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Perceived social status associated with utilisation of preventive dental services

Perceived social status provides more data than traditional socio-economic status measurements when designing health programmes, according to a new study. (Image: II.studio/Shutterstock)

IOWA CITY, Iowa, US: For any oral health programme or insurance plan, under-utilisation of preventive dental services ultimately results in an increased treatment burden on both patients and clinicians. A study conducted in the US has evaluated whether there is a correlation between the utilisation of preventive Medicaid dental services and self-evaluated perceived social status (PSS), which, according to the study’s authors, is a better means of evaluation than socio-economic status (SES). The findings of the research indicated a positive association between the use of preventive services by Medicare enrollees and their positive evaluation of their social status.

This study was unique in its approach, as it aimed to explore the association between PSS and self-reported dental care utilisation and to compare the relative impact of PSS and traditional SES measures on dental care usage. SES factors usually evaluate only income or employment status, but this study’s methodology involved analysing data from a 2018 mixed-mode survey of Iowa Medicaid programme enrollees with a survey that was comprehensive and included questions about dental plan experiences, dental service usage, barriers to dental care, self-rated oral health, PSS and demographics.

The survey targeted low-income adults aged 19–64 with incomes of up to 138% of the federal poverty level. The survey also incorporated elements from the Consumer Assessment of Healthcare Providers and Systems Dental Plan Survey. The hypothesis was that PSS would be a significant predictor of preventive dental care utilisation, even when controlling for other factors like education, employment status and income. PSS is dynamic, reflecting people’s overall perception of their social standing based on various life experiences. It encompasses a broader range of factors, including past, present and anticipated future resources, economic prospects, self-efficacy, health status and a sense of personal control.

The study noted that PSS has been linked to self-reported oral health and health-promoting behaviours in previous research. For instance, perceived control, a key aspect of PSS, is thought to influence an individual’s engagement in health-promoting behaviours, including routine dental care. This relationship is crucial, as routine dental care is known to have a significant impact on overall oral health and well-being.

The study’s results revealed a notable association between higher PSS and increased utilisation of preventive dental services among Medicaid enrollees. This finding was consistent even after adjusting for SES measures like education, employment and income. The analysis showed that each unit increase in PSS corresponded to a 13% increase in the odds of using preventive dental services. Interestingly, the traditional SES measures did not show a significant association with dental service utilisation when analysed separately. This suggests that PSS might be a more relevant and potent factor in influencing dental care behaviours in low-income populations. The study’s findings challenge the traditional understanding that objective SES measures are the primary determinants of health behaviour, highlighting the importance of subjective perceptions of social status in health-related decision-making, especially in the context of preventive dental care.

The findings also suggest that individuals’ self-perception of their social status, as encapsulated by PSS, has a more substantial impact on their health behaviours than objective socio-economic indicators. This could be due to the psychological factors associated with PSS, such as a heightened sense of control or self-esteem, which might encourage health-promoting behaviours like dental care. The study also highlighted the limitations of traditional SES measures in capturing the nuances of social status, especially in homogeneous low-income groups. The study’s results are some of the first produced in the context of the US, particularly among Medicaid populations, and suggest that PSS could be a critical factor in designing health interventions and policies. However, the study acknowledged limitations like its cross-sectional design and potential non-response bias, suggesting the need for further research to explore the causal relationships between PSS, SES and health behaviours.

According to the Center for Medicare Advocacy, more than 65 million individuals were enrolled in Medicare plans as of March 2023.

The study, titled “Perceived social status, socioeconomic status, and preventative dental utilization among a low-income Medicaid adult population”, was published online on 15 November 2023 in the Journal of Public Health Dentistry, ahead of inclusion in an issue.

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