(PS6-A24) Predicting Healthcare Utilization: Role of Health-related Beliefs

Introduction: Prior research has investigated predictors of healthcare utilization, including predisposing characteristics (e.g., gender and age), enabling factors (e.g., income and health insurance), and psychological factors (e.g., fear of pain, depression, and anxiety). Dental treatment seeking behavior has been used as a model for healthcare utilization, with similar factors such as gender, household income, dental fear, and fear of pain affecting dental care utilization. Few studies have investigated the effects of patient health-related beliefs in predicting healthcare utilization. Patient conceptions, for example, regarding provider communication style and professionalism, in addition to the patient’s healthcare trust and perceived control within healthcare settings, represents an overlooked area of investigation. The present study used dental care utilization as a model for healthcare utilization to examine dental beliefs as a predictor of dental care utilization.

Methods: The sample included 102 participants (M age = 34.2 years, SD = 11.56; 57.8% female) who were volunteers for a laboratory-based oral health study. Participants completed a series self-reported demographics and well-validated psychological measures. Oral healthcare utilization was measured using a single-question self-report item asking, “How long since you last saw a dentist?” Response options were dichotomized into those who had utilized care within the last year (“utilization”) versus those who had not (“under-utilization”). Study predictor measures included the Dental Fear Survey (DFS), Dental Belief Survey (DBS), Fear of Pain Questionnaire (FPQ), and all three subscales of the Anxiety Sensitivity Index (ASI; i.e., physiological, cognitive, and social subscales). Logistic regression models were used to examine predicted associations, controlling for income. 

Results: Most (73.5%) individuals in the sample indicated that they utilized dental care in the last year. Dental beliefs were the strongest predictor of oral healthcare utilization (OR = 0.95, 95% CI [0.91, 0.99]), such that more negative dental beliefs predicted under-utilization, while controlling for the influence of income.  There were significant associations among the predictor variables (e.g., DFS, DBS, FPQ, and ASI)

Conclusions: Using dental care utilization as a model for health care utilization, it was found that more negative beliefs about healthcare providers predicted under-utilization. The relationships among anxiety sensitivity, dental fear, dental beliefs, and fear of pain are noteworthy, and should be further explored. Collinearity among these variables therefore was a limiting consideration in these analyses. Findings suggest that poor provider-client communication and professionalism, as well as patients’ feeling as though they are not in control and do not trust their provider may contribute to under-utilization of dental care. Future research may consider the role of patient health-related beliefs (e.g., provider professionalism and communication) in predicting varying types of healthcare-seeking behaviors.