Table of contents
DECLARATION...................................................................................................................... I
APPROVAL ............................................................................................................................II
DEDICATION.......................................................................................................................III
ACKNOWLEDGEMENT.....................................................................................................IV
LIST OFABBREVIATIONS .................................................................................................V
DEFINITION OF TERMS....................................................................................................VI
TABLE OF CONTENTS ....................................................................................................VII
ABSTRACT............................................................................................................................XI
CHAPTER ONE ......................................................................................................................1
INTRODUCTION....................................................................................................................1
1.0 INTRODUCTION......................................................................................................................1
1.1 BACKGROUND OF THE STUDY................................................................................................1
1.2 PROBLEM STATEMENT ..........................................................................................................3
1.3.1 Broad objective .................................................................................................................4
1.3.2 Specific objectives............................................................................................................4
1.4 RESEARCH QUESTIONS ..........................................................................................................4
1.5 JUSTIFICATION OF THE STUDY ...............................................................................................4
CHAPTER TWO .....................................................................................................................6
LITERATURE REVIEW .......................................................................................................6
2.0 INTRODUCTION......................................................................................................................6
2.1 PREVALENCE OF UTILIZATION OF DENTAL SERVICES BY ADULT SEROPOSITIVE PATIENTS......6
2.2 DETERMINANTS OF THE UTILIZATION OF HEALTHCARE .......................................................10
2.2.1 Familial culture and health beliefs..................................................................................10
2.2.2 Family socioeconomic status..........................................................................................11
2.2.3 Family household income ...............................................................................................12
2.2.4 Education and information..............................................................................................13
2.3 BARRIERS TO UTILISATION OF DENTAL SERVICES ................................................................13
2.4 OVERVIEW OF THE CURRENT STRUCTURE OF ORAL HEALTH SERVICES IN UGANDA:............15
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2.5.1 Theoretical framework....................................................................................................16
2.5.2 The health service utilization model...............................................................................16
2.5.4 The study variables.........................................................................................................19
CHAPTER THREE...............................................................................................................20
METHODOLOGY ................................................................................................................20
3.0 INTRODUCTION....................................................................................................................20
3.1 RESEARCH AREA .................................................................................................................20
3.1.1 Location and population .................................................................................................20
3.2 RESEARCH SITES .................................................................................................................20
3.3 RESEARCH DESIGN ..............................................................................................................20
3.4 STUDY POPULATION AND UNIT OF ANALYSIS.......................................................................21
3.4.1 Inclusion criteria .............................................................................................................21
3.4.2 Exclusion Criteria ...........................................................................................................21
3.5 SAMPLE SIZE DETERMINATION ............................................................................................22
3.6 DATA COLLECTION METHODS..............................................................................................23
3.6.1 Secondary sources...........................................................................................................23
3.6.2 The survey method..........................................................................................................23
3.6.3 Direct observation...........................................................................................................23
3.7 DATA PROCESSING AND ANALYSIS ......................................................................................24
3.8 MINIMIZATION OF ERRORS AND BIASES..............................................................................24
3.9 ETHICAL CONSIDERATIONS.................................................................................................24
3.10 STUDY LIMITATIONS .........................................................................................................24
3.11 DISSEMINATION OF RESULTS .............................................................................................25
CHAPTER FOUR..................................................................................................................26
DATA PROCESSING, ANALYSIS AND PRESENTATION...........................................26
4.1 SOCIAL-DEMOGRAPHIC CHARACTERISTICS..........................................................................26
4.2 PREVALENCE OF UTILIZATION OF DENTAL SERVICES BY ADULT SEROPOSITIVE PATIENTS....28
4.2.1 Oral status of the adult seropositive patients ..................................................................28
4.2.2 Utilization of dental services by adult seropositive patients...........................................28
4.3 DETERMINANTS OF THE UTILIZATION OF DENTAL SERVICES UTILIZATION OF DENTAL
SERVICES BY ADULT SEROPOSITIVE PATIENTS AT KIU-TH....................................................29
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4.3.1 Demographic determinants of utilization of dental services by adult seropositive
patients at KIU-TH ..........................................................................................................29
4.3.2 Other factors that determine utilization of dental services by adult seropositive patients
at KIU-TH........................................................................................................................30
4.4 BARRIERS OF UTILIZATION OF DENTAL SERVICES BY ADULT SEROPOSITIVE PATIENTS AT
KIU-TH................................................................................................................................32
4.4.1 Stigmatization from peers, family members, and health workers ..................................32
4.4.2 No access to dentists because they are few.....................................................................33
4.4.3 High costs of dental services...........................................................................................34
4.4.4 Long distance to health facilities ....................................................................................35
4.4.5 Financial problems of the adult seropositive patients.....................................................36
4.4.6 Despair by the seropositive patient.................................................................................37
CHAPTER FIVE ...................................................................................................................39
DISCUSSION, CONCLUSION AND RECOMMENDATIONS ......................................39
5.0 INTRODUCTION....................................................................................................................39
5.1 DISCUSSION ........................................................................................................................39
5.5.1 Prevalence of utilization of dental services by adult seropositive patients at KIU-TH..39
5.5.2 Determinants of the utilization of dental services utilization of dental services by adult
seropositive patients at KIU-TH ......................................................................................39
5.3 BARRIERS OF UTILIZATION OF DENTAL SERVICES BY ADULT SEROPOSITIVE PATIENTS AT
KIU-TH................................................................................................................................41
5.4 LIMITATIONS OF THE STUDY................................................................................................43
5.5 CONCLUSION.......................................................................................................................43
5.6 RECOMMENDATIONS ...........................................................................................................43
REFERENCES.......................................................................................................................45
APPENDICES........................................................................................................................52
APPENDIX I: CONSENT FORM....................................................................................................52
APPENDIX II: ENGLISH QUESTIONNAIRE FOR INTERVIEW...............................53
APPENDIX III: OBSERVATION CHECKLIST ..............................................................59
ABSTRACT This research report presents findings of a hospital based exploratory and cross sectional study on dental service utilization among 131 seropositive adults in Community Health AIDS Initiative Clinic at Kampala International University Teaching Hospital, Bushenyi District. The central problem of the study were issues associated with the utilization of dental services by seropositive patients, who suffer a preponderance of oral manifestations, and whose need for oral healthcare may be greater than the general population. The study was concerned that, despite the problem of seropositive patients having more unmet oral needs they continue to face limited access to oral healthcare. The general objective of the study was to find out utilization of dental services by enrolled seropositive adult patients at KIU-TH. Specifically, the study sought to determine the influence of caregivers’ oral health perceptions and cultural beliefs, the impact of socioeconomic factors, and the significance of structural factors in the utilization of oral healthcare; to determine barriers to dental service utilization among this cohort. The study was guided by the health services utilization model. The findings of the study indicate that, seropositive patients have prevailing perceptions and cultural beliefs about oral health which are holistic and woven into the social and cultural fabric of their daily lives and influence the utilization of oral healthcare. Two, the socio-economic circumstances of the seropositive patients such as low income levels and lack of social health insurance have a compounding effect on the low utilization of oral healthcare. Finally, structural factors and characteristics of the healthcare system are significant in selecting an oral health provider. It can, therefore, be concluded that a patient’s decision to utilize oral healthcare is a composite of perceptions and cultural beliefs on oral health and dental illnesses, effect of contextual societal factors, and innate characteristics of the healthcare system. Additionally, the patients perceive the cost of services and access to oral healthcare to be prohibitive and this, coupled with low enrollment with social health insurance, constitutes major barriers to the timely utilization of oral healthcare by adult seropositive patients. The study, therefore, recommends that, one, the government considers greater subsidy on social health insurance for low-income earners and pro-poor payments, to enable those in the informal sector with irregular incomes benefit from public health insurance. Two, the government establishes satellite dental health facilities closer to the people to reduce the distances of travel to regulated oral healthcare providers. Three, oral health policy should be revised and xi implemented to fast track the integration of preventive dental care into the primary health programme, and improve awareness while emphasizing the need for preventive dentistry.