|Year : 2020 | Volume
| Issue : 1 | Page : 77-82
Access to public dental care services by differently abled children in Bengaluru City: A cross-sectional study
Sreekanth Bose, R Yashoda, Manjunath P Puranik
Department of Public Health Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka, India
|Date of Submission||09-Apr-2019|
|Date of Decision||18-May-2019|
|Date of Acceptance||06-Feb-2020|
|Date of Web Publication||2-Mar-2020|
Dr. Sreekanth Bose
Department of Public Health Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Oral health is an important aspect of health for all children and is all the more important for differently abled who face unique challenges during routine dental care. Aim: To assess and compare the perceptions of dental health officers and parents of differentially abled children regarding architectural, geographical, organizational, and communicational accessibility of the public dental services. Materials and Methods: A cross-sectional study was conducted among 100 parents of differently abled children and 15 dental health officers working in government hospitals under the Department of Health and Family Welfare, Government of Karnataka, from June to October 2017, in Bengaluru city. Differently abled children with locomotor, speech and hearing, and visual and cognitive disabilities aged 6–12 years were included. A structured self-administered questionnaire was used to evaluate the perceptions regarding architectural, geographical, organizational, and communicational accessibility of the public dental services. Descriptive and analytical statistics was done. A P < 0.05 was considered statistically significant. Results: Higher proportion of dental health officers compared to parents of differentially abled children had a positive perception regarding architectural, geographical, organizational, and communicational accessibility of public dental services. Finding a dentist willing to treat was the most difficult barrier according to the parents of differently abled children (52.6%) and dental health officers (46.66%). Conclusion: A higher proportion of dental health officers compared to parents of differentially abled children had a positive perception regarding architectural, geographical, organizational, and communicational accessibility of the public dental services.
Keywords: Access, barriers, dental health officers, differently abled children, public dental services
|How to cite this article:|
Bose S, Yashoda R, Puranik MP. Access to public dental care services by differently abled children in Bengaluru City: A cross-sectional study. J Indian Assoc Public Health Dent 2020;18:77-82
|How to cite this URL:|
Bose S, Yashoda R, Puranik MP. Access to public dental care services by differently abled children in Bengaluru City: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2020 Jul 7];18:77-82. Available from: http://www.jiaphd.org/text.asp?2020/18/1/77/279822
| Introduction|| |
A differently abled child tends to have poorer health-related outcomes and is more vulnerable to preventable conditions, such as obesity, dental caries, and intestinal parasitic infections.,, Almost 95 million children around the world have some forms of disability. At the same time, family members have to face multiple challenges, such as poor awareness about the child's condition, adverse impact on social life, working life and family relationships, financial constraints, and anxiety, stress, and depression.,
Differently abled children have poor oral health which may stem from dental disease that goes untreated because of improper diagnosis or poor access to dental care. It is recognized that differently abled children have unique challenges when seeking preventative and restorative dental treatment. Complex physical and medical conditions, along with behavioral challenges, can make diagnosis and treatment difficult. This also makes the role parents or caregivers have, in providing daily preventive care, more difficult.
Differently abled children in India are subject to multiple deprivations and limited opportunities in several dimensions of their lives. Some of these include not being enrolled in schools, lower employment rates, limited awareness of entitlements and services available, and lack of social welfare support. Article 41 of the Indian Constitution imposes a duty on state to public assistance basically for those who are sick and disabled. As a signatory to the UN Human Rights Treaty, India has promised to provide barrier-free environment for a better life to its citizens with disabilities. Further, the legal basis to this promise is provided in the Protection of Rights and Full Participation Act, 1995. The Government of India launched the “Accessible India Campaign” on December 3, 2015, for achieving universal accessibility for persons with disability to create an enabling and barrier-free environment. Despite all these efforts, most of the government health services are not barrier-free. Oral health which is an important part of general health is getting very less importance in public healthcare system. Dental services are not properly integrated into the framework of public healthcare programs.
The available dental services in the public sector present with challenges of accessibility to differently abled children due to geographical, architectural, organizational, cultural, economic, and communication barriers. Accessibility which can be understood as the ease with which persons with disabilities can use health services owing to the characteristics of the system and the services, and the chance they have to overcome organizational and geographical barriers as well as barriers presented by the physical structure of dental office and the difficulty in communication between dental health officers and differently abled children.
However, only a few studies have evaluated the accessibility of dental services to differently abled children. Hence, this study was conducted in Bengaluru city, Karnataka, India, with a primary objective to assess and compare the perceptions of differentially abled children's parents and dental health officers regarding architectural, geographical, communicational, and organizational accessibility of the public dental services. The secondary objectives were to assess the perception about satisfaction and importance of access to dental services by parents of differentially abled children and to determine the association between utilization of dental service and sociodemographic factors.
| Materials and Methods|| |
A cross-sectional study was conducted among the parents of differently abled children and dentists working in government hospitals under the Department of Health and Family Welfare, Government of Karnataka, from May to October 2017, in Bengaluru city. Institutional Ethical Committee and Review Board approved the study protocol, and all participants signed informed consent form. A questionnaire was developed using previous literature, which included sections for demographic profile and perceptions about access. It contained three domains (geographical, architectural, and organizational accessibility) and questions to evaluate the difficulty level of barriers that hinder the use of dental services, satisfactory level, and importance of dental treatment.
Before the commencement of the main study, the pilot study was conducted among parents of differently abled children to check the feasibility of the study and validity of questionnaire and to determine the sample size. Internal consistency (α) of the questionnaire was found to be good (0.87). The sample size of differently abled children was calculated using the following formula.
Statistical power=80%, Confidence interval=95%, E (margin of error)=10%, D (design effect)=1.5, P (Prevalence)=90%.
The sample size of 64 was rounded off to 100.
A list of schools for differently abled children (motor, hearing, visual, and cognitive disabilities) in Bengaluru city was obtained. The schools were classified into four (North, South, East, and West), according to the geographical distribution. One school was selected randomly from each geographical location. The parents of differently abled children aged 6–12 years were recruited from the respective schools. All the dental health officers (15) in Bengaluru city from 11 government hospitals having dental departments were included in the study. Data were collected using self-administered structured questionnaires. The investigator distributed the study questionnaire and collected it back once it was filled.
The results were analyzed using SPSS version 22.0 (SPSS Inc., Chicago, IL, USA). Fisher's exact test and logistic regression analysis were performed. Statistical significance was considered at P < 0.05 (95% confidence interval was taken).
| Results|| |
Responses were collected from 100 parents of differently abled children and 15 dental health officers. The age of differently abled children ranged from 6 to 12 years (9.12 ± 1.93 years), while the dentists were aged between 35 and 48 years (39.66 ± 5.23 years). Differently abled children were having cognitive disability (32%), speech and hearing disability (31%), visual disability (22%), and motor disability (15%). Half of the differently abled children were under the age of 10 years and were males. The present study had more number of female participants (73.3%) in the dentist group. Majority of the dentists were in the age group of 35–45 years (86.7%). Almost half of the participants (53.3%) had basic dental educational qualification (BDS) degree.
Most of the parents were graduates with clerical/shopkeeper jobs having a monthly income of 21,361 rupees or more. Majority of them belonged to upper-middle class (67%). Around 86% differently abled children had a history of dental visit.
The dental health officers had more positive perception of accessibility compared with parents of differently abled children. The architectural, geographical, organizational, and communicational characteristics of the public dental setups, from the perception of dentists and parents of differently abled children, are presented in [Table 1], [Table 2], [Table 3].
|Table 1: Distribution of study participants based on perception about architectural accessibility|
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|Table 2: Distribution of study participants based on perception about geographical accessibility|
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|Table 3: Distribution of study participants based on perception about communicational and organizational access|
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Likelihood of dental visit was significantly (P = 0.03) more among parents with higher monthly income (≥21,361 rupees) compared with lower monthly income (≤21,360 rupees) and significantly (P = 0.03) less among younger children (aged 6–9 years) compared with elder children (aged 10–12 years). Parents with positive attitude regarding importance of dental visits have more likelihood of utilization of oral health services. [Table 4] describes the summary of logistic regression analysis for variables predicting dental visit.
|Table 4: Summary of logistic regression analysis for variables predicting dental visit|
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Majority of the parents of differently abled children believed that dental visit is important. The mean percentage of satisfaction regarding treatment was higher among dental health officers (68%) compared with parents (33.2%).
| Discussion|| |
Accessibility is fundamental to realization and enjoyment of any right. The earlier definition of access included only “physical access” and took only architectural barrier into consideration. The modern-day analysis of access is more holistic, which depends on geographical, financial, organizational, and social barriers that limit the utilization of services.
Architectural accessibility is critical for enabling disabled children to gain equal opportunity, live independently, and participate fully in all aspects of life in an inclusive society. According to Accessible India Campaign by the Government of India, “accessible government building is one, where persons with disabilities have no barrier in entering it and using all the facilities therein.” Bengaluru is one of the first cities in India selected to conduct the accessibility audit. The government is committed to gradually make public spaces more accessible for people with disabilities.
The present study obtained the perceptions of parents of differently abled children and dental health officers and compared it. This is done to evaluate the difference in perception between them, with an assumption that dental health officers' perception will be the one which is close to the reality. This will help to understand the general perception about the accessibility in public dental setups by parents and to hypothesize its effect of seeking dental service there.
The mean percentage of perception about the presence of factors included in the architectural accessibility was found to be 36.8% among parents of differently abled children and 46.66% among dental health officers. Even though the frequency of positive perception about architectural accessibility was higher among dental health officers, parents had more positive perception regarding a few factors, such as adapted physical structure, steps, parking spaces, wide doors, and wide corridors. Many government services such as metro rail in Bengaluru provide complete architectural accessibility. This could be the reason for parents of differently abled children having a fair perception of the presence of the physical structures. It is logical to assume that the perception of dental health officers is closer to the actual situation compared to parents' perception.
Study participants believed that the public dental setups were not within a travelable distance but with safe surroundings. Sixty-four primary health centers (PHCs) and 13 community health centers are functioning under the Department of Health and Family Welfare in whole of Bengaluru city. Among these, only 11 centers provide regular dental services. Even though oral health is considered as an integral part of general health, it is not well integrated into the public health system.
According to half of the parents of differently abled children and two-fifth of dental health officers, there was no availability of transportation to public dental setups. Availability with transportation is an issue in rapidly growing cities. Many factors limit differently abled children to use the public transport system, such as the time consumed in busy traffic and work loss days for parents of disabled children. Public transport system is not disabled-friendly. In many instances, taxi cabs are not readily available and quite expensive which create issues in logistics. According to surveys, even public transport is beyond the reach of 20% at the bottom of the income pyramid. Even if increase in oil prices makes transportation expensive, majority of the parents of differently abled children perceived that transportation was affordable. This can be explained by the high proportion of upper-middle-class people in the study population.
Accessibility is a process that begins from the positive attitudes toward disabled people. It includes recognition of and desire to eliminate existing barriers and to replace them with attitudes of welcome and acceptance, which depends on organizational and communicational activities. Majority of the participants from both the groups assumed that priority care is provided and proper referrals are made but disagreed about proper scheduling of the consultations. In this study, three-fifth of the parents and dental health officers did not agree that sufficient dental health officers are in service. Although there are approximately 152,679 registered dentists in India, dental workforce in the government sector is very less. Less than 20% of the existing government health centers in India have the services of a dental health officer available for the population.
Almost all differently abled children had a history of dental visit which is comparable with previous literature that included participants from better socioeconomic background.,,, Dental visit in this study was higher compared to many studies done among nondisabled children in India. The urban setting and high educational status of parents might have facilitated the utilization of dental services. Likelihood of dental visit was significantly more among parents with higher monthly income compared with lower monthly income. Patients tend to seek dental care when it is symptomatic. In this study, likelihood of dental visit was significantly less among younger children (aged 6–9 years) compared with older children (aged 10–12 years), which could be attributed to cumulative and chronic nature of disease and also due to parental attitudes toward deciduous dentition. These findings are consistent with earlier studies.,,,, Studies in the literature have reported that parents' positive dental attitudes resulted in children with fewer carious teeth, better oral hygiene, and having received more dental care. Likelihood of dental visit was significantly more among parents who perceived higher importance for dental visits. In the study, 77% of the parents of differently abled believed that dental visit was important. This is very positive finding compared to earlier studies conducted in Brazil, Singapore, and Nigeria, which showed lesser importance of dental visit.,, The overall mean percentage of satisfaction was found to be double among dental health officers compared to parents. This can be attributed to the positive perceptions about the profession by dental health officers.
To the authors' best knowledge, this is the first study in India assessing the perception of dental health officers working with the Department of Health and Family Welfare and parents of differently abled children with respect to architectural, geographical, organizational, and communicational access. Cross-sectional study design and inherent biases in the questionnaire limit the generalizability of this study. The present study used subjective perceptions to estimate the access which may not give a clear picture of the actual scenario. The study excluded nonschool-going children which could have affected the results.
This study provides insight into the perceptions of parents of differently abled children and dental health officers regarding access to public dental setups. Further studies are needed comparing perceptions with the actual scenario of access assessed by the international guidelines. There should be modification in the architectural structure of government dental setups to make it more disabled-friendly and barrier-free. The public transport system must provide complete access to differently abled children. There should be proper distribution of government dental services with sufficient dental workforce and facilities. Teledentistry should be used as a promising tool to decrease geographical barriers. Installation of a teledentistry unit in each PHC will be the first step toward universally accessible oral health delivery.
| Conclusion|| |
The challenges to obtaining access to dental care are high for differently abled children. Higher proportion of dental health officers compared to parents of differentially abled children had a positive perception regarding architectural, geographical, organizational, and communicational accessibility of the public dental services. Perception was low about satisfaction and high about importance of access to dental services among parents of differentially abled children. The satisfaction regarding dental services is higher among dental health officers. The utilization of dental service is influenced by perception about importance of dental visit. The study highlights the importance of barrier-free environment and need for programs to create awareness about importance of dental visit.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]