Journal of theory and practice of dental public health最新文献

Background: Studies on the barriers to preventive dental care for preschool-aged children in Medicaid often focus on whether parents understand the importance of preventive dental care. Fewer studies have examined the perceptions and experiences of parents once their child begins utilizing dental care. This qualitative study of parents who are using preventive dental care for their preschool-aged, Medicaid enrolled children uses parental perceptions and experiences to help us understand the barriers to preventive dental care.

Methods: This qualitative study focused on 41 parents who participated in focus groups designed to uncover barriers and facilitators to preventive dental care use for young children in Medicaid.

Results: Parents of preschool-aged children enrolled in Medicaid face a number of barriers when trying to utilize preventive dental care, even when the parents are experienced with accessing care for their young children. These barriers can be broadly categorized into system-level barriers and provider-level barriers. System-level barriers are related to the low number of dentists who accept Medicaid and/or young children. Provider-level barriers are centered on dentist behavior or clinic environment.

Conclusion: Families of preschool-aged children in Medicaid continue to encounter barriers to preventive care even after the child initially utilizes care, which suggests that access to dental care is an ongoing problem for young Medicaid-enrolled children. Interventions that address system-level and provider-level barriers to care can help to ensure continual access to preventive dental care through childhood for Medicaid-enrolled children.

Background: Although the poor oral health of adults with intellectual and developmental disabilities (IDD) constitutes a significant health disparity in the United States, few interventions to date have produced lasting results. Moreover, there is minimal application of planning models to inform and design a theory-based strategy that has the potential to be effective and sustainable in this population.

Methods: The PRECEDE-PROCEED planning model is being used to design and evaluate an oral health strategy for adults with IDD. The PRECEDE component involves assessing social, epidemiological, behavioral, environmental, educational, and ecological factors that informed the development of an intervention with underlying social cognitive theory assumptions. The PROCEED component consists of pilot-testing and evaluating the implementation of the strategy, its impact on mediators and outcomes of the population under study.

Results: A The PRECEDE assessment and strategy design results are presented including a conceptual framework and oral health strategy that are linked to social cognitive theory and Health Action Process Approach. We have developed a strategy consisting of a planned actions, capacity building, environmental adaptations, and caregiver reinforcement within group homes. The strategy is designed to increase caregiver self-efficacy, outcome expectancies, and behavioral capability, and also to create environmental influences that will lead to improved self-care behavior of the adult with IDD. It is anticipated that this strategy will improve the oral health and quality of life, including respiratory health, of individuals with IDD. The planned PROCEED component of the planning model includes a description of an in-process pilot study to refine the oral health strategy, along with a future randomized controlled clinical trial to demonstrate its effectiveness.

Conclusions: The application of the PRECEDE-PROCEED planning model presented here demonstrates the feasibility of this planning model for developing and evaluating interventions for adults within the IDD population.

Objective: To examine the 13-year trend in annual dental care utilization among the US non-institutionalized civilian population.

Methods: Data from the BRFSS from 1995-2008 for adults' age 18 and older were abstracted and analyzed using the NIDCR/CDC data query system. Point-estimates, confidence-intervals, trends and differences in trends for self-reported annual dental visits by socio-demographic factors and behavioral factor (smoking) were tested with chi-square tests using Stata® (v11).

Results: The overall, median percent of reported dental visits increased marginally (1.3%; p=0.99) from 68.6% (66.2%, 70.9%) in 1995 to 69.9% (69.1%, 71.7%) in 2008. Trend lines remained flat for most age groups except for those aged 65 and older, which showed a steady rise from 58.9% (52.9%, 64.9%) in 1995 to 66.3% (63.9%, 68.7%) in 2008. Disparities in median annual dental visits between non-Hispanic whites and other racial/ethnic groups increased from a range of a 2-7% point difference (1995) to a 7-11% point difference (2008). A higher percentage of women relative to men reported a visit 70.1% (66.9%, 73.2%) vs. 66.6 % (63.8%, 69.3%) in 1995 and 71.2% (69.2%, 73.2%) vs. 67.4% (65.0%, 69.7%) in 2008; trends and differences in trends among gender remained similar over time (4-5%). No meaningful change in reported dental visit by race/ethnicity; income, education or smoking was seen.

Conclusion: Over 13 years, the proportion of persons visiting a dentist has remained relatively constant. Of note is that disparities in dental visits by socio-demographic factors also remained the same over time.