Department of Public Health, Policy & Systems, Institute of Population Health, University of Liverpool, Liverpool, UK.
Population Health Sciences Institute, Newcastle University, Newcastle, UK.
JDR Clin Trans Res. 2023 Oct;8(4):337-348. doi: 10.1177/23800844221118515. Epub 2022 Aug 29.
To discover whether dental visiting behavior can be understood as a dichotomy of planned versus problem based, or whether there were a range of different types of understanding and patient behavior, recognizable as patterns of dental visiting behavior.
Secondary analysis drawing on 2 qualitative studies of patients' accounts of dental attendance and oral health, with 1) opportunistic interviews with people attending urgent dental care services ( = 43; including 19 with follow-up) and 2) home-based, in-depth interviews with people attending a dental practice with a mixture of improved or deteriorated/poor periodontal health ( = 25).
Four distinguishable patterns of dental visiting were identified in patients' accounts: Accepting and Active Monitoring, as well as Ambivalent and Active Problem-based dental visiting behavior. Individuals' patterns were relatively stable over time but could shift at turning points. Accepting Monitors were characterized as accepting dentists' recommendations and dental practice policies relating to oral health and visits, whereas Active Monitors were more independent in judging how often to attend for preventive appointments, while still valuing anticipatory care. Ambivalent Problem-based visitors placed a relatively low value on anticipatory care for oral health maintenance and drifted into lapsed attendance, in part because of service-related factors. This contrasted with Active Problem-based visitors, for whom using services only in an emergency was a conscious decision, with low value placed on anticipatory care.
This article demonstrates the dynamic nature of patterns of dental visiting where the dental system itself is partly instrumental in shaping patterns of utilization in an ecological way. Thus, service-related factors tend to combine with patients' behavior in expanding inequalities. This illuminates the reasons why risk-based recalls are challenging to implement as a dental policy.
The results of this analysis can be used by clinicians and policymakers to inform policy around supporting uptake of preventive health care visits, contributing in particular to understanding how risk-based preventive visiting policies may be better adapted to patients' understanding of the purpose of visits, taking into account that this is in part shaped by service-related factors in an ecological way, arising from patients' and dental teams' expectations.
探究看牙医的行为是否可以理解为计划性和基于问题的行为之间的二分法，或者是否存在一系列不同类型的理解和患者行为，可以被视为看牙医行为的模式。
二次分析借鉴了两项关于患者就诊和口腔健康的定性研究，其中 1）对急诊牙科就诊者（共 43 人，包括 19 名随访者）进行机会性访谈；2）对牙周健康状况改善或恶化/较差的牙科诊所就诊者（共 25 人）进行家庭式深入访谈。
在患者的描述中，发现了四种可区分的看牙医模式：接受和主动监测，以及矛盾和主动基于问题的看牙医行为。个体的模式在时间上相对稳定，但在转折点时可能会发生变化。接受型监测者的特点是接受牙医关于口腔健康和就诊的建议和牙科实践政策，而主动型监测者在判断多久进行一次预防性预约时更加独立，同时仍然重视预期护理。矛盾型基于问题的就诊者相对轻视口腔健康维护的预期护理，就诊率下降，部分原因是服务相关因素。这与主动型基于问题的就诊者形成对比，后者只有在紧急情况下才使用服务，对预期护理的重视程度较低。
本文展示了看牙医模式的动态性质，即牙科系统本身以生态方式在一定程度上塑造了利用模式。因此，服务相关因素往往与患者的行为一起，扩大了不平等。这解释了为什么基于风险的召回作为一项牙科政策具有挑战性。
该分析结果可被临床医生和决策者用于为支持预防性保健就诊提供信息，特别是有助于理解如何更好地适应基于风险的预防性就诊政策，以适应患者对就诊目的的理解，同时考虑到这部分是由服务相关因素在生态方面塑造的，源于患者和牙科团队的期望。
