Public Health Model of the Dental Care Process: A Review and Synthesis of the Dental Utilization Literature. Executive Summary and Final Report

摘要

In the U.S. inequitable access to dental care is a major public health issue. Designing interventions to increase use among poor and elderly groups requires a thorough understanding of why they avoid the dentist, yet this knowledge base is incomplete. To reduce this knowledge gap, the dental and medical utilization literature is reviewed to develop a behavioral model explaining the dental care process, particularly among the poor. The probability of beginning an episode of care is determined by four groups of variables: structure (e.g., social class, race), history (e.g., past preventive behavior, oral health), cognition (e.g., dental knowledge and salience of dental care), and expected rewards and costs. Episode outcomes are determined by the balance of power and the balance of perceived rewards and costs in the dentist-patient relation. Interventions for reducing inequities in the dental care process are derived from the model.