Introduction
One of the most important and widely recognized public health issues is that of access to care (Perwira, 2014). In the field of oral and dental health, the persisting challenges of poor access to care can be found all around the world in developed, as well as developing countries. Moreover, the populations and communities suffering from this problem are multiple and diverse; therefore, their needs and health issues differ as well. In that way, to address the problem of access to oral care, healthcare systems of the world focus on a broad scope of factors contributing to its development and prevalence (Maxey, 2014). Due to the complexity of the issue, there exist the need for further research in this area to facilitate a deeper understanding of root causes, dynamics, mechanisms, and effects of inequalities in dental care access. The present research will focus on the exploration of limited access to oral care among rural and underserved populations and seek to identify some of the most frequently identified causes of the problem at the global level and in the territory of the United States specifically.
Purpose of Research
Because the explored problem is not particularly unique to the United States and is of a global rather than local nature, there exists a variety of methods and approaches designed for minimization of the effect of this issue. Some of the measures addressing the problem of limited access to oral and dental care focus on the engagement of volunteer oral health care practitioners and dental students, thus allowing the creation of the systems helping to deliver flexible and affordable services to the populations and communities in need (Razdan, Degenholtz, & Rubin, 2016). Moreover, another model helping to address the issue of unequal access to oral care involves the organization of portable dental centers that enables oral health professionals to provide care to remote areas, individuals who require dental services in homebound settings, and displaced groups of the population (Ganavadiya, Chandrashekar, Goel, Hongal, & Jain, 2014).
In the contemporary world, the research in this area is particularly important due to the ongoing relocation of different population groups under the impact of globalization and other socio-economic factors (Keboa, Hiles, & Macdonald, 2016). Differently put, the purpose of this research is to expand the existing body of knowledge about unequal access to oral health care in underserved and rural populations that could have dynamic causes changing over time due to the shifts of environmental, economic, and social conditions in the areas where the aforementioned populations reside. The limitations of access to care continue to persist regardless of the applied solutions and strategies designed for the minimization of the problem (Razdan et al., 2016; Ganavadiya et al., 2014). This tendency points at the need for more refined approaches formulated specifically to target individual populations with their unique sets of contributing factors. In that way, this research is aimed at the identification of specific features of the underserved communities worldwide and in the United States to enable more efficient strategies to address the issue. Additionally, the study is focused on finding the connections and correlations between the determinants of the prevalence of access limitations and the effects that follow; in that way, this approach can provide the additional basis for the evaluation of the contributing factors and their meaning and significance.
Significance
To identify the primary care areas of medicine, there exists a substantial body of research and several assessment strategies relying on such factors as the population size, density, and other characteristics (McKernan, 2012). However, the field of dentistry is currently in need of research focusing on the provision of access to care, the cause of its inequalities, and the contributors to its prevalence in different groups and populations (Perwira, 2014; Razdan et al., 2016). The significance of this issue is reflected in the relation of the problem of limited access to oral care to several serious periodontal diseases that can also be linked to an even wider scope of health risks of chronic, inflammatory, and systematic nature such as CVD, cerebrovascular disease, ventilator-associated pneumonia (VAP), kidney disease, and impaired cognition (Wiener & Meckstroth, 2014). Apart from creating risks to people’s physical health, inequalities in access to oral care often result in a variety of socioeconomic problems such as difficulties with finding employment and a deteriorating quality of life (Yfantopoulos, Papaioannou, Oulis, & Yfantopoulos, 2015; Cenafils-Brutus, 2016).
Implication
First of all, studying the factors that contribute to inequalities in access to oral care and their potential outcomes create the basis for the development of a standardized solution strategy or an assessment approach to different types of root causes and their most common combinations, thus helping to form efficient responses to the persisting challenges for a faster elimination or minimization of their negative effects. In addition, discussing the implications of research aimed at the establishment of a deeper understanding of the dynamics and mechanisms of limited access to dental and oral care in rural and underserved populations could help expand the perspectives on the phenomena involved in the formation of the problem in different circumstances and environments. Moreover, such research has the potential to enable the upstream approach to the problem of inequalities in the access to oral care that, in turn, would be likely to power long-term changes and cost-effective, sustainable solutions to the issue applicable to the communities and populations of different types and helping to ensure preventative measures and avoiding the reoccurrence of the problem. Also, knowing that the problem of limited access to dental and oral care is linked to a wide scope of health threats of chronic, inflammatory, and systematic nature, researchers working on the minimization of these elaborate outcomes could use the information gathered in this study to help address the root causes instead of ineffectively treating the outcomes, and, in that way, facilitate the minimization of prevalence rates of the conditions related to the incidence of poor access to care in the affected groups.
Problem Statement
The phenomenon of inequalities of access to oral care is connected to a broad scope of serious conditions such as diabetes and heart disease, and also translates into the limitations regarding employment opportunities and the overall poor quality of life (Malecki et al., 2015). The problem is rather significant and thus is the focus of attention of healthcare leaders who work on the development of versatile solutions and strategies helping to minimize the effects of the issues. As mentioned previously, one of the most popular models of fighting the inequalities in access to care is the provision of flexible and affordable care services for the populations with a low level of income or living in isolation (Ganavadiya et al., 2014). This model can be used for a variety of tasks such as preventative treatments, health promotion, and educational lectures about oral hygiene. The other model is based on the engagement of the volunteer dental care professionals and dental students for the participation in specialized outreach programs helping reach remote and rural areas and provide affordable care of high quality to the underserved communities (Razdan et al., 2016)
Due to its complex and multifaceted nature involving multiple factors, the problem is difficult to resolve and continues to persist regardless of the applied solutions. The tendency may occur because the aforementioned solutions target primarily the effects of the problem but not its root causes. There exists a theoretical approach to the problem of limited access to oral care viewing the problem as the result of a set of socioeconomic drivers but not of the individual behaviors, physiological predispositions, choices, and biological factors (Moysés, 2012).
In that way, due to this approach, it becomes potentially possible to formulate upstream strategies helping address the problem that is focused on its root causes, thus fostering long-term changes and preventative treatments (Cheema & Sabbah, 2016). The major obstacles to this approach are the diverse contributing factors that enable the problem and may differ from one population group or area to another. Therefore, to create potentially effective strategies and facilitate a sustainable solution to the issue, it is necessary to identify the exact root causes participating in the creation of the problem in different environments.
Some of the most frequently identified factors contributing to the limitations in access to oral care are geographic location, low level of income, and social status. Specifically, the individuals and families with a low level of income are often unable to afford dental care in the appropriate amount or at the time when it is needed; as a result, their oral conditions tend to be left untreated (Friedman & Mathu-Muju, 2014; Malecki et al., 2015). Additionally, the individuals whose mobility is limited due to some reasons (jail inmates, people with disabilities, frail older adults, migrants, displaced communities, and people on institutional living) represent one more group suffering from inequalities in access to oral care (Perwira, 2014). Moreover, another group likely to face access inequalities is comprised of the residents of remote areas located far away from the facilities providing oral care (Wendling, 2016; Fisher-Owens et al., 2016; Emami, Khiyani, Habra, Chassé, & Rompré, 2015). Also, it is important to note that the rural communities often tend to be affected by a combination of the previously mentioned contributing factors such as the low level of income and a remote geographic location; as a result, they can be recognized as one of the limited groups.
The number of the populations affected by inequalities in access to dental care can be high as it also includes the individuals placed in mental health institutions, communities that had to relocate due to environmental impacts or political reasons, and homeless people. Each of the underserved groups can be characterized by a set of unique contributing factors, and thus requiring specifically formed solutions. Additionally, some other drivers of the limited access to care are the environmental and anthropogenic factors such as oil spills, floods, hurricanes, and tornados; these happenings tend to force socioeconomic transformations in the affected regions, thus depriving their residents of access to quality health care.
Knowledge Gap
When it comes to the gaps in knowledge concerning the issues of poor access to oral and dental care services, the primary challenge lies in the development of suitable solution strategies and programs that could remain effective and generate sustainable change working through the complex nature of the problem (Emami et al., 2016). As the oral conditions tend to aggravate over time as the patient age, there is a likelihood that the communities that are well-informed about self-management and dental hygiene could face serious periodontal conditions due to the lack of sufficient access to care and treatment (Friedman & Mathu-Muju, 2014). As a result, modern research in this field should be aimed at the exploration of the nature of poor access to oral health and the related phenomena and mechanisms due to which the problem prevails. By bridging this knowledge gap, contemporary researchers and practitioners could facilitate change and address one of the most significant and persistent public health concerns observable on the global scale.
The large and growing number of population groups suffering from the problem of limited access to oral and dental care indicates that the latter issue requires professional (and possibly, cross-disciplinary) attention helping to form solutions and provide inclusion to the underserved communities.
Possible Contribution
A deeper and more detailed understanding of the mechanisms powering the limited access to care among rural and underserved populations could create the basis for policies addressing the issue and improving the quality of life of the affected groups. A theoretical vision of the problem as resulting from a combination of socioeconomic factors could affect the scientific perspective on the causes of different oral and dental conditions, thus moving the source of the solutions to the issue and its prevalence to the governments and healthcare systems and not the individual communities. In turn, under the influence of the new vision of the problem and the potentially novel solutions, it would be possible to introduce changes to the approaches to dental hygiene and health education provided to the communities affected by limited access to oral and dental care. The latter could include the solutions applicable to the specific population groups and effective on a larger scale targeting socioeconomic contributors and not only the involved biological and physiological factors and processes.
The process of globalization is responsible for a variety of changes happening in the contemporary world and affecting modern people and causing complex phenomena combining social, political, and economic root causes, it seems that the issue of limited access to oral and dental care among the rural and underserved populations is one of them (Keboa et al., 2016). Exploring this problem, the researchers may have to use the collaborative approach to bring in knowledge from the other fields that are usually considered indirectly related or unrelated to healthcare, thus enabling the holistic approach to the problem and investigating it as a small part of a bigger picture.
Research Questions
The research questions for this study are focused on the identification of root causes and outcomes of the inequalities in access to care.
- What are the most common reasons for impaired access to oral care globally?
- What are the most common reasons for impaired access to oral care in the United States?
- What are the outcomes of poor access to care in the underserved and rural communities in the United States?
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