Study On The Utilization Of Oral Health Services And Its Influencing Factors Of Rural Residents In Yunnan Province

Objectives: To investigate the utilization status of oral health services among rural residents in Luquan County,Longyang District,Baoshan City and Shidian County,Kunming City,Yunnan Province,and analyze the utilization status and main influencing factors of oral health services among rural residents,in order to provide evidence for improving the provision and utilization of oral health services among rural residents.Methods: In this cross-sectional study,three counties(districts)with representative socio-economic environment are selected within the scope of Yunnan Province by using multi-stage stratified cluster sampling method,which respectively represent the three degrees of good,average and lagging.Each county is divided into two levels according to its economic level and distance from the county seat,and two towns(streets)are selected.2 administrative villages(communities)are selected from each township(street)according to the distance.Finally,6 townships(streets)were selected,including Pingshan Street and Maoshan Township,Luquan County,Kunming City,Qinghua Street and Hetu Street,Longyang District,Baoshan City,Youwang Town and Renhe Town,Shidian County,Baoshan City,and 12 administrative villages(communities)were selected for field investigation.The questionnaire survey was completed by using the question paper specially designed for the project.The main contents of the questionnaire include: general information of the respondents,knowledge,letter and practice of oral health,knowledge of HIV/HCV,and utilization of oral health services.After double data entry,SPSS20.0was used for statistical analysis,and descriptive analysis was conducted on the basic demographic information,knowledge,letter and practice of oral health of the research objects: The measurement data meeting the normal distribution were expressed by mean ± standard deviation((?)±s)and the count data were expressed by frequency and component ratio(%).Single factor analysis was performed by Chi-square test or rank sum test,with the test level α=0.05(bilateral).The variables with statistical significance(P<0.05)in univariate analysis were included in the binary Logistic regression equation to further analyze the influencing factors of oral health service utilization of rural residents in Yunnan province.Results:(1)A total of 2,100 rural residents in Yunnan Province were investigated in this study,2,100 questionnaires were collected,2,066 were effective,and the effective rate was 98.38%.There were 915(44.29%)males and 1151(55.71%)females;The maximum age was 93 years old,the minimum age was 9 years old,and the average age was 39.47±22.04 years old.530(25.65%)were aged 9 to 18,1050(50.82%)were aged 19 to 59,and 486(23.52%)were aged 60 and above.Of the people surveyed,658(31.85%)were from Luquan County,758(36.69%)from Longyang District and 650(31.46%)from Shidian County.The Han nationality had the largest number of 1876(90.80%),and the other nationalities 190(9.20%).981students(47.78%)from primary school or below,447 students(21.64%)from junior middle school,192 students(9.29%)from senior high school or technical secondary school,210 students(10.16%)from junior college,236 students(11.42%)from undergraduate or above.Farmers(837)and students(40.51 percent)accounted for the largest number of jobs,and 540(26.14 percent),respectively.The total average score of the survey subjects’ oral health knowledge was(3.18±0.95)points,4-5 points was recorded as good oral health knowledge,accounting for 43.08%,0-3 points was recorded as poor oral health knowledge,accounting for 56.92%.It can be seen that rural residents lack oral health knowledge.Although 1,794 people(86.83 percent)knew that bacteria can cause dental caries(cavities),1,867 people(90.37 percent)wrongly believed that eating sugar can cause dental caries(cavities),and 39.45 percent wrongly believed that bleeding gums are normal when brushing teeth.The total average score of oral health attitude knowledge was(4.76±0.94)points.0-4points were defined as negative oral health attitude,accounting for 29.77%,and 5-6points were defined as positive oral health attitude,accounting for 70.23%.Therefore,most of the subjects had positive oral health attitude.In the survey,2,027 people(98.11 percent)brushed their teeth every day,with 21.39 percent brushing once a day and 76.72 percent brushing twice a day or more.Only 29.09% use fluoride toothpaste;Only 1.50% floss every day,and 63.89% never floss;25.12% changed their toothbrush once a month,47.19% changed their toothbrush once 1-3 months,and27.69% changed their toothbrush over 3 months.It can be seen that rural residents have poor oral hygiene habits.(2)Demand for oral health services: Among 2066 subjects,842 people had good oral health evaluation(including very good and good),accounting for 41.12%;900 people had average oral health evaluation,accounting for 43.56%;324 people had poor oral health evaluation(including poor and very poor),accounting for15.68%;There were 589 people(28.51%)who had never seen a dentist,among which484 people(82.18%)who had graduated from junior high school or below had never seen a dentist.Among occupational types,386 farmers(65.53%)had never seen a dentist.The main reasons for not seeing a tooth were as follows: 323 people(54.84%)felt that there was no tooth problem;190 people(32.26%)think that the tooth does not hurt/pain,do not need to see;23 people(3.90%)bought painkillers when they had a toothache,16 people(2.71%)did not consciously go to the dentist,8 people(1.36%)said they did not have time to go to the dentist,7 people(1.19%)said they had financial difficulties,6 people(1.02%)thought the tooth disease was not serious,and7 people(1.19%)thought it was some other reason.(3)Utilization of oral health services: Among the 2066 people surveyed,1477(71.49%)had medical experience,among which 19.70% had the last dental visit for less than 6 months,22.07% for 6-12 months,and 58.23% for more than 12 months.The top three reasons for the last visit were examination,extraction and filling,accounting for 29.65%,26.88% and 21.73%,respectively.The rate of dental visit in the past 12 months was significantly higher for women than for men,and there was no difference in the top three main reasons for last dental visit between men and women.In the choice of the type of medical institution for the last visit,the number of people who chose to go to the county level and above hospitals for treatment of stomatology was the largest,followed by individual dental clinics;The main reasons for rural residents to choose different types of medical institutions are the high level of medical skills of dental medical staff,good environment and service attitude of medical institutions and the proximity of medical treatment.Univariate analysis was conducted on whether there had been medical experience in the past.The results showed that region,age,nationality,education level,occupation,oral health knowledge,oral health attitude,oral health self-evaluation,HIV knowledge and HCV knowledge had significant effects,and the difference was statistically significant(P<0.05).The results of multivariate binary Logistic regression analysis showed that region,age,educational level,oral health attitude,oral health self-evaluation,HIV knowledge and HCV knowledge had significant effects on whether oral health services had been used(P<0.05).According to the single factor analysis of the department of stomatology of county-level and above hospitals selected for the last oral medical institution,the results showed that region,age,education level,occupation,oral health knowledge,oral health attitude,self-evaluation of oral health,HIV knowledge,HCV knowledge,and the reason of medical treatment had significant effects,and the difference was statistically significant(P<0.05).The results of multivariate binary Logistic regression analysis showed that region,occupation,oral health self-evaluation,HCV knowledge,and medical reasons had an impact on the selection of stomatology department of county-level and above hospitals for the last oral medical institution(P<0.05).(4)Utilization of oral health services in the past year: 617 people(29.86%)visited dentists in the past year.With the increase of age,the rate of visits shows a downward trend.The contents of oral health service utilization were different among different age groups.In the age group of 9-18 years old,the top three reasons for dental treatment in the past year were extraction(43.72%),examination(31,58%)and filling(17.00%),respectively.In the age group of 19-59 years old,the top three reasons for visiting doctors in the past year from high to low were examination(32.48%),filling(26.05%)and cleaning(16.40%).In the age group 60 and above,the top three reasons for medical treatment in the past year were examination(22.03%),dental filling(18.64%)and dental prosthesis(18.64%).The largest number of patients went to the stomatology department of county-level hospitals and above,409(66.329%),143(23.18%)individual dental clinics,61(9.89%)township health centers,and 4(0.65%)tourist doctors.Among different age groups,the group aged9-18 years had the highest rate of choosing the dental department of county-level hospitals or above(71.66%),and the group aged 60 years or above had the highest rate of choosing individual dental clinics(27.12%).The main reasons for choosing different medical institutions from high to low were 68.56% trustworthy doctors,55.11% good environment and service attitude,41.17% close,20.75% medical insurance card for designated units,18.80% for low price,and 1.94% for other reasons.The univariate analysis of whether to see a doctor in the past year showed that region,age,education level,occupation,oral health knowledge,oral health attitude,self-evaluation of oral health,HIV knowledge and HCV knowledge had significant effects,and the difference was statistically significant(P < 0.05).Binary Logistic regression analysis showed that age,occupation and HIV knowledge had significant effects on oral health service utilization in the past year(P<0.05).Conclusions:(1)The surveyed rural residents lack oral health knowledge,most of them have a positive attitude towards oral health,but poor oral health behavior.(2)Investigated rural residents do not pay attention to oral health,ignore regular oral health examination,passive medical treatment.(3)The surveyed rural residents have a great demand for oral health services,but the utilization rate of oral health services is low.(4)The surveyed rural residents mainly choose the stomatology department of county-level and above hospitals as the main medical institutions,which is not convenient to see a doctor;The main factors to consider in the selection of oral medical institutions are high level of medical technology,reliability,environment,good service attitude and proximity.