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