Factors that Influence Utilization of Low Cost Dental Resources for Children
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Student Name
University of California, Irvine
Field Studies, Spring 2008
Factors that Influence Utilization of Low Cost Dental Resources for
Children
General Background Tooth decay (TD):
Most common chronic problem for children in US Number one health problem for children in California
*21,000 children surveyed Dental Health Foundation, 2006
General Background
Tooth decay- easily preventable, but a progressive infection if left untreated
Consequences of untreated TD:Chronic PainLow self-esteemPoor NutritionTooth lossSleep deprivation
Key Terms
Dental resources
Caregivers
Provider
School Health Curriculum
Medicaid & Denti-Cal
Beneficiary
72% of Latino children have a history of TD30% need treatment26% had rampant decay
Nearly twice the rate of non-Latino white children surveyed
General BackgroundPopulation at Risk:
1/3 of low income children have untreated TD vs. the 1/5 of higher income children
40% of children w/ no insurance vs. 21% children w/ private insurance
Dental Health Foundation, 2006
What are the Problems?
California ‘s reimbursement rate for publicly funded dental care are among the lowest in the nation
Less than half of dentists accept Denti-Cal patientsLow service use for those that qualify for Denti-Cal
California HealthCare Foundation, 2007
Purpose of the Study
To investigate the dental resources, particularly those promoted through the elementary schools, available in a community in which low-income families are the minority
To investigate factors that influence caregivers to use or not use these dental resources.
Theory of Planned Behavior
Intention
Attitude
Subjective Norm
Perceived Behavioral Control
Behavior:
Utilizing Dental
Resources
Ajzen, 1991
Review of LiteratureAttitude
Mother Dental Phobia: Caregivers reported dental care
experiences influenced their dental beliefs and behaviors,(Kelly, Binkley, Neace& Gale, 2005, Milgrom, Mancl,
King, Weinstein, Wells & Jeffcott, 1998).
Child Dental Phobia: Caregivers were less likely to have
taken their child to the dental office if their child expressed fear of the dentist,
(Milgrom, Mancl, King, Weinstein, Wells & Jeffcott, 1998).
Education Level: Different levels of education
attainment influence reasons caregivers took the child to the dental office,
(Kelly, Binkley, Neace& Gale, 2005).
Review of Literature
Subjective NormSchool Health Curriculum:
Child health curriculums with a parent component are more effective for the child and can also benefit the parent,
(Gray, Byrd, Crossman, Chromiak, Cheek, & Jackson, 2007, Hopper, Munoz, Gruber & Nguyen, 2005).
Government & Nonprofit dental referrals:
Children in the WIC program are more likely to use preventive and restorative services and are less likely to use emergency services than WIC nonparticipants, (Lee, Gary Rozier, Norton, Kotch & Vann Jr., 2004).
Review of Literature
Perceived Behavioral Control (PBC):Socioeconomic Status (SES)
Low SES families experience competing needs, such as other health issues, inflexible work hours, and distance to providers, which drain already limited resources available for dental care. (Frazier, Jenny, Bagramain, Robinson &Proshek, 1977)
The Role of the ProviderMedicaid patients face lack of providers and have trouble
scheduling appointments at offices that do accept Medicaid (Mofidi, Rozier& King, 2002)
Providers appear to hold condemnatory attitudes toward lower class clients. (Frazier, Jenny, Bagramain, Robinson &Proshek, 1977)
Research Questions
1. What types of dental resources are offered in communities in which low-income families are the minority?
2. What factors influence low-income families to utilize or not utilize these dental resources?
Methodology: Research DesignMixed Methods Study:
Site interactionObserve participant interaction with health curriculumInformal and formal interviews with key informantsSurvey with an open-ended comments section at the end
Triangulation:Multiple site observationsMultiple informant interviews
Site Selection:Guidance Resources, Irvine Unified School District
Selection based on involvement with health curriculum
Methodology: Participants
Participants knowledgeable about the educational resources:6 classes observed:
2 kindergarten classes & 4 first grade classesAbout 19-23 students in each class
4 Teachers interviewed:1 teacher piloted the program & taught 3 yrs3 teachers taught the program for 3 yrs
1 Nurse interviewed:Piloted the program Gives lessons during the GBS
Methodology: Participants
Participants knowledgeable about community dental resources:3 Nurses and 1 health clerk interviewed:
All had 2+ years with the district2 participated at the 2007 free dental health
screening1 involved in School Readiness program
1 Community Dentist interviewed:Has experience with Denti-cal and pediatric
dentistry in the Irvine Community
Methodology: Data Analysis
Extensive review of field notes, RQ’s and theoretical framework
Peer review and evaluation of preliminary findings
Coding, sorting, and recordingHi-lighting, boxing, underlining, and symbolsIdentifying common themes and co-occuring
patternsTallying and Matrix Enumeration used during
classroom observations
Theory of Planned Behavior, revisited
Intention
Attitude
Subjective Norm
Perceived Behavioral Control
Behavior:
Utilizing Dental
Resources
Ajzen, 1991
Findings: Subjective Norm
State RequirementsFree Dental Health Screenings
School Policies Program “There’s so much going home that we try keeping it in the
classroom as much as we can. Student issues are sent home …How many of them get home, I don’t know.” -Mrs. Alison
“I saw only one issue… about puberty and personal hygiene. We had a really interesting discussion about it ….”
Nurse referral “I don’t see that many students come in with tooth aches
during the year, but when they do I take it seriously, and call home.” –Nurse Bev
Findings: Perceived Behavioral Control
Difficulty in Finding a Provider“Medi-cal providing is
hard in this district and town, because there aren’t that many. “Medi-cal only pays a certain amount of money, so dentists and physician say I will take so many Medi-cal patients….” –Nurse Linda
Resident & Coverage Status“But we have a huge
influx of families out of the country, and so they need help a little bit, because they don’t know where to go” -Nurse Bev
“New to the area”, have used them in other areas and want to know what’s available here to use. They’ve been in the system before” –Nurse Reyna
DiscussionAttitude:
Caregiver and child dental phobia: not observedEducation level: confirmed
Subjective Norm:School health curriculum: confirmedGovernment and nonprofit dental referral:
confirmedPerceived Behavioral Control:
SES: not observedThe role of the provider: confirmed
Data collection could not be from direct contact with parents
Did not consistently observe dental lessons
Did not have consecutive observations with the same class of participants
Informant knowledge was limited about parent attitudes and utilization of program
Data collection could not be from direct contact with parents
Dentist was not a Denti-cal provider in the Irvine Community
Informants were only able to provide general comments on parent attitude and utilization of resources
Limitations
ImplicationsTo Practice
Proactively target low-income families through the Irvine Support to Families in Need Task Force
Strengthen GBS parent componentTo Research
Need further research involving direct observation and interview with parents
A follow up research study that can show the effect of: The growing low income population Program implementation
Acknowledgements
Dr. Castellanos
Debra Bianchi
Kim Snodgrass
Nancy Colocino
Teri Skinker
The Class
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