|Year : 2020 | Volume
| Issue : 2 | Page : 173-178
Documentation of oral health care seeking behavior and influencing factors through community consultations in the field practice area of a teaching dental institution
Suresh Chand Yaddanapalli, Srinivas Pachava, Srinivas Ravoori, Vikram Simha Bommireddy, Devaki Talluri, Pranoti Hiralkar
Department of Public Health Dentistry, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India
|Date of Submission||28-Nov-2018|
|Date of Decision||27-Apr-2020|
|Date of Acceptance||08-May-2020|
|Date of Web Publication||24-Jun-2020|
Dr. Srinivas Pachava
SIBAR Institute of Dental Sciences, Takkelapadu, Guntur, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Preventive dental visits help in the prior detection and treatment of oral diseases; therefore, to improve oral health outcomes, an opposite knowledge of the way the individuals use health services and the factors apocalyptic of this behavior is essential. Aim: To quantify oral health-care-seeking behavior and influencing factors in the field practice area. Materials and Methods: A cross-sectional study was done in the field practice area among WHO indexed age groups using a pretested and validated questionnaire in August 2017. A stratified random sampling technique was used resulting in a sample size of 200 to assess oral health-care-seeking behavior and influencing factors in this population. Obtained data were analyzed using SPSS version 20. Descriptive statistics, Chi-square test, and binomial logistic regression analysis were used to summarize the results, whereP ≤ 0.05 was considered as statistically significant. Results: The results of this study evinced a female preponderance of 64% with less proportionate (26%) of the study population seeking oral health services, out of which private dental clinic occupied the first choice in using dental services (17%). A carious tooth without pain was the most common dental problem irrespective of age (47.5%). Females were 0.392 times more likely to attend dental visits when compared to males (P = 0.003), while considering social class, people belonging to the upper-middle class were 0.24 times more likely to avail dental services when compared to lower social class (P = 0.015). Conclusion: This study revealed lower rates of dental services sought among the field practice area where most of them availed private clinics compared to government clinics.
Keywords: Behavior, community, consultations, dental health services, oral health
|How to cite this article:|
Yaddanapalli SC, Pachava S, Ravoori S, Bommireddy VS, Talluri D, Hiralkar P. Documentation of oral health care seeking behavior and influencing factors through community consultations in the field practice area of a teaching dental institution. J Indian Assoc Public Health Dent 2020;18:173-8
|How to cite this URL:|
Yaddanapalli SC, Pachava S, Ravoori S, Bommireddy VS, Talluri D, Hiralkar P. Documentation of oral health care seeking behavior and influencing factors through community consultations in the field practice area of a teaching dental institution. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2020 Jul 9];18:173-8. Available from: http://www.jiaphd.org/text.asp?2020/18/2/173/287633
| Introduction|| |
Although the mindful of thought exists as oral health an additionally integral part of general health, when it comes about the usage of services, it is the other way around suggestive of barriers in obtaining services, unawareness or ignorance of oral health condition, and socioeconomic status (SES) which have already been documented in previous studies.,,,,
Community consultations are one of the effective vehicles to educate policymakers and health-care professionals regarding important areas of perceived health-care needs for developing effective programs or policies.
Generating evidence requires a complex undertaking that calls for proven procedures and protocols and cross-disciplinary, cross-cultural expertise. An exchange of versions and views as part of the review process makes it easier to deal with regional variance, idiosyncratic interpretations, and inevitable oversights. Group discussion, including input from survey fielding staff, helps to identify comprehension problems for low-literacy populations and ambiguities more easily missed by someone working on his or her own. Therefore, generating meticulous instruments is essential to get reliable information on oral health-seeking behavior. To improve oral health outcomes, an adequate knowledge of the way the individuals use health services and factors predictive of this behavior is required. Therefore, this study was undertaken to generate evidence on oral health-seeking behavior in the field practice area.
This study was the first in kind, owing to the importance of WHO index age groups as they reflect the overall population, while the questionnaire was constructed by observing human behavior, conversing or interaction with people about their views, actions or beliefs to access areas that are generally not amenable to conventional questionnaires. With this background, we aimed to elicit oral health-care-seeking behavior, its profile, pattern, self-reported oral health diseases, and type of service received in the field practice area through community consultations.
| Materials and Methods|| |
A cross-sectional, single-visit, multilocality study was done using an interviewer-administered, pretested, and validated questionnaire to generate evidence on oral health-care-seeking behavior and influencing factors.
Field practice area: Area of the study and practice located within 10 km radius of the dental teaching institution.
Period of the study
Data were collected in the period of August 2017.
Stratified random sampling technique
The study area was divided into four sites, i.e., north, east, west, and south directions around the field practice area, where from each site, one ward is randomly chosen; further data were collected from 10 members of each WHO age group from each site resulting in the sample size of 200.
We included both males and females of WHO-recommended index age groups: 5 years, 12 years, 15 years, 35–44 years, and 65–74 years. In the present study, the data were collected using an interviewer-administered questionnaire, while for the age groups, i.e. 5 years, 12 years, and 15 years, the questionnaire was administered to their parents/guardians/caretakers.
Individuals with the following criteria were included in the study:
- Both males and females of WHO-recommended age groups
- Individuals who are present on the day of the study.
Individuals with the following criteria were excluded from the study:
- Noncooperative and mentally challenged
- Who are nonresidents of the field practice area.
Ethical clearance was obtained from the institutional ethical committee with protocol no: 45/IEC/SIBAR/15, and informed consent was obtained from all the study participants before the start of the study.
Developing a questionnaire
Initially, the topic was explained to the public chosen on a random basis (n = 40) from the same locality where the study was planned to conduct, and then, the participants were divided into groups constituting 2–3 members for each group, as with larger groups, some people may not participate.
They were asked about their comments regarding health-seeking behavior that were recorded into domains, and finally, the results of group work were integrated into the closing discussion and refer back to those comments made, when relevant, in subsequent sessions until there are no more responses stated. Finally, the comments were sorted and made into questions for further evaluation of psychometric analysis.
Evaluation of psychometric properties of the questionnaire
Initially, face validity was tested which signified the validity of the question and adequate representation of each and every aspect that totally balances the coverage of the issue.
Further content validity was checked to know whether the questionnaire covers the domains to be measured, and it was done by quantifying eight experts' degree of agreement regarding the content relevance of the questions from the department of public health dentistry.
Content validity was calculated by the formula:
Calculation of content validity ratio (CVR)
CVR = n − N/2/N/2
where n is the number of experts who gave a rating of essential for an item
N is the total number of experts
where values can range from −1 to +1 and those closer to +1 suggest that a majority of experts agree there is an association between item and domain. In the present study, the content value of the questionnaire is 0.75, that is, adequate.
A pilot study was done in the month of July 2017 on a sample of 25 participants, to check the feasibility of the study using a semi-structured, pretested, validated, interviewer-administered questionnaire. Through the pilot test, the internal consistency of the questionnaire was tested and yielded a result of Cronbach's α value of 0.81. The questionnaire consist of two parts, the first part comprises of demographic details of the study participants where the socioeconomic status (SES) was calculated using BG Prasad SES scale and the second part consists of questions which were based on the frequency of dental care visits, reasons, and barriers for dental visits.
The Statistical Package for the Social Sciences (IBM SPSS, Chicago, IL, USA) version 20.0 was used for the analysis, and data obtained were summarized using descriptive statistics, Chi-square test, and binomial logistic regression analysis, where P ≤ 0.05 was considered as statistically significant.
| Results|| |
The total study population comprises 200 participants, out of which 36% were male and 64% were female. Twenty-six percent of the participants sought dental services where the majority of them sought care from private dental clinics (16%), followed by teaching dental institutions and hospitals (8%), while least from the government dental clinic (2%).
Out of 26% of the study participants who have sought dental services, a different portion of participants were using them for different reasons under four domains. The main reasons for the selection of particular dental services were due to better and quick treatment, followed by accessibility, while the main reason for the last dental visit was carious teeth without pain (12%). Most of the participants have visited the dentist in the last 1–2 years, followed by 1–6 months. Most of the participants have spent 251–500 INR for treatment, while the mode of payment was mostly through out of pocket (86.5%), followed by usage of government hospital/schemes (13.5%) [Table 1].
According to the age groups considered, 65–74 years had suffered from most of the dental problems, and in all the age groups, the most commonly suffered dental problem by the participants was tooth decay without pain that was found to be statistically significant (P = 0.028) [Table 2].
|Table 2: Distribution of different dental problems suffered according to age|
Click here to view
According to the distribution of various barriers for seeking services with respect to age, 12 and 65–74 years of age groups have reported with a maximum number of barriers, and among all the age groups, negligence toward the dental problems was found to be statistically significant (P = 0.001) [Table 3].
|Table 3: Distribution of various barriers for oral health-seeking behavior according to age|
Click here to view
According to BG Prasad (2017) SES scale, lower-middle class was found to be the predominant class suffered by almost all the dental problems, but the common dental problem suffered by all the classes was tooth decay without pain [Table 4], while the middle and lower-middle classes have experienced almost all the barriers compared to other classes for exercising oral health care, and the common barrier was found to be negligence toward dental treatment [Table 5].
|Table 4: Distribution of different dental problems suffered according to socioeconomic status|
Click here to view
|Table 5: Distribution of various barriers for health-care-seeking behavior according to socioeconomic status|
Click here to view
Binomial regression analysis was done by taking oral health-seeking behavior as the dependent variable and gender, social class, and age groups as independent variables. Females were 0.392 times more likely to attend dental visits when compared to males (P = 0.003), while considering social class, people belonging to the upper-middle class were 0.24 times more likely to avail dental services when compared to a lower social class (P = 0.015). Participants of 5 years, 12 years, and 15 years were more likely to utilize dental services with odds 13.61, 1.78, and 3.41, respectively, when compared to participants belonging to higher age groups that are 65–74 years [Table 6].
|Table 6: Binomial logistic regression between health-care-seeking behavior and independent variables|
Click here to view
| Discussion|| |
The development of the questionnaire is one of the prime requisites to draw authoritative conclusions. To generate evidence on oral health-care-seeking behavior of the public, an instrument that reflects the inner essence of the public being studied requires meticulous construction without which comprehension of the health-seeking behavior cannot be achieved. At first, investigators need to be given support materials, for example, texts, and other information relevant for their part in producing instruments, including information on the target audience and administrative mode.
Following the methodological way, an instrument was developed to assess the oral health-care-seeking behavior of 200 participants among WHO-recommended index age groups in the field practice area. The developed schedule was then subjected to participants who revealed that 26% exercised oral health care.
In spite of the presence of the dental institution in the area of the study, the oral health-seeking behavior was found to be very low and the results are not conclusive with the other studies done.,,,
Regardless of so many dental colleges in India and mass of graduating dentist every year, researchers have reported that heaps of barriers in seeking dental care services were confronted by consumers with the factors such as presence or absence of dental symptoms, poverty, geographical region, social status, religion, race or ethnicity, occupation, income, marital status, and community type.
Participants who sought care from private dental clinics (16%) were in agreement with the study done by Bommireddy VS et al. (2017), whereas in another study done by Nirma R et al. (2014), most of the participants sought care from dental college. However, none of the studies documented the validity and reliability of the schedule. The reason for consulting private dental clinics as the choice could be due to mushrooming of the private dental clinics in and around the city even to the nearest villages located next to city limits in the peri-urban area resulting in the provision of accessibility and might also due to the fact that they provide quick treatments when compared to dental colleges and government clinics. Typically, dental procedures are complex, multiple visits are required to complete them, and even appointments may take longer because dental colleges only operate during the weekdays resulting in missing a day at work and may lose one day's pay. Besides government clinics do not provide a wide variety of services limiting the utilization of dental services.
The reason for not exploiting health-care facilities by lower SES population maybe that experiencing budgetary, social and material burdens that bargain their capacity to bear the expenses of dental services and benefits to live in salubrious condition; furthermore, low financial status people have more fatalistic notions about their well-being and have a lower perceived need for care, leading to less self-care and lower usage of preventive health services. People high in dental anxiety usually stay away from consistent dental care and avoid dental care in the case of dental emergencies.
There is a lack of oral health awareness, which affects oral health perception, behavior, and practices among all age groups. Most of the participants in the present study are females (64%), who are engaged in agriculture besides executing the household responsibilities that may restrict them to spend more time in the quest of seeking oral health care. For long-term ailments, rural Indian women are three times more inclined to abandon treatment than rural Indian men, an inclination saw even among the nonpoor. Furthermore, the treatment costs are altogether lower for women than men. To enhance steady dental attendance, the barriers must be controlled by proper education and intervention.
The main barrier for oral health-seeking behavior in the present study was negligence towards oral health which was in accordance with the study done by Bommireddy VS et al. (2017), whereas high cost and unaffordability is the main barrier for dental health-seeking resulted in the studies done by Pradeep Y et al. (2016), Bhaskar BV et al. (2016), Gupta S et al. (2014), Malhi R et al. (2015). The negligence towards care seeking in this study could be because of poor attitude and lack of knowledge toward dental problems suggesting awareness programmes to the parents as responsibility of child's oral health depends on parents attitude.
The present study emphasizes the importance of oral health care seeking behavior, which indicates the general population's need for community involvement and coordination to improve their oral health.
Despite the fact that the major proportion of studies conducted in dental research are questionnaire studies where development of inventory was often neglected which may results in erroneous conclusion. Therefore, this study was done to attenuate the specious results in generating evidence through community consultations regarding oral health-seeking behavior in the field practice area.
| Conclusion|| |
Community consultations conducted have revealed inadequate use of dental services among the field practice area where private clinics were used more relatively compared to teaching dental college and government clinics. The main reason for the last dental visit was carious teeth without pain, while negligence toward dental problems was found to be the common barrier for oral health care. Development of inventory in this study has culminated the significance of qualitative research methods such as observing human behavior, conversing with people about their beliefs or actions, and views to access areas that are generally not amenable to conventional questionnaires.
Public health significance
This study bestowed sufficient evidence on significant barriers in accessing health-care services and highlights the importance of inventory development and also the prerequisite of effective awareness programs to increase health-seeking behavior in the field practice area.
| Recommendations|| |
- Changing the perception toward oral health, undertaking an effective program to build science transfer, increasing the workforce by strengthening the safety net system, and successfully partnering in all levels of society can bring healthy life
- Dental institutions should train their workforce and increase their competencies in such a way that they could provide better and faster treatments on par with private establishments
- Insight should be given to inventory framing as most of the studies done in the research are questionnaire based.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Maniyar R, Umashankar GK. Knowledge and attitude towards dental insurance and utilization of dental services among insured and uninsured patients: A cross-sectional study. J Oral Res Rev 2018;10:1-6. [Full text]
Shaik R, Nagarjuna P, Shaik S, Nagarjuna, Shaik S, Praveen S, et al
. Utilization of dental health care services and its barriers among the white-collar port workers in Nellore, India – A cross-sectional questionnaire study. Int J Curr Res 2018;10:65603-7.
Umashankar GK, Vanishree MK, Benjamin N. Gender based inequality and use of oral health care services in Bangalore city. SM Prev Med Public Health 2019;3:1027.
Nagarjuna P, Reddy VC, Sudhir KM, 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. [Full text]
Bhatt S, Rajesh GR, Rao A, Shenoy R, Pai MB, Nayak V. Factors influencing oral health and utilization of oral health care in an Indian fishing community, Mangaluru city, India. World J Dent 2017;8:321-6.
Hankivsky O, Vorobyova A, Salnykova A, Rouhani S. The importance of community consultations for generating evidence for health reform in Ukraine. Int J Health Policy Manag 2017;6:135-45.
Zamanzadeh V, Ghahramanian A, Rassouli M, Abbaszadeh A, Alavi-Majd H, Nikanfar AR. Design and implementation content validity study: Development of an instrument for measuring patient-centered communication. J Caring Sci 2015;4:165-78.
Singh T, Sharma S, Nagesh S. Socio-economic status scales updated for 2017. Int J Res Med Sci 2017;5:3264-7.
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, 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. [Full text]
Bommireddy VS, Pachava S, Ravoori S, Sanikommu S, Talluri D, Vinnakota NR. Socio-economic status, needs, and utilization of dental services among rural adults in a primary health center area in Southern India. J Int Oral Health 2014;6:56-60.
Kakade SP, Hegde-Shetiya S, Shirahatti RV, Agrawal D, Mahuli A, Mittal-Mahuli S. Dental care utilization pattern and barriers encountered toward seeking oral health care services among the residents of Nimbut village, Maharashtra, India. J Dent Res Rev 2017;4:63-6. [Full text]
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.
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. [Full text]
Nirma R, Naveen R, Sanajay J, Mathew T, Roshan U. Knowledge, attitudes towards prosthodontics rehabilitation and utilization of dental services among Songadh and Amargadh population. J Dent Med Med Sci 2014;4:1-6.
Narang R, Mittal L, Jha K, Anamika, Roseka. Caries experience and its relationship with parent's education, occupation and socio economic status of the family among 3-6 years old preschool children of Sri Ganganagar City, India. Open J Dent Oral Med 2013;1:1-4.
Skaret E, Berg E, Kvale G, Raadal M. Psychological characteristics of Norwegian adolescents reporting no likelihood of visiting a dentist in a situation with toothache. Int J Paediatr Dent 2007;17:430-8.
Iyer A, Sen G, George A. The dynamics of gender and class in access to health care: Evidence from rural Karnataka, India. Int J Health Serv 2007;37:537-54.
Pradeep Y, Chakravarty KK, Simhadri K, Ghenam A, Naidu GM, Vundavalli S. Gaps in need, demand, and effective demand for dental care utilization among residents of Krishna district, Andhra Pradesh, India. J Int Soc Prev Community Dent 2016;6 Suppl 2:S116-21.
Bhaskar BV, Janakiram C, Joseph J. Access to dental care among differently-abled children in Kochi. J Indian Assoc Public Health Dent 2016;14:29-34. [Full text]
Malhi R, Basavaraj P, Singla A, Jankiram C, Pandita V, Vashishtha V. Perceived barriers in accessing dental care among patients attending dental institute using decision-making trial and evaluation laboratory method. J Indian Assoc Public Health Dent 2015;13:152-7. [Full text]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]