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Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis

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  • Fernando José Herkrath
  • Mario Vianna Vettore
  • Guilherme Loureiro Werneck

Abstract

Background: Inequalities in the utilisation of dental services in Brazil are remarkable. The aim of this study was to evaluate the association of contextual and individual factors with the utilisation of dental services by Brazilian adults using the Andersen’s behavioural model. Methods: Individual-level data from 27,017 adults residents in the State capitals who were interviewed in the 2013 Brazilian National Health Survey were pooled with contextual city-level data. The outcomes were non-utilisation of dental services and last dental visit over 12 months ago. Individual predisposing variables were age, sex, race/skin colour, schooling and social network. Individual enabling variables included income, health insurance and registration in primary health care. Individual need variables were self-perceived dental health and self-reported missing teeth. Multilevel logistic regression models were performed to estimate odds ratio (OR) and 95% confidence intervals (95% CIs) of the association of contextual and individual predisposing, enabling and need-related variables with dental services outcomes. Results: Predisposing (OR = 0.89; 95% CI 0.81–0.97) and enabling (OR = 0.90; 95% CI 0.85–0.96) contextual factors were associated with non-utilisation of dental services. Individual predisposing (sex, race/skin colour, schooling), enabling (income, health insurance) and need (self-perceived oral health, missing teeth) were associated with non-utilisation of dental services and last dental visit over 12 months ago. The latter was also associated with other individual predisposing (age, social network) and need (eating difficulties due to oral problems) characteristics. Conclusions: Individual and contextual determinants influenced dental services utilisation in Brazilian adults. These factors should be on the policy agenda and considered in the organisation of health services aiming to reduce oral health inequalities related to access and utilisation of dental services.

Suggested Citation

  • Fernando José Herkrath & Mario Vianna Vettore & Guilherme Loureiro Werneck, 2018. "Contextual and individual factors associated with dental services utilisation by Brazilian adults: A multilevel analysis," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-17, February.
    • Handle: RePEc:plo:pone00:0192771
    DOI: 10.1371/journal.pone.0192771
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    References listed on IDEAS

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    1. Rafaela da Silveira Pinto & Angelo Giuseppe Roncalli & Mauro Henrique Nogueira Guimarães Abreu & Andréa Maria Duarte Vargas, 2016. "Use of Public Oral Health Services by the Adult Population: A Multilevel Analysis," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-13, January.
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    Cited by:

    1. André Hajek & Benedikt Kretzler & Hans-Helmut König, 2021. "Factors Associated with Dental Service Use Based on the Andersen Model: A Systematic Review," IJERPH, MDPI, vol. 18(5), pages 1-28, March.
    2. Patricio Solis-Urra & Julio Plaza-Diaz & Ana Isabel Álvarez-Mercado & Fernando Rodríguez-Rodríguez & Carlos Cristi-Montero & Juan Pablo Zavala-Crichton & Jorge Olivares-Arancibia & Javier Sanchez-Mart, 2020. "The Mediation Effect of Self–Report Physical Activity Patterns in the Relationship between Educational Level and Cognitive Impairment in Elderly: A Cross-Sectional Analysis of Chilean Health National ," IJERPH, MDPI, vol. 17(8), pages 1-12, April.
    3. Cornelia Melinda Adi Santoso & Taufan Bramantoro & Minh Chau Nguyen & Zsuzsa Bagoly & Attila Nagy, 2020. "Factors Affecting Dental Service Utilisation in Indonesia: A Population-Based Multilevel Analysis," IJERPH, MDPI, vol. 17(15), pages 1-11, July.
    4. Tais Freire Galvao & Gustavo Magno Baldin Tiguman & Mónica Caicedo Roa & Marcus Tolentino Silva, 2019. "Inequity in utilizing health services in the Brazilian Amazon: A population‐based survey, 2015," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(4), pages 1846-1853, October.
    5. Wael Sabbah & Aswathikutty Gireesh & Malini Chari & Elsa K. Delgado-Angulo & Eduardo Bernabé, 2019. "Racial Discrimination and Uptake of Dental Services among American Adults," IJERPH, MDPI, vol. 16(9), pages 1-8, May.

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