A Three Delays theoretical framework to describe social determinants as barriers to dental care

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Community dentistry and oral epidemiology Pub Date : 2024-02-29 DOI:10.1111/cdoe.12949

Shenam Ticku, Olivia Watrous, Danielle Burgess, Yuanyuan Laura Luo, Sabina DSouza, Catherine Simpson, Kareem King Jr., Christine A. Riedy, Brittany Seymour

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引用次数: 0

Abstract

Objectives

The Three Delays model is a well-established global public health framework for the utilization of obstetric services where each delay represents a series of factors affecting utilization: (1) Delay #1—Deciding to seek care, (2) Delay #2—Reaching an appropriate facility and (3) Delay #3—Receiving adequate care. The aim of this qualitative study was to explore the application of the Three Delays model to dental service utilization and describe factors attributed to delayed utilization within this framework.

Methods

This study utilized a framework analysis, underpinned by the Three Delays model, to examine delays in dental care utilization. A criterion purposive sample of English-speaking adults (18+ years) in Massachusetts and Florida, USA with limited dental care access was recruited. Data were collected via semi-structured interviews conducted in two phases: 17 individual interviews, followed by interviews with a subset of five participants over 3 months (a total of 18 interviews). The analysis involved inductive thematic coding and systematic organization within the framework.

Results

Major themes and subthemes were constructed from the participants' narratives, identified and categorized as factors in the Three Delays framework. Each of the delays was interrelated to the other two, and Delay #1 was the most common delay based on the participants' interviews. The themes and subthemes contributing to one or more delays included interpersonal communication, prior dental experience, financial considerations, childcare costs, social connection, technology literacy, time constraints, competing priorities, stressors such as eviction and immigration status and microaggressions including racism and stigma.

Conclusion

The Three Delays model was applicable to the study of dental care utilization and factors that impact the decision to seek dental care, reaching an appropriate dental facility and receiving adequate dental care in this study context.

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用 "三个延迟 "理论框架来描述作为牙科保健障碍的社会决定因素。

目标：三延迟模型是一个成熟的产科服务利用的全球公共卫生框架，其中每一个延迟都代表了一系列影响利用的因素：（1）延迟 #1-决定寻求医疗服务，（2）延迟 #2-到达合适的医疗机构，（3）延迟 #3-获得足够的医疗服务。这项定性研究的目的是探索 "三个延迟 "模型在牙科服务利用中的应用，并在此框架内描述导致延迟利用的因素：本研究采用了以 "三个延迟 "模型为基础的框架分析法来研究牙科保健使用中的延迟。研究对象是美国马萨诸塞州和佛罗里达州的英语成年人（18 岁以上），他们牙科保健机会有限。数据通过分两个阶段进行的半结构化访谈收集：先进行了 17 次个别访谈，然后在 3 个月内对 5 名参与者的子集进行了访谈（共进行了 18 次访谈）。分析包括归纳式主题编码和框架内的系统组织：从参与者的叙述中构建了主要主题和次主题，并将其确定和归类为 "三个延迟 "框架中的因素。每一个延迟都与其他两个延迟相互关联，而根据参与者的访谈，延迟 1 是最常见的延迟。导致一个或多个延迟的主题和次主题包括人际沟通、之前的牙科经验、经济考虑、育儿成本、社会关系、技术知识、时间限制、优先事项竞争、压力因素（如驱逐和移民身份）以及微观侵害（包括种族主义和污名化）：三个延迟 "模型适用于研究牙科保健的使用情况，以及影响寻求牙科保健的决定、到达合适的牙科机构和接受适当的牙科保健的因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Community dentistry and oral epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

4.40

自引率

8.70%

发文量

审稿时长

6 months

期刊介绍： The aim of Community Dentistry and Oral Epidemiology is to serve as a forum for scientifically based information in community dentistry, with the intention of continually expanding the knowledge base in the field. The scope is therefore broad, ranging from original studies in epidemiology, behavioral sciences related to dentistry, and health services research through to methodological reports in program planning, implementation and evaluation. Reports dealing with people of all age groups are welcome. The journal encourages manuscripts which present methodologically detailed scientific research findings from original data collection or analysis of existing databases. Preference is given to new findings. Confirmations of previous findings can be of value, but the journal seeks to avoid needless repetition. It also encourages thoughtful, provocative commentaries on subjects ranging from research methods to public policies. Purely descriptive reports are not encouraged, nor are behavioral science reports with only marginal application to dentistry. The journal is published bimonthly.