Individual and contextual factors influencing dental health care utilization by preschool children: a multilevel analysis

Abstract

The effect of contextual factors on dental care utilization was evaluated after adjustment for individual characteristics of Brazilian preschool children. This cross-sectional study assessed 639 preschool children aged 1 to 5 years from Santa Maria, a town in Rio Grande do Sul State, located in southern Brazil. Participants were randomly selected from children attending the National Children's Vaccination Day and 15 health centers were selected for this research. Visual examinations followed the ICDAS criteria. Parents answered a questionnaire about demographic and socioeconomic characteristics. Contextual influences on children's dental care utilization were obtained from two community-related variables: presence of dentists and presence of workers' associations in the neighborhood. Unadjusted and adjusted multilevel logistic regression models were used to describe the association between outcome and predictor variables. A prevalence of 21.6% was found for regular use of dental services. The unadjusted assessment of the associations of dental health care utilization with individual and contextual factors included children's ages, family income, parents' schooling, mothers' participation in their children's school activities, dental caries, and presence of workers' associations in the neighborhood as the main outcome covariates. Individual variables remained associated with the outcome after adding contextual variables in the model. In conclusion, individual and contextual variables were associated with dental health care utilization by preschool children.

Contextual and individual determinants of oral health-related quality of life among five-year-old children: a multilevel analysis

“…It is possible that some schools, besides having children with a better economic status, also develop activities that stress the importance of health care. In a study involving children aged one to five years, children whose mothers had a greater participation in their children’s schools were more likely to make use of oral health services (Piovesan et al, 2017). Thus, health programs for children should consider the school environment.…”

“…Contextual factors seem to be strongly associated with different oral health outcomes (Fernández et al, 2015; Piovesan et al, 2017) and the study of these factors is undoubtedly important to the planning of services as well as the investigation of health inequalities (Petersen & Kwan, 2011). The school setting is important to the intellectual development of children and also exerts an influence on health behaviors.…”

“…The school setting is important to the intellectual development of children and also exerts an influence on health behaviors. Moreover, there is a relationship between economic status and the type of preschool a child attends (Piovesan et al, 2017). Thus, understanding these contextual disparities could be the basis for directed interventions and health policies.…”

Importance of contextual variables related to cavitated lesions in 5‐year‐old children

“…Individual socioeconomic issues are associated with the occurrence of dental caries. Some studies have also found a relationship between dental caries and contextual factors. A child's surrounding environment can exert an influence on oral health, since individuals who live in the same context tend to exhibit similar behaviors.…”

“…The school at which a child studies can be used as an indicator of socioeconomic status and is considered a viable predictor of caries experience in epidemiological studies conducted in Brazil. Studies have been conducted to analyse the influence of individual and contextual determinants on oral health. However, studies involving multilevel analyses on dental caries among 5‐year‐old children have limitations related to the sample.…”