Applying Andersen’s behavioural model to oral health: what are the contextual factors shaping perceived oral health outcomes?
- 12 November 2009
- journal article
- Published by Wiley in Community Dentistry and Oral Epidemiology
- Vol. 37 (6), 485-494
- https://doi.org/10.1111/j.1600-0528.2009.00495.x
Abstract
Andersen's revised behavioural model provides a framework for understanding the factors which influence utilization of health services and key health outcomes. To date, there have been few studies that have explicitly tested the model in relation to oral health. The aim of this study was to test the model and to examine the direct and mediated pathways between social, attitudinal and behavioural factors and perceived oral health outcomes. The model was tested in a general population sample with data from the UK adult dental health survey (N = 3815) using the two-stage process of structural equation modelling. Structural equation modelling indicated support in line with the hypotheses within the model; enabling resources (oral health education advice, type of dental service, finding NHS treatment expensive, dental anxiety) predicted need (number of decayed or unsound teeth and perceived treatment need); enabling resources and need predicted personal health practices and use of services (frequency of toothbrushing, recent dental attendance, attendance orientation) which, in turn, predicted perceived oral health outcomes (oral health quality of life). Both enabling resources and need also predicted perceived oral health outcomes. The impact of predisposing factors (social class, qualifications, income) on need, personal health practices and use of services, and oral health outcomes was indirect; that is, mediated by intervening factors. In the final model, 26%, 37%, 49% and 21% of the variance was accounted for in enabling resources, treatment need, personal health practices and use of services and perceived oral health outcomes respectively. The results provide support for Andersen's behavioural model as applied to perceived oral health. Further conceptual development of the model is discussed.This publication has 17 references indexed in Scilit:
- Theoretical explanations for social inequalities in oral healthCommunity Dentistry and Oral Epidemiology, 2007
- Sociobehavioural risk factors in dental caries – international perspectivesCommunity Dentistry and Oral Epidemiology, 2005
- The social determinants of oral health: new approaches to conceptualizing and researching complex causal networksCommunity Dentistry and Oral Epidemiology, 2005
- Expanding the Andersen Model: The Role of Psychosocial Factors in Long‐Term Care UseHealth Services Research, 2002
- A comparison of methods to test mediation and other intervening variable effects.Psychological Methods, 2002
- Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternativesStructural Equation Modeling: A Multidisciplinary Journal, 1999
- Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples from the child-clinical and pediatric psychology literatures.Journal of Consulting and Clinical Psychology, 1997
- The theory of planned behaviorOrganizational Behavior and Human Decision Processes, 1991
- Causal Inference, Path Analysis, and Recursive Structural Equations ModelsSociological Methodology, 1988