76 - Exploring social determinants as barriers to dental care using a Three Delays theoretical framework

Abstract: The Three Delays model is a well-established global public health framework where each delay represents a series of factors affecting obstetric service utilization: 1) Delay #1- Deciding to seek care, 2) Delay #2- Reaching an appropriate facility, and 3) Delay #3- Receiving adequate care. The aim of this qualitative study was to test the validity of the Three Delays model as it applies to dental care utilization and to describe factors attributed to delayed utilization of dental services within this framework. We utilized criterion purposive sampling to conduct 17 individual interviews followed by 18 subsequent interviews with a subset of five of those participants over three months. Interviews were transcribed and aggregated for comprehensive content analysis using NVivo qualitative software plus manual analysis with trained, calibrated study team members. We utilized inductive and theory-driven approaches for constructing seven major themes: 1) Communication between patient and provider, 2) Financial considerations, 3) Stress factors, 4) Participant’s prior healthcare experiences, 5) Participant’s social cohesion, 6) Participant’s oral health literacy, 7) Time and 8) Participant’s definition and perception of health. Example sub-themes within each theme include interpersonal communication, childcare costs, eviction, immigration status, racism, stigma, social connection, technology literacy, time constraints, and competing priorities. Themes and subthemes were then categorized as factors into the ‘Three Delays’ framework, corroborating this model for the study of dental care utilization. A Three Delays dental framework can help identify modifiable barriers and data-driven points of intervention for more effectively uncovering and addressing delays in oral health care utilization.

Source of Funding: This project was made possible by the support of the DentaQuest Partnership for Oral Health Advancement (now CareQuest Institute for Oral Health).