Yuan Siyang, Freeman Ruth, Hill Kirsty, Newton Tim, Humphris Gerry
School of Dentistry, University of Dundee, Dundee DD1 4HN, UK.
School of Dentistry, University of Birmingham, Birmingham B5 7EG, UK.
Dent J (Basel). 2020 Oct 13;8(4):118. doi: 10.3390/dj8040118.
Effective communication forges the dentist-patient treatment alliance and is thus essential for providing person-centred care. Social rank theory suggests that shame, trust, communication and anxiety are linked together, they are moderated by socio-economic position. The study is aimed to propose and test an explanatory model to predict dental attendance behaviours using person-centred and socio-economic position factors. A secondary data analysis was conducted on a cross-sectional representative survey of a two-stage cluster sample of adults including England, Wales and Northern Ireland. Data were drawn from structured interview. Path analysis of proposed model was calculated following measurement development and confirmation of reliable constructs. The findings show model fit was good. Dental anxiety was predicted negatively by patient's trust and positively by reported dentist communication. Patient's shame was positively associated with dental anxiety, whereas self-reported dental attendance was negatively associated with dental anxiety. Both patient's trust and dentist's communication effects were moderated by social class. Manual classes were most sensitive to the reported dentist's communications. Some evidence for the proposed model was found. The relationships reflected in the model were illuminated further when social class was introduced as moderator and indicated dentists should attend to communication processes carefully across different categories of patients.
有效的沟通有助于建立牙医与患者的治疗联盟，因此对于提供以患者为中心的护理至关重要。社会等级理论表明，羞耻、信任、沟通和焦虑相互关联，它们受到社会经济地位的调节。本研究旨在提出并检验一个解释模型，该模型利用以患者为中心的因素和社会经济地位因素来预测看牙行为。对包括英格兰、威尔士和北爱尔兰在内的成年人两阶段整群抽样的横断面代表性调查进行了二次数据分析。数据来自结构化访谈。在测量发展和确认可靠的结构后，对所提出模型进行路径分析计算。结果表明模型拟合良好。患者的信任对牙科焦虑有负向预测作用，而报告的牙医沟通对牙科焦虑有正向预测作用。患者的羞耻感与牙科焦虑呈正相关，而自我报告的看牙行为与牙科焦虑呈负相关。患者的信任和牙医的沟通效果都受到社会阶层的调节。体力劳动者阶层对报告的牙医沟通最为敏感。为所提出的模型找到了一些证据。当引入社会阶层作为调节因素时，模型中反映的关系得到了进一步阐明，这表明牙医应该在不同类型的患者中仔细关注沟通流程。
