study.
The patients aged above 20 years and those who visited the CHCs were included in the study. Patients with special needs and who were uncooperative were excluded from the study. The purpose of the survey was explained to the participants and informed consent was obtained from them during the survey. Sample size was calculated as 600 based on the population census (2011) of Nellore with an allowable error at 1%.
Multistage cluster sampling methodology was followed. Nellore is divided into five divisions. The five divisions of Nellore were divided into a total of 46 mandals, and then, two mandals were randomly selected from each revenue division. Two mandals having CHCs were randomly selected from each division. Representative age group people in the selected mandals who visit CHCs were included in the study. Here, each mandal were considered as a cluster.
A self-administered, anonymous questionnaire prepared in the local language was used to collect data about sociodemographic characteristics, dental visit history, and reasons for not visiting a dentist. The sociodemographic data of the participants were recorded using Kuppuswamy's socioeconomic scale. The questionnaire was filled in the presence of the investigator who gave required information whenever needed. The internal consistency of the questionnaire was pilot tested on fifty individuals, and Cronbach's alpha value of 0.87 was obtained. A total of 600 questionnaires were collected in 1-month duration of the study.
Data was entered and analyzed using a software program IBM SPSS Statistics version 22 (Armonk, NY: IBM Corp). Descriptive statistics were used to summarize the results. Association between the sociodemographic factors was tested using Chi-square test. Multiple logistic regression analysis was performed using questions related to the barriers as independent variables. A significant relationship was assumed to exist if the P value was found to be <0.05.
| Results|| |
This present study was done on 600 individuals. The mean age of the participants was 35 ± 7.50 years. Males comprise about 57.83% and females comprise about 42.17%. Majority of the population comes under upper lower class 53.6% (322) [Table 1].
|Table 1: Distribution of study participants according to age, gender, and socioeconomic status|
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Of the respondents, 216 (36%) visited a dentist in the last 12 months. The most common reported reasons for the last dental visit were pain or a dental emergency (154, 71%), followed by restorative treatment (38, 17%) and other reasons (24, 12%) such as oral prophylaxis and prosthesis [Table 2].
The relationship between gender and previous dental visit of the study population is explained in [Table 3]. Majority of males (54%) visited the dentist in the last 12 months when compared to females (46%). However, there was no statistically significant difference in relation to gender of population for those who had visited and not visited the dentist in the last 12 months.
|Table 3: Comparison of response rates of males and females based on the last dental visit in 12 months|
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[Table 4] explains the reasons for not visiting the dentist in the last 12 months. Majority of them 360 (60%) felt that “no need to visit dentist unless there is pain” and no gender difference was seen for this statement. 304 (51%) of them felt “dental diseases are not serious” and 235 (45.8%) of them felt “lack of time” as reasons which were commonly reported by males (P < 0.05). 290 (48.6%) of them felt “fear about dental treatment” as a reason which was commonly by females (P < 0.05). 33.3% of them believe “Dental treatment is expensive” and 26.3% felt “The dentist is at a long distance” as reasons for not visiting the dentist in the last 12 months.
Logistic regression analysis showed that the strongest factors for not visiting dentist were belief that there is “no need unless pain was present” (odds ratio: 1.95, confidence interval: 1.71–2.22), “lack of time” (1.64; 1.39–1.89), and “fear of dental procedures” (1.51; 1.27–1.78). In addition, older respondents (35–45 years), female gender, higher socioeconomic status, and those having only basic education were less likely to visit a dentist in the previous 1 year [Table 5].
|Table 5: Regression analysis of factors associated with not having a dental visit in the last 12 months|
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| Discussion|| |
The present study provides an excellent opportunity to understand the pattern of utilization of dental services and its barriers among the patients visiting CHC in Nellore, Andhra Pradesh.
Utilization of the dental service among patients visiting CHC was very low. This finding was similar to the findings from other studies ,,, and in other countries such as China (20%) and Spain (34.3%). In contrast, dental service utilization is high in a study (67%) and in developed countries such as Denmark 61%), the UK (47%), Finland (56%), and Singapore (43%). Health insurance which covers dental services in these countries can be speculated for the high utilization, which is nonexistent in India. Insurance schemes either at microlevel or at macrolevel for oral health services for our population should be considered.
In the present study, the younger age group visited the dentist more regularly in comparison to the older age group, which was similar to other studies.,,,, This may be due to the fact that the younger age group had more knowledge and fewer barriers. However, a study  from India and other countries ,, reported that older dentate adults were more likely to attend a dentist on a regular basis than the younger ones.
Females showed higher dental fear which was seen in some studies.,,, This may be one of the reasons of dental visit being lower in females in the present study in comparison with the male population. This is because, in our population, females are largely dependent on other family members, and decisions regarding matters such as visits to the dentists are made by others. However, other studies show opposite trend.,,,,
Higher education group showed higher dental visits than the lower education group in this study because the education may be correlated with high health awareness, which in turn stimulates preventive behavior such as regular visits for a checkup. This is similar to the findings of other studies.,,
Toothbrushing is a health behavior, which indicates oral health attitudes. The present study shows that only 25% of the subjects used to brush twice daily. The positive association between toothbrushing frequency and utilization of dental services was also supported by a study.
The main reasons for the dental visits by the participants were tooth extractions or treatment of acute symptoms (71%), followed by restorations (17%) and other reasons (12%). This was similar to other studies ,,,, where the three most common treatments received in the participants during the last dental visits were extractions, restorations, and dental prosthesis. In addition, extraction was the most common treatment performed with few patients seeking treatment for preventive oral health care. This supports the fact that dental visits are usually motivated by pain and the need for emergency treatment as reported by a study. Several studies , have also reported that low level of dental awareness is a major factor for underutilization of dental services, and this may also be responsible for the late presentation of patients seeking treatment only when in pain or in need of extraction seen in this study, thereby increasing the likelihood of receiving treatment.
“There is no need unless pain was present” was considered the most common barrier in the multivariate analysis. This finding was also observed in other studies., Hence, we can say that the patient's perceived need to visit a dentist was only if they had symptoms such as pain and emergency as can be seen from the present study. They also believe that dental diseases are not serious as reported by over half of the population. Hence, there is a need for increasing awareness and encouraging more positive attitudes toward oral health in the same population.
Fear of dental procedures was another factor for not visiting the dentist in the present study. Here females showed higher dental fear which was also seen in other studies.,,,,, This may be one of the reasons of dental visit being lower in females in the present study in comparison with the male population. Unlike other studies,,, even though dental fear was more common in females, they utilized dental services more frequently than males possibly due to the fact that females have greater tendency to expect good outcome from dental attendance.
Cost of dental treatment was also reported by the patients in this study, which is similar to other studies., It is important to remove the barrier of high cost of health care by conducting free health camps, which have proved to be effective in screening for diseases and for providing preventive care. A free referral can also be provided to the participants in these camps when necessary.
The distance from the patient was also reported by the patients in this study, which is similar to other findings., The health centers should have complete oral health setup so that all the services could be provided to the rural people in their village and they do not have to travel long distances to get oral health care. Lack of time was also reported as a barrier for not visiting a dentist in this study which was also reported by other studies.,,,
While our study provides important information, there are some limitations. The utilization of health services is assessed by means of self-reporting, which could affect the validity of the information as the respondents may have difficulty recalling exact attendance. However, according to Gilbert et al., this method is sufficiently valid for most important research questions.
The people should be educated on basic oral care methods such as proper brushing of teeth, use of fluoridated toothpaste, and rinsing mouth after meals. They should also include education on effects of type and frequency of sweets intake. Dentists should educate the importance of oral health and motivate them to make regular dental visits.
| Conclusions|| |
Only 36% of the population reported of having a dental visit in previous 1 year. The highly reported reason for not visiting a dentist in this study was “Not needed unless having pain,” indicating the low felt need of the people. The cost of dental care, fear toward dental treatment, and patient's self-care methods were identified as main barriers toward utilization of dental services.
We convey our sincere thanks to Dr. Shivalingappa Javali fpr his help in statistical analysis.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Jain VK, Sequeira P, Jain J, Chancy U, Maliyil MJ, Bhagwandas SC. Barriers in utilization of oral health care services among patients attending primary and community health centres in Virajpet, South Karnataka. Natl J Med Dent Res 2013;1:39-47.
Gambhir RS, Brar P, Singh G, Sofat A, Kakar H. Utilization of dental care: An Indian outlook. J Nat Sci Biol Med 2013;4:292-7.
Holm-Pedersen P, Vigild M, Nitschke I, Berkey DB. Dental care for aging populations in Denmark, Sweden, Norway, United Kingdom, and Germany. J Dent Educ 2005;69:987-97.
Gururaj, Maheshwaran. Kuppuswamy's socio-economic status scale – A revision of income parameter for 2014. Int J Recent Trends Sci Technol 2014;11:1-2.
Kadaluru UG, Kempraj VM, Muddaiah P. Utilization of oral health care services among adults attending community outreach programs. Indian J Dent Res 2012;23:841-2.
Shailee F, Sharma KR, Bharadwaj V, Sogi GM. Barriers to the utilization of dental services in Shimla, India. Eur J Dent 2013;2:139-43.
Devaraj C, Eswar P. Reasons for use and non-use of dental services among people visiting a dental college hospital in India: A descriptive cross-sectional study. Eur J Dent 2012;6:422-7.
Gill M, Pal K, Gambhir RS. Oral hygiene practices, attitude, and access barriers to oral health among patients visiting a rural dental college in North India. J Dent Res Rev 2014;1:114-7.
Lo EC, Lin HC, Wang ZJ, Wong MC, Schwarz E. Utilization of dental services in Southern China. J Dent Res 2001;80:1471-4.
Pizarro V, Ferrer M, Domingo-Salvany A, Benach J, Borrell C, Pont A, et al.
The utilization of dental care services according to health insurance coverage in Catalonia (Spain). Community Dent Oral Epidemiol 2009;37:78-84.
Poudyal S, Rao A, Shenoy R, Priya H. Utilization of dental services in a field practice area in Mangalore, Karnataka. Indian J Community Med 2010;35:424-5.
Petersen PE. Dental visits and self-assessment of dental health status in the adult Danish population. Scand J Prim Health Care 1984;2:167-73.
McGrath C, Bedi R, Dhawan N. Factors influencing older people's self reported use of dental services in the UK. Gerodontology 1999;16:97-102.
Murtomaa H. Utilization of dental services by Finnish adults in 1971 and 1980. Acta Odontol Scand 1983;41:65-70.
Lo GL. The use of dental services by adult Singaporeans. Singapore Dent J 1993;18:22-5.
Vashisth S, Gupta N, Bansal M, Rao NC. Utilization of services rendered in dental outreach programs in rural areas of Haryana. Contemp Clin Dent 2012;3 Suppl 2:S164-6.
Syrjälä AH, Knuuttila ML, Syrjälä LK. Reasons preventing regular dental care. Community Dent Oral Epidemiol 1992;20:10-4.
Kakatkar G, Bhat N, Nagarajappa R, Prasad V, Sharda A, Asawa K, et al.
Barriers to the utilization of dental services in Udaipur, India. J Dent (Tehran) 2011;8:81-9.
Kelly M, Steele J, Nuttall N, Bradnock G, Morris J, Nunn J, et al
. Adult dental health survey: Dental attendance in 1998 and implications for the future. Br Dent J 2001;190:177-82.
Locker D, Leake JL, Lee J, Main PA, Hicks T, Hamilton M. Utilization of dental services by older adults in four Ontario communities. J Can Dent Assoc 1991;57:879-86.
Fukai K, Takaesu Y, Maki Y. Gender differences in oral health behavior and general health habits in an adult population. Bull Tokyo Dent Coll 1999;40:187-93.
Liddell A, Locker D. Gender and age differences in attitudes to dental pain and dental control. Community Dent Oral Epidemiol 1997;25:314-8.
Manski RJ, Magder LS. Demographic and socioeconomic predictors of dental care utilization. J Am Dent Assoc 1998;129:195-200.
Meng X, Heft MW, Bradley MM, Lang PJ. Effect of fear on dental utilization behaviors and oral health outcome. Community Dent Oral Epidemiol 2007;35:292-301.
Slack-Smith LM, Mills CR, Bulsara MK, O'Grady MJ. Demographic, health and lifestyle factors associated with dental service attendance by young adults. Aust Dent J 2007;52:205-9.
Ekanayake L, Ando Y, Miyazaki H. Patterns and factors affecting dental utilisation among adolescents in Sri Lanka. Int Dent J 2001;51:353-8.
Manski RJ, Moeller JF. Use of dental services: An analysis of visits, procedures and providers, 1996. J Am Dent Assoc 2002;133:167-75.
Sohn W, Ismail A, Amaya A, Lepkowski J. Determinants of dental care visits among low-income African-American children. J Am Dent Assoc 2007;138:309-18.
Helöe LA, Aarö LE, Sögaard AJ. Dental health practices in Norwegian adults. Community Dent Oral Epidemiol 1982;10:308-12.
Gilbert P, McEwan K, Matos M, Rivis A. Fears of compassion: Development of three self-report measures. Psychol Psychother 2011;84:239-55.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]