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Okunseri C, Zheng C, Zhang Y, Okunseri E, Garcia R, Szabo A. Acculturation and Children's dental service utilization in the United States. Community Dent Oral Epidemiol 2023; 51:380-387. [PMID: 37038268 DOI: 10.1111/cdoe.12860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/28/2023] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE The study examined changes in acculturation level, socio-economic status, and their association with preventive dental service use, receipt of restorative, or surgical care, and unmet dental needs. METHODS Data from the Medical Expenditure Panel Survey (MEPS) for children aged 1 to 17 years from 2007 to 2015 were analysed. Firstly, a cross-sectional structural equation model (SEM) that included both a measurement model and a structural model was fitted simultaneously to obtain predicted latent variables for acculturation, socio-economic status (SES), dental service utilization, and unmet dental needs. Secondly, the change in acculturation, SES, dental service utilization, and unmet dental needs were calculated over two consecutive years within the same child. Finally, the structural model in these changes was fitted, and the indirect and direct pathways between acculturation and SES were tested with dental insurance as a mediator. RESULTS Data for 33 507 children in both panel years were analysed. An increase in family acculturation resulted in lower utilization of preventive dental service and more unmet dental need, with socio-economic status and dental insurance kept constant between the panel years, and after adjusting for race/ethnicity, gender, and age. In addition, increased acculturation was associated with higher SES, and a higher probability of having obtained dental insurance, both of which resulted in increased preventive dental service utilization and less unmet dental need. The positive direct effect and negative indirect effect of acculturation on unmet dental need cancelled each other out and resulted to almost zero total effect between acculturation and unmet dental need. Similarly, the negative direct effect and positive indirect effect of acculturation on preventive dental service cancelled each other out leading to a small increase in preventive dental service utilization. CONCLUSION Children of immigrant families are at risk of inadequate access to dental care as their families becomes more acculturated, without increase in SES and access to dental insurance. This study supports policies that promote immigrant family's adequate access to dental insurance and employment to improve their socio-economic status.
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Affiliation(s)
- Christopher Okunseri
- Department of Clinical Services, School of Dentistry, Marquette University Milwaukee Wisconsin, Milwaukee, Wisconsin, United States
| | - Cheng Zheng
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Yiwen Zhang
- Joseph. J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States
| | - Elaye Okunseri
- Department of Clinical Services, School of Dentistry, Marquette University Milwaukee Wisconsin, Milwaukee, Wisconsin, United States
| | - Raul Garcia
- Department of Health Policy & Health Services Research, Boston University Henry M. Goldman, School of Dental Medicine Massachusetts, Boston, Massachusetts, United States
| | - Aniko Szabo
- Institute of Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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Sano Y, Antabe R. Regular Dental Care Utilization: The Case of Immigrants in Ontario, Canada. J Immigr Minor Health 2021; 24:162-169. [PMID: 34453263 DOI: 10.1007/s10903-021-01265-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
Considering the critical role of oral health on people's well-being, access to regular dental care to improve oral health may be a useful medium for improving immigrant integration and settlement in Canada. Using the 2013-14 Canadian Community Health Survey, this study contributes to the literature and policy by examining if there are disparities in regular utilization of dental care among recent immigrants, established immigrants, and the native-born in Ontario, Canada. Adopting Andersen's behavioural model of health services use as a conceptual framework, we introduce three sets of variables in our statistical analysis including predisposing, need, and enabling factors. At the bivariate level, recent (OR = 0.42, p < 0.001) and established immigrants (OR = 0.81, p < 0.001) are less likely to use dental care at least once a year than their native-born counterparts. Once accounting for enabling characteristics, however, we observe that the direction of the association becomes positive for established immigrants (OR = 1.15, p < 0.05). The difference between recent immigrants and the native-born is partially attenuated when we control for enabling characteristics but remains statistically significant (OR = 0.73, p < 0.05). Based on these findings, we provide several implications for policymakers and future research.
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Affiliation(s)
- Yujiro Sano
- Department of Sociology and Anthropology, Nipissing University, North Bay, ON, Canada.
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, ON, Canada
- Graduate Department of Geography and Planning, University of Toronto, Toronto, ON, Canada
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Kaur N, Kandelman D, Potvin L. Development and pilot testing of an oral hygiene self-care photonovel for Punjabi immigrants: a qualitative study. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2021; 55:30-38. [PMID: 33643415 PMCID: PMC7906123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 06/26/2020] [Accepted: 10/23/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The purpose of this research study was to develop and pilot test a culturally and linguistically appropriate oral hygiene self-care photonovel for Punjabi immigrants. METHODS Purposeful sampling technique was used to recruit 5 members of a Punjabi community organization (the Sikh Women's Association of Montreal) for participation in 3 focus group sessions in August 2015. A thematic content analysis approach was used to sort the data, enabling identification of the storyline and photonovel contents from the themes that emerged. Comic Life 3 version 3.1.1 software was used to create a "Safeguard Your Smile" (SYS) photonovel, which was printed for pilot testing. Ten additional participants were recruited for this pilot testing, enabling further revision of the photonovel based on their suggestions. RESULTS Four major themes emerged from the focus group discussions: 1) lack of understanding of oral hygiene self-care and risk factors; 2) lack of oral hygiene self-care-related awareness and routine; 3) lack of emphasis on prevention by oral health care providers; and 4) perceived barriers to accessing dental health care. Thematic content analysis revealed a lack of knowledge of oral hygiene self-care skills and routine. Guided by these overarching themes, a final version of the photonovel script was created including photographs of key characters. The photonovel was subsequently printed for pilot testing. Pilot test results revealed close to 80% of participants agreed that the SYS photonovel was culturally and linguistically appropriate and easy to understand. CONCLUSIONS A culturally and linguistically appropriate photonovel may be a useful tool for enhancing oral hygiene self-care knowledge among ethnic communities. Further studies are required to test the effectiveness of such a tool.
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Affiliation(s)
- Navdeep Kaur
- Research associate, Unité de recherche en psychiatrie des toxicomanies, Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal,
QC, Canada
| | - Daniel Kandelman
- Associate professor, Faculty of Dental Medicine, Université de Montréal, Montreal, QC, Canada
| | - Louise Potvin
- Canada Research Chair, Community Approaches and Health Inequalities; Scientific director, Centre de recherche en santé publique, Université de Montréal; Centre
intégré universitaire de santé et services sociaux du Centre-sud-de-l’île-de-Montréal, Montreal, QC, Canada
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Ferraz Dos Santos B, Dabbagh B. A 10-year retrospective study of paediatric emergency department visits for dental conditions in Montreal, Canada. Int J Paediatr Dent 2020; 30:741-748. [PMID: 32278337 DOI: 10.1111/ipd.12651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 03/15/2020] [Accepted: 03/22/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Trends of paediatric emergency visits (ED) for dental conditions have been broadly discussed; however, little has been published in the Canadian context. AIM To describe the utilization of ED for dental conditions among children and to investigate demographic characteristics influencing its use. DESIGN A comprehensive review of records of all children aged 1-17 years who attended the ED service of a paediatric hospital in Montreal, Canada, for dental conditions over a 10-year period (2004-2013) was completed. Information on the child's principal dental diagnosis, sociodemographic data, and source of referral was obtained. RESULTS A total of 10 905 paediatric ED visits were seen during the study period. Among the children, 54.7% were male and the majority was younger than 6 years old. Dental caries constituted the most common reason for ED presentation comprising close to 43% of total visits for a dental complaint. Females, teenagers, and self-referred children were more likely to experience ED visits due to non-traumatic dental conditions. CONCLUSIONS The utilization of ED for dental conditions has increased among pre-school children in the last decade and was mostly due to caries-related dental problems. Effective preventive strategies are needed to improve the oral health condition of children.
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Affiliation(s)
- Beatriz Ferraz Dos Santos
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, QC, Canada.,Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Basma Dabbagh
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children's Hospital, Montreal, QC, Canada
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Kaur N, Kandelman D, Potvin L. Effectiveness of "Safeguard Your Smile," an oral health literacy intervention, on oral hygiene self-care behaviour among Punjabi immigrants:A randomized controlled trial. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2019; 53:23-32. [PMID: 33240339 PMCID: PMC7533823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 12/14/2018] [Accepted: 01/14/2019] [Indexed: 06/11/2023]
Abstract
BACKGROUND Research shows that immigrants have higher rates of oral diseases, poorer access to dental care services, and lower levels of health literacy than their Canadian-born peers. Oral health literacy has emerged as a potential pathway to reduce oral health disparities. The scarcity of studies on oral health literacy interventions, particularly among immigrants, lent urgency to this study, the purpose of which was to evaluate the effectiveness of an oral health literacy intervention promoting oral hygiene self-care behaviour among Punjabi immigrants. METHODS The study used a parallel group, non-blinded, randomized controlled trial design. One hundred and forty (140) Punjabi immigrants between 18 and 60 years of age were enrolled. Participants were randomly allocated to receive either the Safeguard Your Smile (SYS) intervention or a conventional pamphlet. The following outcome measures were assessed at baseline and 3 months post-intervention: self-reported oral hygiene self-care behaviour and knowledge, plaque and gingival indices, and oral health literacy. A linear mixed model for repeated measures was used to compare the intervention and control groups (between) at pre- and post-intervention (within). RESULTS Participants who received the SYS intervention showed improvements ( p <0.0001) for the following dependent variables: oral hygiene self-care knowledge and behaviour, oral health literacy, and plaque and gingival indices. CONCLUSIONS SYS intervention enhanced positive oral hygiene self-care behaviour among Punjabi immigrants with low oral health literacy. SYS intervention can be employed among other vulnerable groups with low levels of oral health literacy to improve oral hygiene self-care behaviour.
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Affiliation(s)
- Navdeep Kaur
- Postdoctoral researcher, Method development platform, Quebec SPOR-SUPPORT Unit, Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Daniel Kandelman
- Associate professor, Faculty of Dental Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Louise Potvin
- Tier 1 Canada Research Chair, Institut de recherche en santé publique, School of Public Health, Université de Montréal; Centre de recherche Léa-Roback, Montreal, Quebec, Canada
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Brzoska P, Erdsiek F, Waury D. Enabling and Predisposing Factors for the Utilization of Preventive Dental Health Care in Migrants and Non-Migrants in Germany. Front Public Health 2017; 5:201. [PMID: 28856132 PMCID: PMC5557791 DOI: 10.3389/fpubh.2017.00201] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/24/2017] [Indexed: 11/30/2022] Open
Abstract
Background In many European countries including Germany, migrants utilize preventive services less frequently than the majority population. This is also true for the utilization of dental checkups. Little is known about which demographic, social, behavioral, and health-related factors influence the decision of migrants to seek preventive dental health care and how these factors differ from those in non-migrants. The aim of the present study was to examine the role of these factors among migrants and non-migrants residing in Germany. Methods Data from cross-sectional national health surveys are used, providing information on preventive dental health behavior from n = 41,220 individuals, of which 15.0% are migrants. Andersen’s Behavioral Model of Health Services Use is the conceptual framework of the investigation. Multiple logistic regression models were applied to examine the role of different predisposing and enabling factors. Interaction terms were included in order to examine whether determinants differ between migrants and non-migrants. Average marginal effects (AMEs) are reported in addition to odds ratios (ORs) as measures of effect size which are robust against bias arising from unobserved heterogeneity. Results Migrants are at an about 36% lower chance of utilizing regular dental checkups than non-migrants [OR = 0.64 (95% confidence interval, 95% CI: 0.61, 0.68); AME = −0.081 (95% CI = −0.093, −0.069)]. Differences are partly explained by the influence of demographic, social, behavioral, and health-related factors [adjusted OR = 0.69 (95% CI: 0.64, 0.73); AME = −0.065 (95% CI = −0.076, −0.053)]. Younger age, being male, lower socioeconomic status, a non-statutory health insurance, not living in a relationship, living in the Western part of Germany and in an urban setting, and poor limited social support were associated with a lower chance of utilizing regular dental checkups. Interaction effects could be observed for age and for the type of health insurance. Discussion The study identifies different enabling and predisposing factors that are relevant for the utilization of dental checkups among the population in Germany, some of which differ between migrants and non-migrants. Differences are particularly pronounced for younger ages. This differs from findings on other preventive services where older migrants tend to be more disadvantaged. Additional explanatory factors such as barriers that migrants experience in the dental health care system need to be considered in order to implement patient-oriented services and to reduce disparities in access to dental prevention.
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Affiliation(s)
- Patrick Brzoska
- Chemnitz University of Technology, Faculty of Behavioral and Social Sciences, Institute of Sociology, Epidemiology Unit, Chemnitz, Germany
| | - Fabian Erdsiek
- Chemnitz University of Technology, Faculty of Behavioral and Social Sciences, Institute of Sociology, Epidemiology Unit, Chemnitz, Germany
| | - Dorothee Waury
- Chemnitz University of Technology, Faculty of Behavioral and Social Sciences, Institute of Sociology, Epidemiology Unit, Chemnitz, Germany
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Erdsiek F, Waury D, Brzoska P. Oral health behaviour in migrant and non-migrant adults in Germany: the utilization of regular dental check-ups. BMC Oral Health 2017; 17:84. [PMID: 28526074 PMCID: PMC5437560 DOI: 10.1186/s12903-017-0377-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 05/10/2017] [Indexed: 12/01/2022] Open
Abstract
Background Migrants in many European countries including Germany tend to utilize preventive measures less frequently than the majority population. Little is known about the dental health of migrants as well as about their oral health behaviour, particularly in the adult population. The aim of this study was to examine differences in the uptake of annual dental check-ups in adult migrants and non-migrants in Germany. Methods We used data from the cross-sectional survey ‘German Health Update 2010’ conducted by the Robert Koch Institute (n = 22,050). Data from 21,741 German-speaking respondents with information on the use of dental check-ups was available, of which 3404 (15.7%) were migrants. Multiple logistic regression models were applied to adjust for demographic and socioeconomic confounders, including the place of residence as well as type of health insurance. Results Migrants were generally younger, had a lower socioeconomic status and showed a lower utilization of dental check-ups. The unadjusted odds ratio (OR) for utilization was 0.67 (95%-CI = 0.61–0.73). After adjusting for demographic and socioeconomic confounders the chance only increased slightly (adjusted OR = 0.71; 95%-CI = 0.65–0.77). Conclusions The analysis shows that migration status is associated with a reduced chance of attending dental check-ups, independently of demographic and socioeconomic factors. The influence of other factors, such as type of health insurance and place of residence had also no influence on the association. Migrants are exposed to different barriers in the health care system, comprising the patient, provider and system level. Further studies need to examine the relevant barriers for the uptake of preventive dental services in order to devise appropriate migrant- sensitive measures of dental prevention.
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Affiliation(s)
- Fabian Erdsiek
- Epidemiology Unit, Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, D-09107, Chemnitz, Germany
| | - Dorothee Waury
- Epidemiology Unit, Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, D-09107, Chemnitz, Germany
| | - Patrick Brzoska
- Epidemiology Unit, Institute of Sociology, Faculty of Behavioral and Social Sciences, Chemnitz University of Technology, D-09107, Chemnitz, Germany.
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Singhal S, Mamdani M, Mitchell A, Tenenbaum H, Lebovic G, Quiñonez C. Dental treatment and employment outcomes among social assistance recipients in Ontario, Canada. Health Policy 2016; 120:1202-1208. [PMID: 27639285 DOI: 10.1016/j.healthpol.2016.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 07/08/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Policy advocates continue to argue for the expansion of dental care services for people on social assistance in order to meet their health needs and to promote the move from welfare-to-work. However, there is little to no evidence to support the idea that receiving dental care ultimately improves employment outcomes. METHODS A retrospective cohort study was designed using administrative data from five Ontario regions and from the province's social assistance ministry. Employment outcomes among treatment and no-treatment cohorts were assessed at three, six and 12 months from baseline. Multivariable regression modeling was performed. RESULTS We received data for 8742 people (2742 treatment, 6000 no-treatment). At one year, employment outcomes were not significantly different between the two groups (adjusted odds ratio=0.93; 95% CI: 0.83-1.03). Post-hoc analysis show that the change in proportion of individuals leaving social assistance for employment over time was significantly higher (p=0.0014) among those receiving treatment (13-29%; 124% increase) than those not receiving treatment (18-33%; 83% increase). CONCLUSION At one year, dental treatment alone does not appear to be significantly associated with leaving assistance for employment in this population. However, this study suggests that people who received dental treatment may have been particularly disadvantaged and dental treatment may help to level them up in terms of employment outcomes over time.
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Affiliation(s)
- Sonica Singhal
- Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Ontario, Canada.
| | - Muhammad Mamdani
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Ontario, Canada.
| | - Andrew Mitchell
- Factor-Iwentash Faculty of Social Work, University of Toronto, Ontario, Canada.
| | - Howard Tenenbaum
- Hospital for Sick Children, Department of Pediatrics, Faculty of Medicine, University of Toronto, Ontario, Canada.
| | - Gerald Lebovic
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Ontario, Canada.
| | - Carlos Quiñonez
- Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Ontario, Canada.
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Factors associated with unmet dental care needs in Canadian immigrants: an analysis of the longitudinal survey of immigrants to Canada. BMC Oral Health 2014; 14:145. [PMID: 25465024 PMCID: PMC4265528 DOI: 10.1186/1472-6831-14-145] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/20/2014] [Indexed: 11/10/2022] Open
Abstract
Background Immigrants are often considered to have poorer oral health than native born-populations. One possible explanation for immigrants’ poor oral health is lack of access to dental care. There is very little information on Canadian immigrants’ access to dental care, and unmet dental care needs. This study examines predictors of unmet dental care needs among a sample of adult immigrants to Canada over a three-point-five-year post-migration period. Methods A secondary data analysis was conducted on the Longitudinal Survey of Immigrants to Canada (LSIC). Sampling and bootstrap weights were applied to make the data nationally representative. Simple descriptive analyses were conducted to describe the demographic characteristics of the sample. Bivariate and multiple logistic regression analyses were applied to identify factors associated with immigrants’ unmet dental care needs over a three-point-five-year period. Results Approximately 32% of immigrants reported unmet dental care needs. Immigrants lacking dental insurance (OR = 2.63; 95% CI: 2.05-3.37), and those with an average household income of $20,000 to $40,000 per year (OR = 1.62; 95% CI: 1.01-2.61), and lower than $20,000 (OR = 2.25; 95% CI: 1.31-3.86), were more likely to report unmet dental care needs than those earning more than $60,000 per year. In addition, South Asian (OR = 1.85; CI: 1.25-2.73) and Chinese (OR = 2.17; CI: 1.47-3.21) immigrants had significantly higher odds of reporting unmet dental care needs than Europeans. Conclusions Lack of dental insurance, low income and ethnicity predicted unmet dental care needs over a three-point-five-year period in a sample of immigrants to Canada.
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Pottie K, Greenaway C, Feightner J, Welch V, Swinkels H, Rashid M, Narasiah L, Kirmayer LJ, Ueffing E, MacDonald NE, Hassan G, McNally M, Khan K, Buhrmann R, Dunn S, Dominic A, McCarthy AE, Gagnon AJ, Rousseau C, Tugwell P. Evidence-based clinical guidelines for immigrants and refugees. CMAJ 2011; 183:E824-925. [PMID: 20530168 PMCID: PMC3168666 DOI: 10.1503/cmaj.090313] [Citation(s) in RCA: 281] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Dias S, Gama A, Cortes M, de Sousa B. Healthcare-seeking patterns among immigrants in Portugal. HEALTH & SOCIAL CARE IN THE COMMUNITY 2011; 19:514-521. [PMID: 21585582 DOI: 10.1111/j.1365-2524.2011.00996.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Equity of access to health services is a major concern as it is an important precondition for positive health outcomes. However, inequities in use of health services among immigrant populations persist. Despite the increasing research in the field, patterns of healthcare seeking among immigrant populations and its associated factors are not fully understood. This study aimed to investigate healthcare-seeking patterns among immigrants in Portugal and identify factors associated with utilisation of health services. A cross-sectional study was conducted between October 2008 and May 2009 with a sample of 1,375 immigrants residing in the Lisbon region. Data were collected through a structured questionnaire applied by trained interviewers. Two stepwise logistic regressions were conducted to identify which factors were associated with utilisation of the National Health Service (NHS) and with healthcare seeking for the first time in Portugal at the Primary Health Care service, estimated by calculating odds ratios and 95% confidence intervals. Among participants, around 77% reported having used the NHS; 50% sought health-care for the first time at the Primary Health Care service and 33% at the emergency room. Lower odds of having used the NHS were associated with being male, Brazilian or eastern European compared with being African, and undocumented. Lower odds of having sought health-care for the first time at the Primary Health Care service were associated with being male and undocumented. These results suggest that further efforts are needed to tackle inequalities in access to care and promote the utilisation of health services, particularly among the more vulnerable immigrant groups. Increasing appropriate utilisation of health services, including the primary and preventive care services, may lead to better health outcomes. Immigrants' involvement and participation should be incorporated into the development of health strategies to improve access and utilisation of healthcare services.
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Affiliation(s)
- Sónia Dias
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
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Muirhead VE, Quiñonez C, Figueiredo R, Locker D. Predictors of dental care utilization among working poor Canadians. Community Dent Oral Epidemiol 2009; 37:199-208. [PMID: 19508268 DOI: 10.1111/j.1600-0528.2009.00471.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study used the Gelberg-Andersen Behavioral Model for Vulnerable Populations to identify predictors of dental care utilization by working poor Canadians. METHODS A cross-sectional stratified sampling study design and telephone survey methodology was used to collect data from a nationally representative sample of 1049 working poor individuals aged 18 to 64 years. Working poor persons worked > or = 20 h a week, were not full-time students and had annual family incomes <$34,300. A pretested questionnaire included sociodemographic items, self-reported oral health measures and two dental care utilization outcomes: time since their last dental visit and the usual reason for dental visits. RESULTS Hierarchical stepwise logistic analyses identified independent predictors associated with visiting the dentist >1 year ago: male gender (OR = 1.63; P = 0.005), aged 25-34 years (OR = 2.05; P = 0.02), paying for dental care with cash or credit (OR = 2.31; P < 0.001), past welfare recipients (OR = 1.65; P = 0.03), <21 teeth (OR = 4.23; P < 0.001) and having a perceived need for dental treatment (OR=2.78; P < 0.001). Sacrificing goods or services to pay for dental treatment was associated with visiting the dentist within the past year. The predictors of visiting the dentist only when in pain/trouble were lone parent status (OR = 4.04; P < 0.001), immigrant status (OR = 1.72; P = 0.006), paying for dental care with cash or credit (OR = 2.71; P < 0.001), a history of an inability to afford dental care (OR = 1.62; P = 0.01), a satisfactory/poor/very poor self-rated oral health (OR = 2.10; P < 0.001), number of teeth <21 (OR = 2.58; P < 0.001) and having a perceived need for dental treatment (OR = 2.99; P < 0.001). CONCLUSIONS This study identified predisposing and enabling vulnerabilities that jeopardize the dental care-seeking practices of working poor persons. Dental care utilization was associated with relinquishing spending on other goods and services, which suggests that dental care utilization is a competing financial demand for economically constrained adults.
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Affiliation(s)
- V E Muirhead
- Faculty of Dentistry, Division of Oral Health and Society, McGill University, Montreal, QC, Canada.
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Akresh IR. Health Service Utilization Among Immigrants to the United States. POPULATION RESEARCH AND POLICY REVIEW 2009. [DOI: 10.1007/s11113-009-9129-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Seirawan H. Parsimonious prediction model for the prevalence of dental visits. Community Dent Oral Epidemiol 2008; 36:401-8. [DOI: 10.1111/j.1600-0528.2007.00420.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fenta H, Hyman I, Noh S. Health service utilization by Ethiopian immigrants and refugees in Toronto. J Immigr Minor Health 2007; 9:349-57. [PMID: 17380388 DOI: 10.1007/s10903-007-9043-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to examine the health service utilization patterns of Ethiopian immigrants and refugees in a random sample of 342 adults residing in Toronto. The results suggested that 85% of the study participants used one or more type of health services, most often from a family physician. However, only 12.5% of them with a mental disorder received services from formal healthcare providers, mainly family physicians. While the presence of somatic symptoms was significantly associated with increased use of healthcare (p < 0.05), having a mental disorder was associated with lower rate of health service use (p < 0.05). These findings suggest that family physicians could play important role in identifying and treating Ethiopian clients who present with somatic symptoms, as these symptoms may reflect mental health problems. Further research is necessary to determine the reasons for the low rates of mental health services use in this population.
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Affiliation(s)
- Haile Fenta
- Social Equity and Health Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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Abstract
The purpose of this study was to examine the mental health service utilization patterns of Ethiopians in Toronto. A cross-sectional epidemiological survey of 342 randomly selected adults was conducted, based on a conceptual model of healthcare utilization suggested by Anderson and Newman. The results suggested that 5% of the respondents sought mental health services from healthcare professionals and 8% consulted nonhealthcare professionals. Although Ethiopians' utilization rate of mental health services did not greatly differ from the rates of the general population of Ontario (6%), only a small proportion (12.5%) of Ethiopians with mental disorders used services from healthcare professionals, mostly family physicians. The data also suggested that Ethiopians were more likely to consult traditional healers than healthcare professionals for mental health problems (18.8% vs. 12.5%). In multivariate logistic regression analyses, while the number of somatic symptoms experienced was positively associated with increased mental healthcare utilization (OR = 1.515, p < 0.05), having a mental disorder was associated with decreased mental healthcare utilization (OR = 0.784, p < 0.01). Our findings have important implications for mental health services. On the one hand, the findings suggest that somatic symptoms could lead to increased use of mental health services, particularly family physicians' services. On the other hand, the data suggested that although the mental healthcare needs of Ethiopians are high, they use fewer mental health services from healthcare professionals. It would seem that family physicians could play important role in identifying and treating Ethiopian clients with somatic symptoms, as these symptoms may reflect mental disorder.
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Affiliation(s)
- Haile Fenta
- Culture, Community, and Health Studies, Center for Addiction and Mental Health, Toronto, Ontario, Canada.
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