Behavioral economic analysis for dental caries
- Autores: Ana Cristina Mafla Chamorro
- Directores de la Tesis: Falk Schwendicke (dir. tes.), Carmen Gallardo Pino (dir. tes.)
- Lectura: En la Universidad Rey Juan Carlos ( España ) en 2024
- Idioma: español
- Tribunal Calificador de la Tesis: Ángel Gil de Miguel (presid.), Ángel Asúnsolo del Barco (secret.), Manuel Bravo Pérez (voc.)
- Programa de doctorado: Programa de Doctorado en Epidemiología y Salud Pública por la Universidad Autónoma de Madrid; la Universidad de Alcalá y la Universidad Rey Juan Carlos
- Materias:
- Enlaces
- Tesis en acceso abierto en: TESEO
- Resumen
Dental caries is one of the earliest infections in human beings. The caries experience begins in the early childhood, with a prevalence from 26 to 89%. Dental caries is a multifactorial disease that includes complex risk factors, such as genetic and biological factors, social environment, health behaviors, and dental and medical care. A health behavior is an action taken to prevent illness or identify diseases with the purpose of enhancing overall health and wellness. The role of cognitive variables (illness perceptions, sense of coherence, self-efficacy, and health literacy) as described in the psychological literature may have a pivotal role in the understanding of health behaviors. Further, health economics applies economic principles to the healthcare. Given the existence of numerous communities with limited healthcare resources, this field would address such challenges focusing on efficiency, aiming to optimize the benefits derived from the available resources. Most studies on this topic are focused more on factors associated with effectiveness of treatments than shifts in behaviors and attitudes towards having a treatment. There are few studies that include illness perceptions, sense of coherence, self-efficacy and health literacy as factors and that affect the cost of the treated dental caries. Receiving or not dental treatment not only may depend on the dental cost per se, but multiple factors such as dental care facilities, dental anxiety, dental check-ups habits, beliefs or misinformation, especially in painless stages of the dental caries, in low-income communities. The aim of this study was to determine a behavioral economic analysis for dental caries to design promotion and prevention programs based on cognitive variables. An observational study (prevalence, analytical) was carried out in a sample of 1,267 patients 18 years old or older from the campus and Dental Clinic at Universidad Cooperativa de Colombia, Pasto, Colombia. A data collection format included socio-demographic variables, dental caries indices (ICDAS - II, DMFT and DMFS indices) and costs of untreated caries, fillings, other restorative treatments, and missing teeth. Regarding cognitive variables, scales and questionnaires such as brief illness perception questionnaire (BIPQ-8), sense of coherence (SOC-13), general self-efficacy (GSE-10) and health literacy in dentistry (HeLD-14) were used. Frequencies and percentages were estimated to determine the distribution of sociodemographic variables. Independent Chi2 tests were conducted for categorical variables. Psychometric properties of BIPQ-8, SOC-13 and HeLD-14 were determined. To observe the interaction of scales and questionnaires on cost for managing dental caries, multivariate models such as a structural equation model (SEM) and generalized linear models (GLMs) were performed. The significance was set at P<0.05. In relation to psychometric properties, a Cronbach's alpha = 0.62, and a McDonald's omega = 0.72 determined the internal consistency of the scale of BIPQ-8. We observed that SOC-13 using 3 dimensions was a reliable and valid tool for assessing the sense of coherence in Colombian populations, and we developed a HeLD-Col, after evaluating the properties of HeLD-14, which was a unidimensional reliable and valid instrument to assess oral health literacy in Colombian older adults. The caries experience in this group of individuals was 99.5%. The prevalence of dental caries was 84.9%, there were statistically significant differences by socioeconomic status, place where they received dental treatments and barriers to oral healthcare. The total cost of non-treated and treated dental caries was 1.005.100,54 CO (SD= 581.704,25). The SEM showed a strong direct effect of dental caries perception (ß = 0.79, P= 0.02) and sense of coherence (ß = 0.68, P=0.02) on costs for managing dental caries. Oral health literacy displayed a moderate direct effect (ß = 0.18, P= 0.02), and self-efficacy had a moderate indirect effect (ß= -0.19, P= 0.03). The coefficient of determination (R2) was 0.38 which means that 38.0% of costs for managing dental caries were explained by cognitive skills. According to GLMs, only general self-efficacy (ß = -9,629.60; 95% CI: -18,852.08 - -407.13; P= 0.041), decreased the costs for managing dental caries after modelling using different predictors.
