Using the Unified Theory of Acceptance and Use of Technology (UTAUT) to predict the behavioral intent of teledentistry utilization amongst United States adults.

INTRODUCTION: Teledentistry is an innovative health care delivery platform that can potentially improve oral health access and outcomes. The purpose of this study was to predict teledentistry utilization intentions of U.S. adults using the Unified Theory of Acceptance and Use of Technology (UTAUT) as a framework. METHODS: This mixed-method, cross-sectional study surveyed 899 participants from two independent samples in August and September 2021. Convenience samples of Minnesota State Fair attendees and ResearchMatch volunteers completed electronic surveys to identify the behavioral intention (BI) for teledentistry use within the next 6 months. Independent variables were the UTAUT constructs of performance expectancy (PE), effort expectancy (EE), social influence (SI), and facilitating conditions (FC). Data were analyzed using univariate analysis and multiple linear regression adjusting for age, gender and educational level. Qualitative analysis used thematic analysis using UTAUT as a coding framework. RESULTS: Univariate analysis showed statistical significance between each construct with BI (P < 0.0001). Adjusted multiple linear regression revealed statistical significance between PE and SI with BI (P < 0.0001). Qualitative responses corroborated quantitative results and revealed a lack of teledentistry knowledge. CONCLUSION: The majority of participants indicated an intention not to use teledentistry within the next 6 months. The lack of prior experience of telehealth or teledentistry use in addition to lack of knowledge regarding teledentistry may contribute to these results. Future interventions to improve the BI to use teledentistry may benefit from focusing on PE and SI constructs for educational and marketing strategies.

A comparison of simulation and traditional local anesthesia teaching methods among dental hygiene students.

BACKGROUND: The COVID-19 pandemic forced dental educators to quickly modify the teaching-learning platform without testing outcomes of alternative teaching methods prior to implementation. One critical course affected was the teaching of local anesthesia (LA) that moved from practicing injections using the traditional student-to-student method to the simulation model using manikins. PURPOSE: This study compared two LA teaching methods (student-to-student versus simulation) in two consecutive cohorts before and during the pandemic to assess differences in students' skill level and self-confidence. METHODS: This quasi-experimental study recruited a convenience sample of dental hygiene students at the University of Minnesota during 2020 and 2021. Consent was collected prior to student-to-student injection practice and survey distribution. Data collected were clinical and summative clinical assessments to determine LA skill level, and student surveys to assess self-confidence. Analyses included descriptive statistics, linear models within and between cohorts, and inductive analysis for qualitative survey responses. RESULTS: Fifty of 57 students (88%) completed the survey, and 54 (95%) consented access to their clinical assessments. Skill level was significantly higher for the simulation cohort compared to the student-to-student cohort on the LA summative clinical assessment (59.0 vs. 55.6, p = 0.004). No differences were found in self-confidence between cohorts. A positive association was found between students' self-confidence and skill levels for both cohorts, but only student-to-student cohort results were statistically significant (student-to-student: r = 0.44, p = 0.02; simulation: r = 0.24, p = 0.26). CONCLUSION: Results support incorporating simulation manikin teaching methods for LA with a student-to-student partner component.

Functional Oral Health Literacy and Periodontal Health.

Purpose: Growing evidence associates low oral health literacy (OHL) with poor oral health outcomes. While nearly half of United States adults have periodontal disease (PD), there are conflicting results on association between OHL and PD. The purpose of this pilot study was to explore the association between functional OHL and periodontal health as defined by the American Academy of Periodontology (AAP) classification system.Methods: A cross-sectional study was conducted with a convenience sample of dental patients presenting for care at a Midwestern Federally Qualified Health Center. Functional OHL was measured using the Oral Health Literacy Adults Questionnaire (OHL-AQ), and periodontal health was measured clinically and categorized by stage and grade using the recently revised AAP classification system. Additional demographic factors and health history information related to periodontal health were collected. Descriptive analysis reported the median and range for ordered variables, and frequency and percentages for categorical variables. Wilcoxon rank sum test, Kruskal-Wallis test, and Spearman correlation coefficients were used to find association between functional OHL and periodontal health.Results: Among fifty-four participants, statistically significant associations were found between OHL-AQ scores and AAP staging and grading categories. Periodontal disease stage increased with age, and periodontal disease grades progressed among participants with diabetes. No associations were found between periodontal health and sex, race, ethnicity, education, insurance, or country of origin.Conclusion: Functional oral health literacy had a significant inverse relationship with both AAP periodontal disease staging and grading. A larger study is needed to confirm the findings of this pilot study.

Human Papillomavirus Content Inclusion in Dental Hygiene Program Curricula in the United States.

Purpose: Human papillomavirus (HPV)-related oropharyngeal cancers (OPC) have significantly increased over the past three decades despite vaccine availability to prevent carcinogenic HPV types. Dental hygienists are well-positioned to provide HPV counsel to patients; however, most do not feel prepared to do so. The purpose of this study was to examine HPV content inclusion in dental hygiene program curricula in the United States (US).Methods: Dental hygiene program directors in the US were invited to participate in an electronic survey (n=309). The 20-item survey assessed the curricular content related to HPV as well as the faculty training in this area. Descriptive statistics were used to analyze the data.Results: Ninety surveys were returned for a response rate of 29%. Most programs spent up to 2 hours on HPV content. Students across all institutional settings received education on OPC risk factors (66.3%); HPV screening, referral, and management (78.7%); HPV vaccine knowledge (79.8%); and communication skills about HPV (77.5%). The majority of HPV-related content was taught by dental hygiene faculty, although dentists, oral pathologists or medical specialists were involved across all institutional settings.Conclusion: Results indicate that dental hygiene programs, regardless of institutional setting, provide two hours or less of HPV didactic content and clinical application. More research is needed to confirm the adequate time and teaching strategies required to assure that dental hygienists are well-prepared to address HPV preventive strategies.

Acceptance of Dental Office Obstructive Sleep Apnea Screening among Minnesota State Fair Attendees.

Purpose: Obstructive sleep apnea (OSA) is a common breathing disorder; however, many individuals remain undiagnosed. The purpose of this study was to assess the comfort level of community-dwelling adults to participate in OSA screening in a dental office setting and survey the OSA risk levels of an adult population.Methods: This cross-sectional study was conducted among adults presenting at the University of Minnesota Driven to Discover Research Facility during the 2018 Minnesota State Fair. Participants completed a brief survey including the eight-item STOP-Bang questionnaire for OSA screening. Electronic tablets were used for data capture. Data analyses included descriptive statistics, t-tests, and Chi-square tests.Results: A total of 639 adults met the survey inclusion criteria (n=639). The majority of participants (88%) reported no prior OSA diagnosis. Based on STOP-Bang criteria, 61% (n=344) of the participants were at low, 29% (n=161) intermediate, and 10% (n= 56) high risk of OSA. A majority (64%) of participants reported being either "comfortable" or "very comfortable'"with OSA screening performed in a dental office setting.Conclusion: Over one third of participants with no prior OSA diagnosis were at moderate to high risk for OSA, and the majority stated that they would be comfortable undergoing OSA screening in a dental office setting. Dental hygienists screening patients for OSA with the STOP-BANG questionnaire are likely to have a high level of patient acceptance. Referring patients to the appropriate health care provider for further testing may increase timely diagnoses and treatment of OSA.

Item and scale properties of the Oral Health Literacy Adults Questionnaire assessed by item response theory.

OBJECTIVES: a) To evaluate the item and scale properties of the Oral Health Literacy Adults Questionnaire (OHL-AQ) in an adult general population. b) To determine precision or accuracy of the respondents' estimated scores along the Oral Health Literacy (OHL) spectrum using item response theory (IRT) modeling. METHODS: Survey data were collected from a convenience sample of 405 adult attendees of the 2014 Minnesota State Fair. We used the two-parameter logistic (2PL) model for the item response theory (IRT) analyses of OHL-AQ data and calibrated items to estimate model-based item difficulty and discrimination parameters. Item and scale properties were also assessed by plotting and interpreting item characteristic curves (ICCs), test characteristic curve (TCC), and test information function (TIF). RESULTS: Based on interpretation of model coefficients, statistical testing, and model fit criteria, we deemed the 2PL model superior and selected this model to examine item and scale properties. Scale reliability was shown to be good through the test information function (TIF). TIF from our analysis showed that higher levels of OHL were measured less precisely than lower levels of OHL. CONCLUSION: We demonstrated OHL-AQ as a whole has promising psychometric properties. However, for equiprecise measurement across the scale range, the scale needs more items for measuring higher levels of OHL.

The Association of Social Determinants of Health with Somali Refugee Mother-Child Caries.

Minnesota has the largest population of Somali refugees with the majority depending on public insurance for dental care. The social determinants of health (SDOH) framework is helpful to identify factors that may be related to oral health, and subsequently plan for public health initiatives. The purpose of this study was to measure the correlation between Somali refugee mother-child caries experience, and to identify associations between SDOH factors and child caries. The study was conducted in day care facilities where oral screenings and surveys identified SDOH factors at the individual, provider, community and environmental levels. A positive correlation was found between mother-child caries experience. Factors associated with child caries (p ≤ 0.05) were found at all SDOH levels except the provider level though only individual level factors for mothers and children yielded the expected results. SDOH affecting child caries were limited to individual demographic, behavioral and attitudinal factors.

Obstructive Sleep Apnea Knowledge: Attitudes and screening practices of Minnesota dental hygienists.

Purpose: Reported cases of obstructive sleep apnea (OSA) range between 4% to 9%, however between 70% to 90% of adults in the United States remain undiagnosed. The purpose of this study was to determine the current knowledge and attitudes of OSA among Minnesota dental hygienists and inventory OSA screening protocols currently used in dental practices.Methods: The cross sectional study used an adapted Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) survey instrument. Survey items included demographic variables, and measured attitudes, knowledge and perceived knowledge about OSA, routine screening procedures, and use of validated OSA screening protocols. Paper surveys were mailed to a random sample of 750 licensed Minnesota dental hygienists. Analyses included descriptive statistics (counts and frequencies), and analytic tests (one-way ANOVA, Pearson's correlation, and t-tests, Cronbach's alpha), as appropriate.Results: Twenty-six percent of the returned surveys met inclusion criteria (n=197) and were used in the final analyses. Respondent age ranged from 19 to 70 years and mean years in practice experience was 19.9. The majority (93.9%) were in general practice and had completed an associate degree (59.6%). The mean (SD) self-rated OSA knowledge was 3.5 (3.3) on a scale of 0-10, attitude score was 3.2 (0.8) on a 5-point Likert scale, and knowledge score was 9.5 (range 0-17). No significant differences were found by age, degree type, or years in practice and OSA knowledge or attitudes. Routine practices included head and neck exams (89.3%), taking blood pressure (41.6%). Using a validated OSA screening protocol was reported by 9.6% of the respondents.Conclusion: Dental hygienists perceive that assessing patients for OSA is important, however they have moderate knowledge of the disease. Results support incorporating OSA into dental hygiene practice through additions to the dental hygiene education curriculum and ongoing professional development courses with the goal of improving the screening and referral of patients presenting with OSA symptoms.

Confirmation of the unidimensional structure of the Oral Health Literacy Adults Questionnaire.

OBJECTIVES: The Oral Health Literacy Adults Questionnaire (OHL-AQ) was designed to test functional oral health literacy in general populations. Exploratory analyses suggested a unidimensional structure rather than the four constructs proposed (reading comprehension, numeracy, listening and decision-making). The purpose of this study was to conduct a confirmatory analysis of the OHL-AQ. METHODS: A cross-sectional study design used a stratified multistage sampling strategy in 22 districts of Tehran, Iran. The OHL-AQ was administered verbally in its original Persian language. Confirmatory analyses replicated the previous exploratory analyses to determine dimensionality and internal consistency. Data were then randomly assigned to two data sets and item analyses were performed to test reliability. RESULTS: Evidence of unidimensionality was confirmed as the exploratory factor analysis could replicate previous results in a different population. In a confirmatory factor analysis, model fit indicators were mixed because chi-square results were statistically significant and the standard root mean square residual (SRMR) neared guideline values. The comparative fit index (CFI) and the Tucker-Lewis index (TLI) did not meet recommended values but the root mean square error of approximation (RMSEA) was well within standards. Both score validity and reliability were adequate. CONCLUSIONS: While findings overall support that OHL measured using the OHL-AQ can be considered unidimensional and therefore OHL can be characterised with one score, further dimensionality studies are needed to investigate populations in which OHL is low.

Did Intraprofessional Training with Dental Therapists Affect Dental Students' Attitudes Toward Caring for the Underserved?

Dental therapy was recently introduced as a new oral health care workforce model to increase care for vulnerable populations in Minnesota. Nine dental therapy and 98 dental students began intraprofessional training at the University of Minnesota in 2009. The aim of this longitudinal study was to determine whether intraprofessional education with the dental therapy students would affect the dental students' attitudes toward caring for underserved populations. One class of dental students was surveyed annually between 2009 and 2013 using the Attitudes Toward Health Care survey to measure attitudinal changes about treating vulnerable patients across their four years of dental school. Participation ranged from 68% to 99% in each year. The results showed that the dental students had positive attitudes toward treating vulnerable patients on entering dental school, but their attitudes became less positive over the four years. While the composite survey results were similar to other studies using the same instrument, variations were seen by domain. These students' attitudes about societal expectations and personal efficacy remained stable, while their dentist/student responsibility and access to care attitudes showed statistically significant declines. Their positive attitudes toward treating the underserved declined over four years regardless of intraprofessional training with dental therapy students. As attitudes toward caring for vulnerable patients are shaped by both personal attitudes and societal norms, additional research is needed to determine whether the addition of an intentional curricular thread may alter results over time compared to intraprofessional training alone.

Provider and interpreter preferences among Somali women in a primary care setting.

OBJECTIVES: Somali people are among the largest refugee populations to resettle in North America and Europe over the past 2 decades, and health disparities are well documented, including barriers to effective navigation of primary health care systems. Patient-provider gender discordance has been described as a barrier to health-seeking behaviors and effective communication by Somali women in past qualitative work. The objective of this study was to elucidate provider and interpreter preferences during clinical encounters according to gender and race among Somali women in the United States. METHODS: Fifty Somali women empanelled to a large primary care practice completed pictorial surveys to elucidate preferences of Somali women for providers of different genders and race for different components of the clinical examination using a Likert-type scale. RESULTS: We found that Somali women generally preferred a female provider for conducting the physical examination, particularly for the pelvic, breast, and abdominal examinations. Likewise, Somali women strongly preferred female interpreters to be present during the physical examination. There was no stated preference for patient-provider racial concordance. CONCLUSIONS: These findings have implications for structural health care changes aimed at delivering culturally sensitive and effective primary care to Somali patients.

Cervical cancer screening adherence among Somali immigrants and refugees to the United States.

Somali women have lower cervical cancer screening (CCS) rates than non-Somali women in the United States. We examined clinical and administrative data associated with CCS adherence among Somali women seen at a large primary care practice over 2 years. Fifty-one percent of 310 women were adherent to CCS, and adherence was associated with more overall health care system visits. Patients saw male providers 65.8% of the time; however, only 20.4% of the CCS tests were performed by male providers. Future interventions that enhance cancer prevention, health literacy, and patient-provider gender concordance may improve rates of CCS among Somali women.

'They leave at least believing they had a part in the discussion': understanding decision aid use and patient-clinician decision-making through qualitative research.

OBJECTIVE: This study explores how patient decision aids (DAs) for antihyperglycemic agents and statins, designed for use during clinical consultations, are embedded into practice, examining how patients and clinicians understand and experience DAs in primary care visits. METHODS: We conducted semistructured in-depth interviews with patients (n=22) and primary care clinicians (n=19), and videorecorded consultations (n=44). Two researchers coded all transcripts. Inductive analyses guided by grounded theory led to the identification of themes. Video and interview data were compared and organized by themes. RESULTS: DAs used during consultations became flexible artifacts, incorporated into existing decision making roles for clinicians (experts, authority figures, persuaders, advisors) and patients (drivers of healthcare, learners, partners). DAs were applied to different decision making steps (deliberation, bargaining, convincing, case assessment), and introduced into an existing knowledge context (participants' literacy regarding shared decision-making (SDM) and DAs). CONCLUSION: DAs' flexible use during consultations effectively provided space for discussion, even when SDM was not achieved. DAs can be used within any decision-making model. PRACTICE IMPLICATIONS: Clinician training in DA use and SDM practice may be needed to facilitate DA implementation and promote more ideal-type forms of sharing in decision making.

Primary care utilization and mental health diagnoses among adult patients requiring interpreters: a retrospective cohort study.

BACKGROUND: Patients requiring interpreters may utilize the health care system differently or more frequently than patients not requiring interpreters; those with mental health issues may be particularly difficult to diagnose. OBJECTIVE: To determine whether adult patients requiring interpreters exhibit different health care utilization patterns and rates of mental health diagnoses than their counterparts. DESIGN: Retrospective cohort study examining patient visits to primary care (PC), express care (EC), or the emergency department (ED) of a large group practice within 1 year. PATIENTS: Adult outpatients (n = 63,525) with at least one visit within the study interval and information regarding interpreter need. MAIN MEASURES: Mean visit counts, counts of mental disorders, and somatic symptom diagnoses between patients requiring interpreters (IS patients) and not requiring interpreters (non-IS patients). KEY RESULTS: IS patients (n = 1,566) had a higher mean number of visits overall (3.10 vs. 2.52), in PC (2.54 vs. 1.95), and in ED (0.53 vs. 0.44) than non-IS patients (all p < 0.01). IS patients had a lower mean number of visits in EC than non-IS patients (0.03 vs. 0.13; p < 0.01). Interpreter need remained a significant predictor of visit count in multivariate analyses including age, sex, insurance, and clinical complexity. A greater proportion of IS patients were high utilizers (10+ visits) than non-IS patients (3.6 % vs. 1.7 %; p < 0.01). IS patients had a lower frequency of mental health diagnoses (13.9 % vs. 16.7 %), but a higher frequency of diagnoses recognized as potential somatic symptoms including diseases of the nervous (29.3 % vs. 24.2 %), digestive (22.6 % vs. 14.5 %), and musculoskeletal systems (43.2 % vs. 34.5 %), and ill-defined conditions (61 % vs. 49.9 %), all p < 0.01. CONCLUSIONS: IS patients visited PC more often than their counterparts and were more often high utilizers of care. Two sources of high utilization, mental health diagnoses and somatic symptoms, differed appreciably between our populations and may be contributing factors.

Evaluating sex and gender competencies in the medical curriculum: a case study.

BACKGROUND: Sex and gender differences exist in the manifestation and prevalence of many conditions and diseases. Yet many clinician training programs neglect to integrate this information across their curricula. OBJECTIVE: This study aimed to measure the sex and gender medical knowledge of medical students enrolled in a program without an explicit directive to integrate sex and gender differences across a block system of core subjects. METHODS: A forced-choice instrument consisting of 35 multiple-choice and true or false questions was adapted from an evaluation tool used in the European Curriculum in Gender Medicine held at Charité Hospital, Berlin, in September 2010. RESULTS: Fourth-year (response rate 93%) and second-year (response rate 70%) students enrolled in Mayo Medical School completed the instrument. More than 50% of students in both classes indicated that topics related to sex and gender were covered in gynecology, cardiology, and pediatrics, and <20% of students indicated inclusion of such topics in nephrology, neurology, and orthopedics. More than twice as many second-year students indicated that topics dealing with sex and gender were included in immunology course material compared with fourth-year students. A consensus of written comments indicated that concepts of sex and gender-based medicine need to be embedded into existing curriculum, with an emphasis on clinically relevant information. CONCLUSIONS: Although this study represents only one medical school in the United States, information regarding sex and gender aspects of medicine is not consistently included in this curriculum without an explicit directive. These results can provide guidance for curriculum improvement to train future physicians.

Predictors of patient comfort and adherence with less frequent cervical cancer screening.

BACKGROUND: The Papanicolaou (Pap) test is an effective, well-accepted screening tool that has led to a decrease in cervical cancer incidence and mortality. Updated evidence-based cervical cancer screening guidelines support less frequent testing in low-risk patients but have met resistance from providers and patients. AIMS: To assess patient knowledge about cervical cancer screening and attitudes toward recommendations for less frequent testing. METHODS: A hard copy of an eight-question survey was distributed to 389 women aged 30-64 years at two primary care clinics in Rochester, Minnesota, over a six-week period. RESULTS: The survey response rate was 86.8%. Of the 280 women who responded to a survey question about the cause of cervical cancer, 212 (75.7%) identified human papillomavirus (HPV) as the cause. Multivariable logistic regression analysis showed that this knowledge was not associated with feeling comfortable with a recommendation for less frequent testing or with support for less frequent testing. The only significant predictor of patient comfort and adherence with a two- to three-year Pap testing interval was the patient's belief about whether a Pap test was needed annually or every two or three years. CONCLUSIONS: Patient belief about Pap testing frequency was the strongest predictor of attitude toward less frequent Pap testing and was not based on knowledge of HPV. Future studies should explore why some patients continue to expect annual testing and identify interventions to help providers elicit and change patients' expectations about cervical cancer screening.

Indicators of acculturation related to Somali refugee women's birth outcomes in Minnesota.

We investigated the effect of indicators of acculturation among Somali refugee women's birth outcomes. Data were extracted from medical records of 584 Somali women delivering infants at a Midwestern hospital between 1993 and 2006. Bivariate analyses measured relationships between independent factors and the dependent variables of gestational age and birthweight. Structural equation modeling (SEM) determined the fit between factors hypothesized to reflect acculturation and the data. Significant increases noted over time were substance use/exposure, interpreter use, body mass index, hemoglobin levels, gestational diabetes and preterm birth. Bivariate analyses showed significance between prenatal care utilization and both preterm birth and gestational age. SEM results indicated a moderate to good fit between the hypothesized model and available data. Factors hypothesized to reflect acculturation and effect birth outcomes among Somali women are increasing but did not account for increased preterm birth. Further investigation is warranted to identify and truncate further disparate birth outcomes.

Somali prenatal education video use in a United States obstetric clinic: a formative evaluation of acceptability.

OBJECTIVE: Because of low health literacy and low priority in seeking prenatal information, health education videos were explored for acceptability by Somali refugee women in a clinical setting. METHODS: Focus groups led to the development of six targeted Somali prenatal education videos. Topics include: preparation for pregnancy, nutrition and exercise, pregnancy myths/facts, the father's role, episiotomies, and caesarean sections. Somali participants were recruited to view programs, and completed an 8-item survey prior to regularly scheduled prenatal appointments. Following the clinical visit, providers completed a 4-item survey indicating the video's helpfulness in facilitating client-provider communication. RESULTS: All study participants "strongly recommended" and rated the videos as "appropriate for Somali clients", 57% indicated the information was "just the right amount," and 60% found the videos "extremely helpful." The primary language spoken at home was Somali (72.7%) and 54.5% indicated Somali as the preferred language to receive health information. Providers indicated 24% of appointments were "more interactive" with 72% finding videos "somewhat" or "extremely helpful." CONCLUSION: Preliminary results from this pilot study suggest that a video format for prenatal education is acceptable to Somali clients with most clients preferring video health education materials presented in the Somali language. PRACTICE IMPLICATIONS: Culturally tailored health education video series for Somali women appear well for use in a clinic setting to facilitate client-provider communication.