Date on Master's Thesis/Doctoral Dissertation

8-2007

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department (Legacy)

Department of Epidemiology and Clinical Investigation Sciences

Committee Chair

Looney, Stephen W.

Author's Keywords

Access to care; Case managers; Medicaid children; Dental care; Intervention

Subject

Poor children--Dental care; Medicaid

Abstract

Oral disease is the greatest unmet healthcare need of disadvantaged children in the United States, with only 20% of disadvantaged Medicaid-eligible children receiving routine dental care. Peter Margolis proposed a theoretical model of access to healthcare services and reported the effectiveness of a case manager intervention in increasing medical care utilization by disadvantaged mothers and infants. This study was based on Margolis's theory and used a case manager to assist parents in obtaining dental care. Methods. The study was based on secondary analyses of data from the "Parental Help Seeking for Dental Care" project. The randomized, controlled intervention study was conducted with 202 parents/caregivers of Medicaid insured children in Louisville, Kentucky, from March 2004 to April 2005. The research questions were: (1) What is the direct effect of the intervention on dental care utilization? (2) Do contextual factors moderate the intervention effects on utilization? (3) What is the effect of the intervention on barriers? The primary dependent variable was dental care utilization and the primary independent variable was group assignment. Covariates included socioeconomic and psychosocial factors. Analyses were conducted using univariate, bivariate, and multivariate statistical techniques. Results. One-fourth of the children enrolled were regular dental utilizers and the intervention did not have a direct effect on utilization for the entire sample of children. Subgroup analyses, however, indicated that younger children in the intervention group were three times more likely to visit the dentist than younger children in the control group. Additional subgroup analyses indicated that intervention families who did not routinely utilize dental care, who had a low family annual income, and/or who completed all study activities were almost three times more likely to see the dentist than similar families in the control group. The intervention did not have any obvious effect on perceived barriers. Conclusions. The intervention was effective in increasing utilization only by younger children, those who had not previously received routine dental care, and those families in the lowest income brackets. Important information was gained from this study that could help develop effective interventions for disadvantaged families, thus reducing oral health disparities.

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