Defense Date
2024
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Social and Behavioral Health
First Advisor
Dr. Maghboeba Mosavel
Second Advisor
Dr. Eleanor Fleming
Third Advisor
Dr. Robert Perera
Fourth Advisor
Dr. Maria Thomson
Abstract
INTRODUCTION: Oral health is essential for overall well-being, yet disparities persist, particularly among marginalized populations including Black adults. Limited access to and underutilization of oral healthcare services exacerbate these disparities. Discrimination, both individual and systemic, acts as a significant barrier to accessing care, contributing to disparities in oral health outcomes. Individuals facing discrimination experience mistrust and fear within oral healthcare settings, leading to delayed or avoided care. Therefore, investigating and addressing discrimination among Black adults is essential for promoting equitable access to oral healthcare, improving overall oral health outcomes, and lessening existing disparities.
PURPOSE: The purpose of this dissertation was to conduct a sequential explanatory mixed methods study to understand the relationship between racial discrimination and the utilization of oral health services among Black adults (21-64 years) in Baltimore. This study also aimed to explore the role of intersectional identities in shaping experiences of discrimination.
METHODS: A survey was conducted via RedCap (n=751) to explore discrimination and psychophysiological factors influencing oral healthcare utilization, guided by the literature and research questions. Simple and multiple regressions were used to understand significant factors associated with utilization, alongside multinomial logistic regression models to identify factors related to discrimination and oral health service utilization. Additionally, a mediation analysis was performed to examine the underlying mechanisms through which discrimination impacts oral healthcare utilization. A qualitative interview guide was developed to explore into the lived experiences of 25 Black adults, focusing on perceived discrimination and its intersection with social identities. The guide explored how these experiences influence psychophysiological functioning and oral health utilization practices. Themes and subthemes were identified through thematic analysis conducted using NVivo qualitative software.
RESULTS: Black participants reported moderate levels of discrimination in oral healthcare settings, with approximately half indicating experiences of discrimination. However, despite this, over 85% of participants sought dental care at emergency rooms in the past year. As anticipated, individuals facing higher levels of discrimination exhibited a greater inclination to utilize emergency room services compared to those experiencing lower levels. The study highlighted the impact of discrimination on mental well-being and service utilization, identifying fear as a significant mediating factor. Additionally, the research highlighted discriminatory practices within the oral healthcare system, revealing themes such as diverse manifestations and intersectionality with gender, age, and class, as well as the psychological barriers to accessing dental care. Regarding gender differences in utilization, women were more prone to delaying care compared to men, especially when facing discrimination. Participants adopted various self-coping strategies in response to discrimination in oral healthcare settings, including prioritizing at-home oral care, postponing, or avoiding dental appointments, and seeking out Black dentists for more understanding care and to mitigate discriminatory experiences.
CONCLUSION: This study is the first of its kind, exploring the psychosocial and behavioral impact of discrimination in oral healthcare settings among Black adults aged 21-64. As research progresses in the realm of health equity and improving the well-being of marginalized populations, it becomes imperative for oral health professionals, dentists, researchers, and public health practitioners to prioritize the cultural norms, beliefs, and values of Black adults. This involves ensuring that their healthcare needs are met with understanding and empathy, while also creating inclusive and supportive environments where patients feel respected, heard, and valued, particularly through trauma-informed care practices. The findings of this study offer valuable insights for future research, public health campaigns, behavioral interventions, dental training programs, and statewide policy initiatives aimed at addressing the needs of Black adults in Baltimore. These recommendations pave the way for further studies and intervention strategies aimed at improving overall health and oral health outcomes within this demographic.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
5-8-2024
Included in
Community Health and Preventive Medicine Commons, Dental Public Health and Education Commons, Health Services Research Commons, Social Work Commons