|Year : 2017 | Volume
| Issue : 3 | Page : 252-257
Oral health care-seeking behaviors and influencing factors among south Indian rural adults: A cross-sectional study
Vikram Simha Bommireddy1, Srinivas Pachava1, V Viswanath1, Devaki Talluri1, Srinivas Ravoori1, Suresh Sanikommu2
1 Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
2 Department of Public Health Dentistry, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh, India
|Date of Web Publication||18-Sep-2017|
Vikram Simha Bommireddy
Flat No. 103, Nandi Arcade, Plot No. 55/3rt, S.R Nagar, Hyderabad - 500 038, Telangana
Source of Support: None, Conflict of Interest: None
Introduction: Oral health has long been recognized as an integral part of general health. The trend indicates an increase in oral health problems in developing countries like India. When it comes to rural population, a multitude of challenges prevail pertaining to the betterment of oral health care. Aim: To determine the oral health care-seeking behaviors in rural Andhra Pradesh and to identify the influencing factors. Materials and Methods: A cross-sectional study was conducted among 18 years and above population using a structured pretested questionnaire. A total of 2711 subjects were selected using stratified proportionate random sampling technique. Data were analyzed by SPSS version 20 software. Percentages of the categorical variables were computed and compared by Chi-square test at 5% level of significance. Logistic regression was used to determine the influence of sociodemographic variables and oral health needs on the utilization of oral health-care services. Results: Of 2711 subjects, 1144 have experienced previous dental problems, toothache being the most experienced dental problem (46.32%) and the common treatment underwent was extraction. Most preferred treatment center by the study subjects were private dental college, and reason identified was accessibility which constituted about 44.5% of all the reasons. Most common reason for not visiting the dentist was the poor attitude of the subjects toward the dental problems as it constituted about 43.75% of the total influencing factors. Conclusion: Poor attitudes on the importance of oral health were quite evident, and efforts must be made to bring a change in this scenario.
Keywords: Health behavior, health care, oral health, rural population
|How to cite this article:|
Bommireddy VS, Pachava S, Viswanath V, Talluri D, Ravoori S, Sanikommu S. Oral health care-seeking behaviors and influencing factors among south Indian rural adults: A cross-sectional study. J Indian Assoc Public Health Dent 2017;15:252-7
|How to cite this URL:|
Bommireddy VS, Pachava S, Viswanath V, Talluri D, Ravoori S, Sanikommu S. Oral health care-seeking behaviors and influencing factors among south Indian rural adults: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2020 Feb 24];15:252-7. Available from: http://www.jiaphd.org/text.asp?2017/15/3/252/215064
| Introduction|| |
India stands as the second most populous country in the world next to China, supporting over 17.45% of the world's population with an estimated population of 1.21 billion. The country has a rich social composition with people from a variety of religions contributing to this social richness rural preponderance is quite obvious in the country with 68.84% of people residing in rural areas. The rural health infrastructure of India has been well designed to cover rural population through 1,48,124 sub centers, 23,887 primary health centers and 4809 community health centers, but preposterously, it is poorly operated. Despite the country's great economic progress in the recent times, there is poor functioning of public health infrastructure with a little public financing for health (1.3% of gross domestic product).
Oral health has long been recognized as an integral part of general health. Especially with the increasing life expectancy of the Indian population, oral health plays a critical role in improving the quality of life of an individual. Unfortunately, the trend indicates an increase in oral health problems in developing countries like India. When it comes to rural population, a multitude of challenges prevails pertaining to the betterment of oral health care. In a country where 30,570 dentists are graduating per year, it is staggering to acknowledge that only 10% of dentists serve the rural people who constitute around 68.8% of the country's population. While inaccessibility to dental care is one of the major challenges, poor utilization of services is another formidable challenge attenuating the scope for improvement of oral health status of rural India. With a pronounced diversity inherent in the Indian culture, disparities in oral health could be expected among people from different socioeconomic and religious backgrounds, reckoning the differences in cultural beliefs, societal norms, and oral hygiene practices. With this background, the objective of this study was to determine the oral health care-seeking behaviors in rural Andhra Pradesh and to identify the influencing factors.
| Materials and Methods|| |
This cross-sectional study was conducted among people aged 18 and above residing in the Pedakakani Mandal of Guntur District, Andhra Pradesh between April 2015 and November 2015. Ethical clearance for the study was obtained from the Institutional Review Board, and informed consent was obtained from all the study participants.
Pedakakani mandal is one of the 57 mandals in Guntur district with a population of 73,689 distributed in 10 villages in the geographic realm of the mandal. The literacy rate in this mandal was around 68.06%. The study size to estimate the rate of utilization was determined using the formula n = (1.96)2 P(1 − p)/d2. The margin for error (d) was kept at 0.02, and P was assumed to be 0.5 to obtain a sample that ensures precision. The sample size obtained was 2400. The potential non-response rate was assumed to be 20%. To compensate for potential nonresponse, 3000 participants were included in the study. However, the response rate was higher than expected and 2764 participants made final sample.
The sampling strategy followed in this study was stratified proportionate systematic random sampling. The ten villages in the mandal constituted the strata. The amount of sample to be drawn from each village was determined based on the proportion of mandal population residing in that village. Within each village, systematic random sampling was followed recruiting all the residents aged 18 and above in every fifth household who were available on the days of collection of data. Nonresidents of Pedakakani mandal and mentally challenged subjects were excluded from the study.
A self-administered structured questionnaire was employed in this study. The questionnaire was first prepared in English and translated to the local language, Telugu by two experts in the field of public health dentistry. The questionnaire was then backward translated into English by a bilinguist, which was checked for conceptual equivalence. The Telugu version was administered to 100 participants, based on the understanding capability of whom, a few linguistic modifications in Telugu were done to the questionnaire as felt necessary by the participants, without disturbing the conceptual equivalence.
The survey questionnaire included questions to collect information regarding age, sex, Kuppuswamy socio-economic scale 2013 for socio-economic status, lifestyle habits such as pan chewing, smoking, oral hygiene practices, visits to dentists, reason for visits, treatments underwent, factors influencing utilization, type of oral health-care facilities preferred, satisfaction levels, and current felt needs. About 20–25 participants were interviewed per day and the time taken to gather information ranged from 7 to 12 min per person. The interview was done only for those participants who could not read and write in the local language, Telugu. Eliminating the data with inconsistencies, the final analysis was made on 2711 participants.
The data were analyzed using SPSS version 20 software (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0., IBM Corp., Armonk, NY, USA). Descriptive statistics, Chi-square tests were used to analyze the data. Alpha level was set at 5%. Logistic regression was used to determine the influence of sociodemographic variables and oral health needs on the utilization of oral health-care services.
| Results|| |
The majority of the study participants were Hindu males with upper lower socioeconomic status and belonging to the 35–44 years age group. Slightly >20% reported tobacco use and 14.1% reported alcohol use. Toothbrush was the most commonly reported cleaning aid (86.4%) followed by twig (8.2%), and toothpaste was the commonly used cleaning material (85.1%). [Table 1] presents the descriptive data of the study participants. Dental problems were experienced at least once in their lives by 42.19%, with no significant differences between males and females [Table 2]. Fifty-six percent of Muslims responded that they had a dental problem sometime in their life which was significantly higher compared to participants from other religions [Table 3]. Tooth pain was the most remembered dental problem, and extraction was the most common care sought. Over 35% of the study participants reported utilizing oral health-care services, and all of them were episodic visitors. Slightly >50% of those who sought care did so at a private dental college. Among those participants, who had not sought care despite experiencing dental problems, 44.8% opined that care need not be sought for dental problems as they are not very important. Accessibility, as reported by the study participants, plays a key role in choosing the oral health-care facilities. A quarter of the study participants reported current felt needs.
|Table 1: Descriptive statistics on demographic characteristics, habits, oral hygiene, and care-seeking behaviors of study participants (n=2711)|
Click here to view
|Table 3: Differences oral health problems and care-seeking behaviors among study participants|
Click here to view
[Table 2],[Table 3],[Table 4] presents the differences in the experience of dental problems, care-seeking behaviors, barriers for seeking care, and preferences for oral health-care facilities based on gender, religion, and age, respectively. Although there were no significant differences between responses given by participants based on gender except for the reasons for choosing an oral health-care facility, significant differences were seen for almost all the responses between people from different religions and age groups.
[Table 5] shows the binomial logistic regression depicting the influence of sociodemographic variables and oral health needs on positive oral health care-seeking behaviors. The model showed that 39% of the variance in the utilization of oral health-care services was explained by the independent variables entered.
|Table 5: Influence of sociodemographic and oral health needs on positive oral health care-seeking behaviors|
Click here to view
| Discussion|| |
The importance of oral health in the maintenance of general health has been long acknowledged by the WHO. The theme for the world health day, 1994 was “oral health for healthy life.” Since then, there have been a lot of efforts towards raising awareness on oral health among the public by various local, national, and international bodies/organizations. Fédération dentaire internationale world dental Federation observes March 20th as world oral health day and has been working in collaboration with dental institutions across the country to promote the importance of oral health. Despite these efforts, oral health continues to be neglected by the people. The fact was not well received by the people, especially in rural areas as observed in this study. Nearly, 45% of those participants who had not sought care despite experiencing dental problems opined that care need not be sought for dental problems as they are not very important. Lack of awareness continues to be one of the major barriers greatly influencing the care seeking behaviors in a negative manner. The results obtained in this regard were similar to those documented in the previous studies.,, All the study participants who sought care were episodic visitors which was similar to the findings in the study. Toothache was the most common reason for seeking care as observed in previous studies.,, It could be comprehended from these observations that oral health-care services were elective unless there was pain in the view of a majority of the rural population. Furthermore, it was reported by the participants that accessibility was one of the main reasons why they had chosen the facility at which they had sought care.
It was observed in the present study that there were significant differences between males and females with regard to the reasons for preferring an oral health-care facility. While a majority of males reported advice from others as the reason, accessibility was the main reason for females which could be explained by the fact that most of the females in the study area engage in agricultural works besides executing the household responsibilities which restrict them to spend more time in the quest of seeking oral health care. This could be the reason why they prefer a facility well within their reach. Considerably higher percentage of Muslims reported experiencing dental problems compared to other religions. Fear was the most common reason reported by Muslim participants for not seeking care despite need. The relatively less likelihood of Muslims, especially women, to go out and engage in social activities could be a reason for their care-seeking behaviors.
Seeking care at private dental clinics was found to increase with an increase in age. As receiving treatment at private dental clinics is far more expensive than the treatment costs at government hospitals and private dental colleges, it may require a degree of economic stability at an individual level. This could be the reason behind the increase in care-seeking at private dental clinics as the individual's age and consequently step into their earning phase of life. The percentage of study participants who reported seeking oral health care was 35.7% which was comparable to the studies,, and was far less than that observed in the study. However, these findings have to be comprehended in light of the fact that a private teaching dental institution is located within the geographical realms of the study area which may have improved the care-seeking behavior. Poor attitudes of the study participants regarding the importance of oral health were the major barrier for utilization of oral health-care services despite regular oral health awareness programs by the dental institution in the study area. This highlights the possibility that the campaigns on raising awareness on the importance of oral health could not bring an improvement in care-seeking behaviors. Emphasis must be placed on improving the social and economic conditions of the people besides aiming to improve their cognitive levels. It is only then that the oral health care-seeking behaviors can improve and result in better oral health status of the population.
Information regarding dental visits within the last 1 year was not considered in the study which would have been a more reliable estimate of care-seeking behaviors of the study population. Information on systemic diseases that could influence oral health care-seeking behaviors would have been a valuable addition to the present study. The findings of this study must be comprehended in view of the existence of a teaching dental institution in the study area and hence may not be generalizable to the state of Andhra Pradesh.
| Conclusion|| |
Oral health care-seeking behaviors among people in Pedakakani mandal were poor. Poor attitudes on the importance of oral health were quite evident, and efforts must be made to bring a change in this scenario. Being the most preferred facilities to seek oral health care, private dental institutions could play a crucial role in improving the oral health status of the country's population.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
FDI World Dental Federation. The Challenge of Oral Disease: A Call for Global Action. The Oral Health Atlas. 2nd
ed. Geneva: FDI World Dental Federation; 2015.
Yadav S, Rawal G. The current status of dental graduates in India. Pan Afr Med J 2016;23:22.
Bommireddy VS, Koka KM, Pachava S, Sanikommu S, Ravoori S, Chandu VC. Dental service utilization: Patterns and barriers among rural elderly in Guntur district, Andhra Pradesh. J Clin Diagn Res 2016;10:43-7.
Kumar BR, Dudala SR, Rao AR. Kuppuswamys socio economic status scale – A revision of economic parameter for 2012. Int J Res Den Health 2014;1:2-4.
Gupta S, Ranjan V, Rai S, Mathur H, Solanki J, Koppula SK. Oral health services utilization among the rural population of western Rajasthan, India. J Indian Acad Oral Med Radiol 2014;26:410-3. [Full text]
Gill M, Patil 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. [Full text]
Nagarjuna P, Reddy VC, Sudhir KM, Krishna Kumar RV, 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. [Full text]
Pavani NP, Pachava S, Sanikommu S, Vinnakota N, Devaki T, Ravoori S. Motivational factors for seeking oral health care at a teaching dental hospital in South India: A cross-sectional study. Int J Oral Care Res 2016;4:16-20.
Fotedar S, Sharma KR, Bhardwaj V, Sogi GM. Barriers to the utilization of dental services in Shimla, India. Eur J Gen Dent 2013;2:139-43. [Full text]
Oswal KC. Oral hygiene practice among patients visiting Terna Dental College. J Oral Health Community Dent 2013;7:33-6.
Desai S, Temsah G. Muslim and Hindu women's public and private behaviors: Gender, family and communalized politics in India. Demography 2014;51:2307-32.
Saddki N, Yusoff A, Hwang YL. Factors associated with dental visit and barriers to utilization of oral health care in a sample of antenatal mothers in hospital university Sains Malaysia. BMC Public Health 2010;10:75.
Maharani DA. Perceived need for and utilization of dental care in Indonesia in 2006 and 2007: A secondary analysis. J Oral Sci 2009;51:545-50.
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.
Sheiham A, Watt RG. The common risk factor approach: A rational basis for promoting oral health. Community Dent Oral Epidemiol 2000;28:399-406.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]