Filling an Unmet Need for Oral Health Care: A New Framework for Understanding Equitable Access and Receipt of Care

Abstract

Background Poor oral health including untreated cavities negatively impact children and families and is associated with other chronic diseases. Many conceptual models and frameworks have been developed to help explain relatively lower rates of preventive oral health care and higher rates of caries, particularly among patients with public health insurance, and to guide programs to improve these factors. Qualitative data from focus groups and individual interviews with caregivers and providers in relation to a Community Dental Health Coordinator program offered at our community-based medical clinics highlighted universal intention to seek care among study participants but not universal access, which prevented patients who sought care from receiving it and having their cavities treated. The data emphasized that current conceptual models may not accurately reflect patient motivations or current realities regarding oral care access in this population, which may lead to investments in ineffective efforts to reduce these health disparities. Based on these findings, we aimed to create a revised conceptual model of pediatric access to and receipt of preventive oral health care that better reflects the realities that many patient families that we care for face, and which may represent the lived experiences of families across the U.S. Methods A multidisciplinary team of experts including community representatives collaborated on the development of a new working conceptual model for pediatric preventive oral health care access and receipt of care. The team met regularly to develop and discuss iterative versions until a final model that most accurately reflected the focus group findings was achieved. Results The newly conceived conceptual model expands on existing models and reflects feedback from our patient families as it more clearly differentiates between systemic factors that impact access and behavioral factors that impact intention to seek care. Our model development process highlighted that while most models emphasize the role of health behaviors as the primary driver of intention to seek out preventive oral health care, the impact of structural barriers on access to and receipt of care can conceal patients’ intentions and efforts to seek care and are the largest driver of health and health care disparities among the patients we surveyed. Conclusion Lack of oral health care among our patient families is largely not about a lack of intention but lack of access that limits receipt of care. In applying this new model to guide our Community Dental Health Coordinator program, we can help to ensure that our efforts are focused on access. However, more advocacy is needed to increase access by re-envisioning the systems around oral health care. For children and families who rely on public insurance, barriers to accessing preventive oral health care are primarily systemic and require policy change and financial incentives to increase the number of quality pediatric dentists with adequate capacity in the communities in which they live. At the provider level, there are missed opportunities for collaboration between dentists and pediatricians to include oral health in community advocacy efforts with the goals of increased rates of oral health care access and decreased rates of untreated cavities. Ensuring that systemic social and structural barriers are reflected and appropriately weighted in frameworks used to determine programs to help reduce health and health care disparities is an essential step toward achieving this vision.

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