|Ahead of print publication
Utilization of dental health-care services by accredited social health activist and anganwadi workers in lucknow district: A cross-sectional study
Dyashwari Devi Khoisnam1, L Vamsi Krishna Reddy2, Pooja M Sinha1, BS Goutham1, Sonali Saha3
1 Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Public Health Dentistry, Anil Neerukonda Institute of Dental Sciences, Visakhapatnam, Andhra Pradesh, India
3 Department of Pediatric and Preventive Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
|Date of Submission||09-Sep-2021|
|Date of Acceptance||01-Apr-2022|
|Date of Web Publication||17-Jun-2022|
Dyashwari Devi Khoisnam,
Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Background: Accredited Social Health Activists (ASHAs) and Anganwadi workers are grassroots-level health activists who are involved in health education and community mobilization and form a bond between the community and the primary health-care delivery system in India. The cross-sectional study was conducted to assess the dental health-care utilization and to estimate the dentition and periodontal status of ASHA and Anganwadi workers. Materials and Methods: The study was conducted at the primary health centers and subcenters of Lucknow District. ASHA and Anganwadi workers presented on the day of the examination were included in the study. The study pro forma was used to record demographic details and dental utilization. Dentition status and periodontal status were used to record dental caries and periodontal status using the World Health Organization Oral Health Assessment Form 2013. Data were analyzed using the SPSS version 21; descriptive statistics, Chi-square test, and regression analysis were used to assess factors related to health-care utilization and P < 0.005 was considered statistically significant. Results: The final study sample comprised 500 health-care workers (220 ASHA and 280 Anganwadi workers). Among the study population, 30% utilized dental services and was found to be statistically significant with age, occupation, and oral findings. However, 56.0% had both dental caries and periodontal diseases followed by dental caries‒32.0%, periodontal disease‒8.0%. There was a significant difference (P < 0.005) in the proportion of dental care utilization and oral diseases among participants. Conclusions: The dental care utilization was found to be short and is not comparative to the diseases among participants.
Keywords: Dental health care, health-care workers, utilization
|How to cite this URL:|
Khoisnam DD, Reddy L V, Sinha PM, Goutham B S, Saha S. Utilization of dental health-care services by accredited social health activist and anganwadi workers in lucknow district: A cross-sectional study. J Indian Assoc Public Health Dent [Epub ahead of print] [cited 2022 Aug 12]. Available from: https://www.jiaphd.org/preprintarticle.asp?id=347727
| Introduction|| |
Oral health is a critical but overlooked component of overall health and well-being among children and adults. Dental conditions may affect the person's well-being and overall quality of life if being untreated. Regular home oral care and a yearly dental checkup are the best means of saving one's teeth.
Dental service is an annual number of dental visits per person or reported first dental visit within a series of visits or lack of dental visits within a specific period. Further, an annual number of dental visits per person, proportion of people visiting a dentist within a year, reported a first dental visit in a series of visits, lack of dental visits within a specific period, aggregated expenditures for dental visits, and routine versus emergency care are some of the parameters that can be considered for dental service utilization.
Oral diseases created a burden on public health in India; among them, 60%–65% of the populations are affected by dental caries and 50%–90% by periodontal diseases. According to research, higher rates of dental diseases occur in rural areas.
Primary health centers (PHC) set up the first point of interaction among the rural community. Oral health-care services in rural areas are inadequate even though India has a strong system of PHC and subcenters.
Accredited Social Health Activists (ASHAs) were chosen as part of a plan to develop infrastructure and strengthen personnel, and they are involved in the preparation and implementation of the village health plan with Anganwadi workers. Anganwadi worker is a community-based volunteer frontline worker. ASHAs and Anganwadi workers are the grassroots level and the community-based voluntary frontline health activists in the community who are involved in health education and community mobilization toward the utilization of the health services. They act as a bridge between the community and the available healthcare system and help them in accessing health-related services available at the Anganwadi, subcenter, and PHCs., Thus, these ASHA and Anganwadi workers might play a key role in areas where there is a deficiency of the dental workforce in providing oral health education.
Dental care utilization indicates the preventive care-seeking behavior of an individual. However, there is no sufficient evidence about dental care utilization among ASHA and Anganwadi workers. Hence, this study was conducted to assess the dental care utilization among ASHA and Anganwadi workers of Lucknow city.
| Materials and Methods|| |
A cross-sectional study was done among ASHA workers and Anganwadi workers visiting the PHCs and subcenters in Lucknow district from November 2019 to April 2020. The study was approved by the Institutional Ethics Committee. The permission was obtained from the Administrative Medical Officers before the start of the study. The study sample included all the ASHA and Anganwadi workers who attended the center on specific days aged 20–59 years and the participants who gave informed consent.
The study excluded those who were anxious and uncooperative were excluded. The sample size was calculated as 500 health-care workers (220 ASHA and 280 Anganwadi workers).
Multistage cluster sampling methodology was followed. Lucknow district is divided into five zones. From every five zones, two PHCs and two subcenters were randomly selected and ASHA and Anganwadi workers aged 20–59 years were selected by a simple random sampling technique.
A self-administered, anonymous questionnaire prepared in a local language was used to collect demographic details such as age, occupation, oral hygiene practices, previous dental visits, and the reasons for not utilizing dental treatment services. Oral clinical examinations included dentition status and periodontal status (consumer price index modified) were recorded to assess dental caries and periodontal status using the World Health Organization (WHO) Oral Health Assessment Form for Adult, 2013. Two investigators received training in conducting oral examinations and recording the research pro forma in the local language. For the oral examination, the interexaminer reliability ranged from 0.82 to 0.86. The information was gathered by a face-to-face interview, and an oral health examination was performed in natural light using a mouth mirror and a WHO probe.
Data were entered and analyzed using the software program IBM SPSS Statistics Windows, Version 21.0 Armonk, NY: IBM Corp. Descriptive statistics, Chi-square tests, and regression analysis were used to assess factors related to dental care utilization. A P < 0.05 was considered statistically significant.
| Results|| |
The study population comprises a total of 500 primary health-care workers. ASHA workers were 220 (44%) and Anganwadi workers were 280 (56%). The majority of the respondent was aged between 30 and 39 (46.0%) followed by 20–29 years (24.0%). Oral diseases were seen among 480 (96%) participants where ASHA workers were 210 (95.4%), whereas Anganwadi workers were 270 (96.4%) [Table 1].
|Table 1: Distribution of study participants according to age, occupation, and oral findings|
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Of the respondent, 110 (22%) had discomfort or pain during the past 12 months and 50 (10.0%) visited a dentist in <6 months, whereas 260 (28.0%) had visited the dentist in more than a year [Table 2].
The association between the occupation and the oral diseases of the study population is shown in [Table 3]. It was shown that the majority the dental care utilization was significantly more in Anganwadi workers (35.7%) as compared to that among ASHA workers (22.7%). However, among the oral findings, dental care utilization was higher among those who had periodontal diseases (75%) and is statistically significant with a P < 0.001.
|Table 3: Utilization of dental health-care services among the study participants|
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[Table 4] explains the reasons for the nonutilization of dental health-care services among the study participants. The majority of the study participants 220 (44%) had the reasons “not needed unless pain,” 180 (36%) of the study participants felt that “anticipation of the painful experience, and 130 (26.0%) felt that “anticipation of the expensive dental charges” with a statistically significant P < 0.001. Among the study participants, 180 (36%) of the study participants felt that “lack of time” and 150 (30.0%) felt that “long distance to the hospital” are one of the reasons for nonutilization of the dental services which is statistically nonsignificant and only 60 (12.0) felt the reason for nonutilization of the dental health-care services is “failure of the previous treatment” statistically nonsignificant with P = 0.334.
[Table 5] shows the regression analysis of the utilization and nonutilization of dental health-care services. The independent variables such as age, occupation, oral diseases, and lack of dental visits had a statistically significant association with dependent variables such as reasons nonutilization of dental health-care services (P < 0.05). Hence, dependent variables have a high risk and negative impact on oral diseases.
|Table 5: Regression analysis of factors utilization and reasons for nonutilization of dental health-care services among the study participants|
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| Discussion|| |
Numerous challenges were tackled by the rural population in the supply of oral health-care services. The factors affecting utilization of health-care services include deficiency of workforce, poor accessibility, affordability, and availability and need of the population toward services. The most feasible and sustainable method to achieve good oral health in the community is through the integration of oral health care into the existing primary health-care activities, through the training of community-level workers.
ASHA and Anganwadi workers have access and form a strong link between the rural community and the health-care delivery system and this study estimated the oral health-care utilization among this group.
Some previous studies of health-care workers have also reported a tendency toward being symptom-oriented in the utilization of oral health services. Regular dental checkup visits are vitally important to prevent dental problems and provide an opportunity to take clinical preventive measures and reinforce healthy home dental care.
In the present study, about 10.0% of the study participants had dental visits <6 months and 52.0% had dental visits for more than a year. The main reason for the dental visit seems to be either discomfort or pain. This supports the fact that dental visits are usually motivated by pain and the need for emergency treatment as reported by a study. Studies have also reported that a major factor for the underutilization of dental services is a low level of dental awareness, and this may be accountable for the late appearance of patients looking for treatment only when in pain or discomfort, thereby increasing the probability of receiving treatment.,
The findings of our study showed that dental care utilization was low (30.0%) among participants. This finding is similar to the studies conducted on ASHA and Anganwadi workers in Chintamani Taluk, Karnataka, with a utilization rate of 28.3% and also similar to the other studies conducted in the adult population in China with a utilization rate of 20%, 28% in Bengaluru, India, and Spain 34.3%.,, The reason for visiting a dentist reported in most studies is dental pain.,,, In contrast, dental service utilization is high in a study (67%) In contrast, dental service utilization is high (67%) in a study conducted by Poudyal S et al (2010), and developed countries like Denmark (61%) and Findland (56%). Health insurance that covers dental services in these countries can be speculated for the high utilization, which is nonexistent in India.
In the present study, dental care utilization was seen more in Anganwadi workers 37.7% than the ASHA workers 22.7%; dental care utilization is only 30% among the study population with oral diseases which is very low, whereas 96.0% of the study population had the oral findings. It shows that the study participants lack awareness about oral health and also shows the difference between dental need and utilization.
The majority of the study participants had shown that “not needed unless pain” is the most common reason for nonutilization of dental health-care services 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. Hence, there is a need for increasing awareness and encouraging more positive attitudes toward oral health in the same population.
Anticipation of painful experiences was another factor for not visiting the dentist in the present study. Anticipation of expensive dental charges was also reported by the patients in this study, which is similar to other studies., It is important to remove the barrier of the high cost of health care by conducting free health camps, which have shown to be effective in screening for diseases and for providing preventive care.
The primary health-care workers, as well as health-care professionals, are responsible for behavioral change in the rural population's health care. People trust ASHA and Anganwadi personnel because they are from the same community. This is an opportunity for them to show their beneficiaries how to use urgent dental treatment.
The WHO has advocated that basic oral health-care services be integrated into the existing primary health-care system to help poor and disadvantaged populations, which could be useful in the Indian context where there is a shortage of dentists.,,, ASHA and Anganwadi workers have a role in raising oral health awareness, increasing dental care utilization, and instilling healthy habits in the rural population. If suitable training is provided, they might be empowered to become oral health educators. They must also be educated on basic oral care methods such as proper tooth brushing, use of fluoridated toothpaste, and mouthrinsing after meals, as well as the effects of the type and frequency of sweets consumed, to provide oral health-care services and perform functions such as identifying disease conditions, educating parents about oral health diets, and educating pregnant women about the oral changes during pregnancy and provide information about the oral hygiene aids and brushing technique to the rural people.
| Conclusions|| |
Merely 30% of the ASHA and Anganwadi workers had utilized dental health-care services. Two-third of the participants had not utilized the services. Dental care utilization is not proportionate with the oral diseases found in the study group. Thus, it is important to create good oral health behavior and awareness among the ASHA and Anganwadi workers so that they have a favorable attitude to educate the community and contribute to oral disease prevention.
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], [Table 5]