Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis.

Fernando José Herkrath,Guilherme Loureiro Werneck,Mario Vianna Vettore,Peter M Milgrom

doi:10.1371/journal.pone.0192771

Abstract

BackgroundInequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model.MethodsIndividual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes.ResultsPredisposing (OR = 0.89; 95% CI 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics.ConclusionsIndividual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services.

Highlights

Public oral health care in Brazil has been historically restricted to a limited range of dental procedures offered in the large urban centres
Predisposing (OR = 0.89; 95% confidence intervals (95% CIs) 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services
Contextual and individual factors associated with dental services utilisation by Brazilian adults

Summary

Introduction

Public oral health care in Brazil has been historically restricted to a limited range of dental procedures offered in the large urban centres. The implementation of the National Oral Health Policy was accompanied by a significant increase in the federal public funding, resulting in the expansion of access and enhancing comprehensiveness of health care [1, 5,6,7]. This propitiated the expansion of oral health teams in primary care and the implementation of dental specialties centers for secondary care, offering procedures that were previously exclusive to private services [1, 5]. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model

Objectives

Methods

Results

Conclusion