|Year : 2020 | Volume
| Issue : 4 | Page : 302-307
Access and dental health service utilization by children of government schools in Bangalore, India: A parent perspective
Vinod Kumar A1, Romshi Raina2, Ranjini Narayanaswamy3, Varsha K Pavithran4
1 Department of Public Health Dentistry, Royal Dental College, Palakkad, Kerala, India
2 Department of Public Health Dentistry, Government Dental College and Hospital, Srinagar, Jammu and Kashmir, India
3 Department of General Dentistry, Leena Multispecialty Hospital, Bengaluru, Karnataka, India
4 Department of Public Health Dentistry, Rajah Muthiah Dental College and Hospital, Annamalai University, Chidambaram, Tamil Nadu, India
|Date of Submission||15-Jan-2020|
|Date of Decision||13-Mar-2020|
|Date of Acceptance||28-Nov-2020|
|Date of Web Publication||16-Dec-2020|
Department of Public Health Dentistry, Government Dental College and Hospital, Srinagar, Jammu and Kashmir
Source of Support: None, Conflict of Interest: None
Background: Access to oral health care refers to patient's ability to utilize oral health care. The availability of oral health services is very scarce in rural India; therefore, the unmet treatment needs of rural population are very high. Aim: We aimed to determine the dental service utilization and factors affecting the same among the 6–12-year-old government schoolchildren in Bangalore South-1, Karnataka, India. Methodology: In-depth interviews regarding access, utilization of dental services, and factors affecting them were conducted with 1080 parents/guardians of 6–12-year-old government schoolchildren from Bangalore South-1 in this cross-sectional analytical study. Chi-square test and multiple logistic regression analysis were used for data analysis using SPSS version 20.0 (IBM Corp. Ltd.). Statistical significance was set at P < 0.05. Results: The most common ailment reported by parents was gum problem (17.5%). Only 7.80% of the parents visited dental facility in the past 12 months. Majority of the parents (62.1%) had access to private dental health services. The barriers to utilization of dental services majorly included financial constraints (45.19%) and parent's unawareness of the oral health-care facilities nearby (21.84%). Multiple regression analyses showed that the head of the household with middle school education and high school education (odds ratio = 1.55; 1.74) had a higher probability of having visited a dentist in the past 1 year. Conclusion: Dental service utilization rate was very low in the past 12 months. Relief from pain was the sole reason for visiting a dentist. Oral health-promoting programs and provision of government hospitals are required for increased utilization of dental services so as to improve the dental attitude, accessibility, and affordability and overcome the barriers among the parents.
Keywords: Dental health service utilization, oral health needs, parental attitude, rural India, schoolchildren, sociodemographic variables
|How to cite this article:|
Kumar A V, Raina R, Narayanaswamy R, Pavithran VK. Access and dental health service utilization by children of government schools in Bangalore, India: A parent perspective. J Indian Assoc Public Health Dent 2020;18:302-7
|How to cite this URL:|
Kumar A V, Raina R, Narayanaswamy R, Pavithran VK. Access and dental health service utilization by children of government schools in Bangalore, India: A parent perspective. J Indian Assoc Public Health Dent [serial online] 2020 [cited 2021 Nov 28];18:302-7. Available from: https://www.jiaphd.org/text.asp?2020/18/4/302/303642
| Introduction|| |
Health is the basic human need for all the cultural groups. General health cannot be attained without oral health. Oral diseases are considered as major public health problems owing to their high prevalence and incidence. The greatest burden of oral diseases is on disadvantaged and socially marginalized populations. In addition, the low utilization of health services adds to this serious public health problem.
Oral health is not equally available to all segments of society, and those who need care the most are often the least likely to receive it. It has been reported that children from low socioeconomic backgrounds have more untreated dental caries than those of high socioeconomic backgrounds and the prevalence of untreated dental caries has been reported to be a measure of access and utilization of dental care.,,
In India, children form about 38% to 40% of its 1090 million total population and 85% of them have high levels of dental disease. Dental diseases if left untreated have a profound impact on the quality of life of the children. These children suffer from pain and, in turn, lose their school time.
Utilization of health care is the actual attendance by the members of the public at health-care facilities to receive care. Utilization, which measures the number of visits per year or the number of people with at least one visit during the previous year, serves as an important tool for oral health policy decision-making.
Barriers to care such as lack of affordability, lack of public funding for specialized services, difficulties accessing the dental care, and lack of availability of appropriate care have led many low-income people, especially children to not receive preventive dental care or treatment for an oral health problem until an infection or other urgent conditions develop.
Parents usually are the primary decision-makers on matters affecting their children's health and health care. Considering parents' central role in ensuring the well-being of young children, their perceptions about their children's oral health is important. These perceptions can affect the preventive dental care children who receive at home and their use of professional dental services.
Understanding factors associated with parents' perceptions about their children's oral health and dental service utilization can contribute to increased access to care and subsequent improvement in oral health status. With this background, a study was undertaken to determine the dental service utilization and factors affecting dental service utilization among the 6–12-year-old government schoolchildren in Bangalore South-1, Karnataka, India
| Methodology|| |
The study was conducted from March to June 2018 in Bangalore, the capital city of Karnataka, India. The primary education is provided mainly through government and private schools. The government primary schools are of two types: government school and government-aided school which is private but aided by the government. For administrative convenience, the schools in Bangalore district are divided into North and South zones. Each zone is again divided into four subdivisions as North 1, 2, 3, and 4 and South 1, 2, 3, and Anekal subdivision.
Study design and study population
A cross-sectional study was conducted among the parents/guardians of 6–12-year-old schoolchildren enrolled in primary and higher primary government schools of Bangalore South-1. Parents/guardians who gave consent to participate in the study were included in the research.
Using the below sample size formula, a total of 1080 subjects were selected using a simple random sampling procedure.
n= (Z2× [p] × [1−p])/C2
Z = Z value for the confidence level chosen (e.g., 1.96 for 95% confidence level).
p = percentage having a particular disease/problem and is expressed as a percentage (generally, it is taken as 0.5).
C = Confidence interval, expressed as a decimal (generally 0.5, i.e., ± 0.5).
The list of schools was obtained from the South-1 Education Board. Schools from the South-1 block were randomly selected using a simple random lottery method. The ethical clearance was obtained from the institutional ethical committee. Official permission was also obtained from the Board Education Officer of Bangalore South-1 and Board Regional Officer of primary education, Bangalore South-1. Informed consent from each parent/guardian was taken after explaining the nature of the study.
After obtaining permission from the school authorities, notices were sent to the parents/guardians of children to participate in the study. Bilingual (Kannada and English) interviewers conducted the interviews in the language preferred by the parent/guardian.
The data were collected using a specially designed and validated pretested pro forma to obtain data regarding utilization of dental health services and associated factors which consisted of sociodemographic characteristics, utilization of dental services, parental attitude, and barriers for utilizing oral health care. Pro forma was initially written in English, then translated into Kannada, and finally back translated into English.
The internal validity of the questionnaire was tested by conducting the pilot survey among 60 parents, and the Cronbach's alpha was found to be 0.88 (good internal consistency).
The data were entered into the computer (MS Office, Excel) and were subjected to statistical analysis using the statistical package IBM SPSS Statistics for Windows, Version 20 (IBM Corp., Armonk, N.Y., USA).
From the collected data, the frequency and percentages were calculated. The descriptive statistics of the key variables were reported. Bivariate association between each potential predictor variables and dental care visits was assessed using Chi-squared analyses. To estimate the degree to which sociodemographic and other variables predicted a dental visit in the past year, we used multiple logistic regression analysis. Nonautomated backward elimination was used to select variables, with the criterion for removal being 0.05 significance on the Chi-square test, and adjusted odds ratios (OR) and 95% confidence interval were calculated. P < 0.05 was considered as statistically significant.
| Results|| |
Among total population (n = 1080), 960 (88.9%) were Hindus, 117 (10.8%) were Muslims, and 3 (0.3%) were Christians; among them, 871 (80.6%) were residing in urban areas, 125 (11.6%) were residing in peri-urban areas, and 84 (7.8%) were residing in rural area.
According to Kuppuswamy's socioeconomic status (SES) scale, 2017, majority of the study subjects had males as a head of their house (n = 993, 91.9%) and few had female heads (n = 87, 8.1%). About 31.4% of the household heads were illiterate and merely 16.7% had completed their high school. 55.34% of the heads were clerical/shop owner/farmer, however, 6.96% were unemployed. According to monthly income of the head of the household, 121 (11.2%), 390 (36.1%), 566 (52.4%), and 3 (0.3%) were earning Rs. <2101, Rs. 2102–6297, Rs. 6298–10495, and Rs.10496–15705, respectively. 84.2% of the families belonged to the upper-middle class, while 0.2% belonged to the upper class in the Kuppuswamy's SES scale.
17.5% of the study population reported that their children suffered from teeth or gum problems in the past 1 year. Only 7.80% of the parents/guardians reported dental visit in the past 12 months. Among those who visited the dentist in the past 12 months (n= 84), it was observed that 81 (7.5%) got their children's teeth filled, extracted, or cleaned, 2 (0.2%) got just general check-up, and only 1 (0.1%) got preventive treatment (pit and fissure sealant application) for their children. Almost 62.1% had access to private practitioner/private dental health services, however, only 2.4% had access to government hospital facilities, 6.9% had no access to facilities, while 28.5% were unaware about the availability of dental health services in their area [Table 1].
The barriers to utilization of dental services majorly included financial constraints (45.19%) and unawareness of the parents/guardians of the oral health-care facilities nearby (21.84%) [Figure 1].
Majority of the parents/guardians reported that it is important to keep their children's teeth in good condition (93.9%). However, only 41.3% of the parents/guardians had ever examined their children's teeth for good oral health [Figure 2].
In bivariate analysis, it was observed that among the independent variables tested in the present study, only SES of the study subjects was significantly associated with the dependent outcome variable. The study subjects belonging to higher SES reported increased utilization of the dental services in the past 1 year [Table 2].
Multiple regression analyses were performed to identify significant factors for each outcome measure when the independent variables were adjusted. The examination of the child's teeth by the parent did not turn out to be a significant factor in influencing the visiting of a dentist (P > 0.05). However, those who did not examine the child's oral health had an OR = 1.11, indicating that there was a higher probability of having visited a dentist in the past 1 year. Even though the education of the head of the household was not a significant factor in influencing the number of times they visited a dentist in the past 1 year (P > 0.05), the head of the household with middle school education (OR = 1.55) and high school education (OR = 1.74) had an OR of >1, indicating that they had the higher probability of having visited a dentist in the past 1 year. The ethnicity of the study subjects was also not a significant factor in influencing the dental visit in the past 1 year, but the Muslims and the Christians visited more (OR = 1.37) than the Hindus [Table 3].
| Discussion|| |
The utilization of health-care services depends on health attitudes, social structure, and social demographic factors along with affordability and accessibility and the need for the use of services. The study of these factors helps us to understand the problem of inadequate utilization of dental care for some segments of the population, especially in a rural region.
In the present study, the majority of the study subjects belong to upper-middle-class SES (84.2%) (Kuppuswamy's SES classification, 2017), residing in an urban area (80.6%), and they were Hindus (88.9%).
In this study, majority of the parents/guardians did not utilize the dental services (92.2%). Few studies documenting the parent perspective regarding dental health services utilization are available. Some of the closest framework studies were conducted by Kim and Telleen, and Dania et al., Observation of these studies was similar to the present study which showed very less oral health-care utilization by parents.
Affordability to the cost of dental service provided was the most important discouraging factors for utilization of dental services. Since majority of the participants in the present study were from lower socioeconomic strata, high cost of dental care was the most discouraging factor for utilizing the dental services and similar results were echoed in the studies conducted by Kim and Telleen, Dania et al., Al Johara and Al-Hussyeen, Priyadarshini et al., and Onyejaka et al.,,,,, The second major answer given was “I am not aware about the dentist and dental treatments,” which shows the level of ignorance of study subject's parents about the oral health care. Few of them also said that “Fear to show their child to a dentist was the reason for not visiting dentist in the past year.” The results are in accordance with a study done by Harikiran et al., where the participants gave a similar answer for their irregular visit.
17.5% of the study subjects perceived that their children were suffering from oral health problems for which they needed dental health services; among them, only 7.8% visited the dentist and got curative treatments done. This result is in contrast with a study done by Vargas and Ronzio, where children with normative needs (defined by the presence of untreated caries diagnosed by a dentist) were less likely to be the regular users.
In the bivariate analysis, only SES of the study subjects was the major factor associated with utilization of dental services.
The multiple logistic regression analysis showed that the higher educational level of the head of the household (OR = 1.74, P = 0.143) and parents who examined their child's teeth frequently (OR = 1.11, P = 0.709) had a higher probability of visiting their dentist. Similar results are seen in the studies conducted by Hayward et al., Jimenez, Isong and Weintraub, and Tapias-Ledesma et al., which showed that the dental health service utilization was more in children having parents/guardian with higher education, but different results were reported by Medina-Solís, which showed that the children having dental health facilities nearby were utilizing more compare to who have far away from their residence.,,,, With regard to parental attitudes toward child's oral health, the findings were similar to the findings of Medina-Solís in which parents having positive attitude were visiting more times to dentist.
Interestingly, in the present study, the subjects who belonged to the lower socioeconomic strata utilized dental services more (OR = 1.03, P = 1.00) as compared to the rest of the subjects. In contrast, studies conducted by Scott et al., Isong and Weintraub, and Medina-Solís reported that subjects of higher SES utilize more dental health services than lower socioeconomic strata.,, This finding could be because the majority of the study subjects belonged to lower socioeconomic strata.
While the present study has provided some important information on factors affecting the utilization of dental services, it has some limitations. Some utilization determinants – such as dental insurance coverage and dental visits – were limited in breadth and detail. The present study was unable to determine if a visit was made for emergency problem or for need purpose. Therefore, a report of a visit to the dentist in the past year could mean that the respondent had either good preventive practices or an acute problem. The present study was unable to differentiate between these two. The study also did not assess the satisfaction level with the dental service utilization, quality of care as a predictor of utilization of dental health services, and influence of dentist–patient interaction on utilization. Further studies should include these aspects into consideration and explore more factors affecting the utilization of dental services in this population in depth.
| Conclusion|| |
In the present study, the dental service utilization rate (8%) was very low in the past 12 months. Relief from pain was the sole reason for visiting a dentist. Majority of the subjects utilized curative treatment, such as restorations and extractions. Oral health-promoting programs and provision of government hospitals are required for increased utilization of dental services so as to improve the dental attitude, accessibility, and affordability and overcome the barriers among the parents.
The authors thank all the parents/guardians and school authorities for taking part in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ajayi DM, Arigbede AO. Barriers to oral health care utilization in Ibadan, South West Nigeria. Afr Health Sci 2012;12:507-13.
Edelstein BL. Disparities in oral health and access to care: Findings of national surveys. Ambul Pediatr 2002;2:141-7.
Dental Council of India. National Oral Health Survey and Fluoride Mapping. New Delhi: Dental Council of India; 2003. p. 101-21.
Isong U, Weintraub JA. Determinants of dental service utilization among 2 to11-year-old California children. J Public Health Dent 2005;65:137-45.
Tapias-Ledesma MA, Jiménez R, Carrasco Garrido P, Gil de Miguel A. Influence of sociodemographic variables on dental service utilization and oral health among the children included in the year 2001 Spanish National Health Survey. J Public Health Dent 2005;65:215-20.
Lal S, Paul D, Vashisht BM. National oral health care programmes (NOHCP) implementations strategies. Indian J Community Med 2004;29:3-10. [Full text]
Manski RJ, Moeller JF, Maas WR. Dental services. An analysis of utilization over 20 years. J Am Dent Assoc 2001;132:655-64.
El-Yousfi S, Jones K, White S, Marshman Z. A rapid review of barriers to oral healthcare for vulnerable people. Br Dent J 2019;227:143-51.
Talekar BS, Rozier RG, Slade GD, Ennett ST. Parental perceptions of their preschool-aged children's oral health. J Am Dent Assoc 2005;136:364-72.
Tabassum N, Rao RL. An updated Kuppuswamy's socioeconomic status classification for 2017. Int J Health Sci Res 2017;7:365-7.
Guay AH. Access to dental care: Solving the problem for underserved populations. J Am Dent Assoc 2004;135:1599-605.
Kim YO, Telleen S. Predictors of the utilization of oral health services by children of Low-income families in the United States: Beliefs, cost, or Provider? J Korean Acad Nurs 2004;34:1460-6.
Dania E, Agili Al, Bronstein JM, McIntyre MG. Access and utilization of dental services by Alabama Medicaid-enrolled children: A parent perspective. Pediatr Dent 2005;27:414-21.
Al Johara A. Al-Hussyeen. Factors affecting utilization of dental health services and satisfaction among adolescent females in Riyadh City. Saudi Dent J 2010;22:19-25.
Priyadarshini C, Puranik MP, Uma SR. Factors affecting utilization of dental care among 6-12-year-old school children in Bangarpet taluk, Karnataka. J Indian Assoc Public Health Dent 2015;13:410-6. [Full text]
Onyejaka NK, Folayan MO, Folaranmi N. Barriers and facilitators of dental service utilization by children aged 8-11 years in Enugu State, Nigeria. BMC Health Services Res 2016;16:93.
Harikiran AG, Pallavi SK, Sapna H, Ashutosh, Nagesh KS. Oral health-related KAP among 11-to-12-years-old school children in a government-aided missionary school of Bangalore city. Indian J Dent Res 2008;19:236-42.
] [Full text]
Vargas CM, Ronzio CR. Relationship between children's dental needs and dental care utilization: United States, 1988-1994. J Public Health 2002;92:1816-21.
Hayward RA, Meetz HK, Shapiro MF, Freeman HE. Utilization of dental services: 1986 patterns and trends. J Public Health Dent 1989;49:147-52.
Jimenez R. Influence of sociodemographic variables on use of dental services, oral health and oral hygiene among Spanish children. Int Dent J 2004;54:187-92
Medina-Solís CE. Factors influencing the use of dental health services by preschool children in Mexico. Pediatr Dent 2006;28:285-92.
Scott G, Brodeur JM, Olivier M, Benigeri M. Parental factors associated with Regular use of dental services by second-year secondary school students in quebec. J Can Dent Assoc 2002;68:604-8.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]