race, ethnicity, culture and educational research
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Race, Ethnicity, Culture and Educational Research. Virginia J. Dodd, PhD, MPH. Approach. Race and health Culture and dental care Ethnicity and dental care Race and dental care Oral health and vulnerable populations Oral health disparities Going to the dentist Social value and oral health - PowerPoint PPT PresentationTRANSCRIPT
Race, Ethnicity, Culture and Educational
ResearchVirginia J. Dodd, PhD, MPH
Educational Research Seminar Series 9/27/2013
Approach• Race and health• Culture and dental care• Ethnicity and dental care• Race and dental care• Oral health and vulnerable populations• Oral health disparities• Going to the dentist• Social value and oral health• Dental care and extrinsic motivators• Dental care and intrinsic motivators
Race and Health
1860 1880 1900 1920 1940 1960 1980 2000 2020 20400
1000
2000
3000
4000
5000
6000
7000
1
3329
578054755179
4696430139113770
341830432722
22922242198718171742
157214941345125912701052994
785701601485381344310255276223240276228224179243244247220214205162143113786170392271031213685326211111211111
N = 72,3311873 - 2013
Race and Oral Health
1900 1920 1940 1960 1980 2000 20200
50
100
150
200
250
104
196188
157
121122120123110
1029395
8388
43
7563
7161
4453
313624231914
71414111191065
167
17791012
51194432121
N = 24661921 - 2013
Culture and Dental Care• May 2013
– Understanding Muslim patients: cross-cultural dental hygiene care
• 1967The practice of dentistry in ancient Egypt
N=1322
N = 1322
Culture and Dental Care
1960 1970 1980 1990 2000 2010 20200
10
20
30
40
50
60
70
80
90
36
81
6966
80
73
68
57
6462
55
5054
45
54
45
39
51
2327
32
181916
18
95
1511
69
67875
85544
2111
Summary: Culture and Dental Care• Managing the socially deprived
patient.• Social and attitudinal correlates of
health care among Mexican Americans.
• Pain: anxiety and attitudes in Black, White and Puerto Rican patients.
• The dental patient's cultural response to the need for dental care.
Summary: Culture and Dental Care
• Predictors of multiple tooth loss among socioculturally diverse elderly subjects.
• Transcultural dental training: addressing the oral health care needs of people from culturally diverse backgrounds.
• Cross cultural adaptation of oral health-related quality of life measures.
• A psychosocial approach to dentistry for the underserved: incorporating theory into practice.
• Screening for oral health literacy in an urban dental clinic.
Summary: Culture and Dental Care
N = 1443
Ethnicity and Dental Care• 2013 = 35 publications
– Evaluation of an oral health promotion program at the time of birth on dental caries in 5-year-old children in Vorarlberg, Austria.
• 1966 = 1 publication– Survey of needs for dental care, 1965. II.
Dental needs according to age and sex of patients: Bureau of Economic Research and Statistics.
Ethnicity and Dental Care
1960 1970 1980 1990 2000 2010 20200
10
20
30
40
50
60
70
80
90
100
35
94
83
747576
87
63
74
54
74
585956
45
363841
31333434
24
13
21
12
4
17
1186
976843455
11
2321111
Summary: Ethnicity and Dental Care
• Burden of oral disease among older adults and implications for public health priorities.
• Edentulism trends among middle-aged and older adults in the United States: comparison of five racial/ethnic groups.
Summary: Ethnicity and Dental Care
• A tool for assessing cultural competence training in dental education
• Are survivors who report cancer-related financial problems more likely to forgo or delay medical care?
• Are there differences in dental care access, treatment, or treatment response by ethnicity?
Race and Dental Care
1960 1970 1980 1990 2000 2010 20200
20
40
60
80
100
120
140
1 1 1 3 1 2 513
6 8 5 72
6 6 4 61 4 4
9 9 1010121716
2517
5
25
36
242019
3440
3539
66
47
5648
545454
131
29
N = 985 1964 - 2013
Summary: Race and Dental Care• Early populations were Native
Americans.• Racial similarities and differences in
family dental care patterns.• Variations in use of dental care
facilities by low-income white and black urban populations.
Summary: Race and Dental Care• 1980s Hispanic populations• 1990s “poor and underserved”• 2000 Use of dental care by HIV-
infected medical patients• Rural-urban differences in Medicaid
use
Summary: Race and Dental Care• 2012: Edentulism trends among
adults. • 2013: Social support and dental
visits.– Geographic differences rural vs. urban
“going to the dentist”
N = 1671946-present
1940 1950 1960 1970 1980 1990 2000 2010 20200
2
4
6
8
10
12
14
1 1121 11111
3
12
12
11
7
5
3
6
1
45
9
2
5
7
1
55
1
6
9
5
3
7
3
1211
8
13
Topic Summary: “going to the dentist”
• Much of the research involved children.
• 1979: A two-wave interview study of frequency of dental visits and dental complaints.
• 1978: How are you going to keep dentists down on the farm once they’ve seen Chicago (or New York)?
Topic Summary: “going to the dentist”
• 1990: Assessment of a single item dental anxiety question.
• 1994: Today’s dental student is training for tomorrow’s elderly baby boomer.
• 1997: Dental health attitudes among dentate black and white adults.
Topic Summary: “going to the dentist”
• 2002: Informed consent: optimism or reality?
• 2004: Who is going to treat our edentulous adults?
• 2005: An exploratory study on cultural variations in oral health attitudes, behaviors, and values of first-year dental students.
Topic Summary: “going to the dentist”
• 2005: People with disabilities: how are we going to meet their needs?
• 2006: How did we get here? Where are we going? Hopes and gaps in access to oral health care.
• 2007: The vicious cycle of dental fear: exploring the interplay between oral health, service utilization and dental fear.
Topic Summary: “going to the dentist”
• 2009: Access to care: what are we going to do about it?
• 2011: Thinking about going to the dentist: a Contemplation Ladder to assess dentally-avoidant individuals' readiness to go to a dentist.
Topic Summary: “going to the dentist”
• 2013: What goes around comes around: revisiting the hypothesized vicious cycle of dental fear and avoidance.
• 2013: The oral health of vulnerable older adults and persons with disabilities.
Social Value and Oral Health
0 2 4 6 8 10 12 14 16 18 200
5
10
15
20
25
10
3
17
13 12
20
9 10 10 11
8
13
97
5 4
10
7
N = 2531967 - 2013
Topic Summary: Social Value and Oral Health
• Religious Leaders' Opinions and Guidance Towards Oral Health Maintenance and Promotion: A Qualitative Study.
• Clinical status in adolescents: is its impact on oral health-related quality of life influenced by psychological characteristics?
N = 2531967 - 2013
Topic Summary: Social Value and Oral Health
• Shaping the next generation of 'population oral healthers'.
• Access to oral health services for urban low-income Latino children: social ecological influences.
• How people on social assistance perceive, experience, and improve oral health.
N = 2
Dental Care and Extrinsic Motivators
• 1994– Obstacles to regular dental care related
to extrinsic and intrinsic motivation. (Finland)
• 2012– The impact of intrinsic and extrinsic
factors on the job satisfaction of dentists.
N = 6
Dental Care and Intrinsic Motivators
• 2012– Evaluating the effects of coaching to
improve motivational interviewing skills of dental hygiene students.
• 1992– Intrinsic motivation in dental care.
Oral Health and Vulnerable Populations
1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 20200
5
10
15
20
25
30
35
12
283030
26
2019
31
15
1112
8
213221111
Oral Health and Vulnerable Populations
• Disparities• Literacy rates • Role of the workforce• Demographic issues• Access barriers
N = 2791973 - 2013
Oral Health Disparities
1975 1980 1985 1990 1995 2000 2005 2010 20150
20
40
60
80
100
120
140
160
59
136
119
959590
445037
2436
202013
2232311111 N= 862 1977 - 2013
Topic Summary: Oral Health Disparities
• Increasing screening intentions for oral and pharyngeal cancer
• The oral health of vulnerable older adults and persons with disabilities
• Integrating oral and general health screening at senior centers for minority elders
• Distinct epidemiologic characteristics of oral tongue cancer patients.
Topic Summary: Oral Health Disparities
• Racial and ethnic disparities in utilization of dental services among children in Iowa: the Latino experience.
• Head and neck cancer disparity in underserved communities: probable causes and the ethics involved.
• Social inequality in oral health.
Topic Summary: Oral Health Disparities
• Racial/ethnic disparities in health and health care among U.S. adolescents.
• Using telehealth technologies to improve oral health for vulnerable and underserved populations.
• Distribution of caries in children: variations between and within populations.
• Social disparity and oral health.
Topic Summary: Oral Health Disparities
• Barriers impeding access to primary oral health care among farm worker families in Central Florida.
• Access to and utilization of oral health care by homeless children/families.
• Socioeconomic factors in adolescents' oral health: are they mediated by oral hygiene behaviors or preventive interventions?
Moving Forward
Moving Forward• The majority of the literature on
racial and ethnic groups offers epidemiologic data on health disparities.– Lacks depth
• Research offering findings on oral health beliefs and practices of specific racial, ethnic, and cultural groups is sparse.
Moving Forward• Use of theoretical or strong
conceptual frameworks is scarce.• Current information available
provides a limited picture of oral health related beliefs, thoughts, and behaviors for specific population groups.
• Differences in use contribute to oral health disparities– how do we remedy the issues? Why are there differences?
Moving Forward• How do we create dental consumers?• Access barriers (intensity) have not
been identified for all population groups.– Methods for reducing/removing the
barriers are absent from the literature.• Looking below the barriers– are there
other “undiscovered” reasons for differences in access patterns?
Moving Forward• Much of the literature employs
samples recruited from clinical populations.– Movement into the community will be
required to reach individuals who do not seek regular dental care.
• Oral health literacy – Related to treatment decisions… how?– Tailored materials- do they make a
difference? What degree of tailoring?
Moving Forward• Cultural competence
– Multi cultural office settings• Does inclusiveness make a difference?
• Treatment by front office staff– Staff trained in cultural competence vs.
untrained staff – is there a difference?• Dignity, judgment
– How can these perceptual barriers?
Moving Forward• Dentist/patient engagement during
appointment.• Does provider training in cultural
competence improve case acceptance and/or return visits?
• Extractions, tooth loss- what does this mean to different population groups?– Missing teeth: Scarlet letter of the poor?
Moving Forward• Do patients who receive care for
acute dental problems in an emergency department follow-up their referral for definitive care?– Why or why not?
• Do treatment decisions differ by level of OHL?
• Identify oral health beliefs, values, and practices of different population groups.
• What are the factors associated with missed dental appointments?
• What is the actual cost of ECC?– DALY…
• Social and intellectual development affected• Permanent teeth may be affected• Malocclusion, missing teeth– self-esteem• Early learning foundation poor– not much to
build on… prospects for college low… job prospects questionable… missing teeth can add to a lack of marketability.
– What is the cumulative cost of early and un or under-treated dental disease?
Moving Forward• It is time to apply some of the broad
concepts to determine how they work.
• Social, behavioral, environmental, biological aspects must be considered.
• Solutions will require an interdisciplinary approach.
Different Perspectives• Consideration of different
perspectives…..
• Coronary angioplasty is like going to the dentist(2000).
Any discussion or questions?
Thank you for your attention!