Factors Associated with Dental Service Use Based on the Andersen Model: A Systematic Review

Abstract

Background: A systematic review synthesizing studies examining the determinants of dental service use drawing on the (extended) Andersen model is lacking. Hence, our purpose was to fill this knowledge gap; Methods: Three established electronic databases (PubMed, PsycInfo, as well as CINAHL) were searched. Observational studies focusing on the determinants of dental service use drawing on the Andersen model were included; Results: In sum, 41 studies have been included (ten studies investigating children/adolescents and 31 studies investigating adults). Among children, particularly higher age (predisposing characteristic), higher income (enabling resource) and more oral health problems (need factor) were associated with increased dental service use. Among adults, findings are, in general, less consistent. However, it should be noted that one half of the studies found an association between increased education (predisposing characteristic) and increased dental service. In general, study quality was rather high. However, it should be noted that most studies did not report how they dealt with missing data; Conclusions: Our systematic review revealed that all components (i.e., predisposing characteristics, enabling resources and need factors) of the Andersen model tend to be associated with dental service use among children, whereas the findings are more mixed among adults. In conclusion, beyond need factors, dental service use also tend to be driven by other factors. This may indicate over—or, more likely—underuse of dental services and could enrich the inequality discussion in dental services research.

Socio-Economic Determinants of Dental Service Expenditure: Findings from a French National Survey

“…As the previous literature has shown, oral health status is the major determinant in the use of dental services [10,19]. Reporting good dental health was positively associated with initial utilization and negatively related to ensuing total expenditure.…”

“…The total sample comprised 6222 individuals. The choice of explicative variables was based on determinants from the last systematic review [10].…”

“…Economic studies show that income, complementary health insurance and socioeconomic status (including educational level, income category and deprivation) all affect access to dental care [4][5][6][7][8][9][10]. Dental pain, fear of dental care, oral health knowledge and dental service trajectories have also been related to dental service utilization [4,7,10]. Perceptions of need for dental treatment have been associated with a low socioeconomic status [4][5][6]11] and non-utilization of dental services [4,6].…”

Prevalence of and factors associated with dental service utilization among early elderly in Lithuania

“…A Brazilian study did not find a significant association between use of dental service in previous 3 years and depressive symptoms [ 6 ]. Interestingly, a systematic 2021 review reported that the components of Andersen’s behavioural model are more likely to be associated with DSU in children, whereas predisposing, enabling, and need-based factors have not been consistently associated with DSU in adults [ 12 ]. In adults, a link between increased dental service use and higher education (predisposing factor) was found [ 12 ].…”

The Big Five personality traits and regularity of lifetime dental visit attendance: evidence of the Survey of Health, Ageing, and Retirement in Europe (SHARE)

“…Literature identified five personality characteristics that are associated with use of preventive health care use [13]: conscientious (individuals tend to be careful and/or diligent and are usually task and goaldirected), neuroticism (individuals tend to feel depressed, anxious, impulsive, and display angry hostility), openness to experience (individuals being imaginative and are open for new ideas), extraversion (individuals are sociable and outgoing), and lastly agreeableness (individuals are compliant, tend to be altruistic and warm). Yet, the association between personality factors and use of dental services remains largely unexplored [14][15][16].…”