Why People Seek Dental Care: A Test of a Conceptual Formulation

Author(s): S. Stephen Kegeles

Source: Journal of Health and Human Behavior, Vol. 4, No. 3 (Autumn, 1963), pp. 166-173
Published by: American Sociological Association
Stable URL: http://www.jstor.org/stable/2948658
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166

WHY PEOPLE SEEK DENTAL CARE:

A TEST OF A CONCEPTUAL FORMULATION
S. StephenKegeles*

Belief and attitudedata on certain variables comparable to variables used in other

studies of preventivehealth behavior were collectedfrom a random sample of factory
employeesin 1958 and used to make predictionsas to whether these employeeswould
make preventiveor symptomaticdental visits over the next three years. The current
study examines the adequacy of these variables for predictivepurposes, and suggests
the revelance of other variables for prediction.It is found that the best single pre-
dictor of behavior is prior behavior. The status of the variables which led to these
two studies is examined and their strengthsand weaknesses noted.

Research carried on over the past five
years has resultedin the identificationof a
series of variables which seem valuable in
delineatingwhymembersof the generalpop-
ulationtake healthactions.' Since the formu-
lation has been describedcarefullyin these
references,it will be presentedhere in out-
line formonly.
It has been hypothesizedand supportedby
evidencethat a person is not likelyto take
a health action unless:
(1) He believeshimselfsusceptibleto the
disease in question;
(2) He believes that the disease in ques-
tion would have serious effectsupon his life
if he shouldcontractit;
(3) He is aware of certain actions that
can be taken and believes that these actions
may reduce his likelihoodof contractingthe
disease, or reducethe severityof the disease
shouldhe contractit; and
(4) He believesthat the threatto him of
taking the action (the barrier force in the
situation) is not as greatas the threatof the
disease itself.
This formulationled to a studyof reasons
why persons make dental visits. In 1958, a
random sample of factoryemployeesin one
plant of the Endicott-Johnson Corporation
*School of Public Health, Universityof Michigan.
1. See: GodfreyM. Hochbaum, Public Participa-
tion in Medical Screening Programs-A Socio-Psy-
chological Study, PHS Pub. No. 572, Washington,
D.C., U.S. GovernmentPrinting Office,1958; Irwin
M. Rosenstock,G. M. Hochbaum, H. Leventhal, et
al., The Impact of Asian Influenza on Community
Life: A Study of Five Cities, Washington, D.C.;
U.S. GovernmentPrinting Office, 1960, PHS Pub.
No. 766; and Fred Heinzelmann, "Determinants of
Prophylaxis Behavior with Respect to Rheumatic
Fever," J. Health & Human Behavior, Summer,
1962, pp. 73-81.
who receivedfree dentalcare for themselves
and theirfamiliesas fringebenefitswere in-
terviewed to determinedifferencesin the
beliefs of those who made preventive,and
those who made symptomaticvisits. It was
foundthat "respondentswho believedthem-
selves highlysusceptibleto dental problems
made morepreventivevisits than those who
believed themselvesbarely susceptible; that
those respondentswho believed that dental
problemswould be serious if they occurred
made more dental visits than those who did
not hold this belief; more respondentswho
believedtheycould take generallybeneficial
actions against dental problemsmade pre-
ventivedental visits than those who did not
hold this belief." Moreover,almost 80 per
cent of those who held all three of these be-
liefs made preventivedental visits, while
none of the respondentscategorizedas low
on these three variables made preventive
visits.2
It was also found that respondentswho
expressedfearof pain, or who expressedanx-
iety about dental treatmentsmade fewer
preventivedental visits than those who did
not express such fear and anxiety.Respond-
ents who expressednegativeattitudesabout
dentistswere also less likelyto make preven-
tive visits than thosewho did not.
These data, then,are furtherevidenceof
the value of the conceptualvariables for un-
derstandinghealthbehavior.However,since
the 1958 studywas an attemptto clarifythe
whole pictureof why persons seeks preven-
tive dental care, variables which were of a
general social and cultural nature, but dif-
2. Stephen Kegeles, "Some Motives for Seeking
Preventive Dental Care," Journal of the American
Dental Association, July,1963, Vol. 67, pp. 90-98.

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 WHY PEOPLESEEK DENTALCARE
feringfromthose deriveddirectlyfromthe
health behavior model were assessed also.
Thus, persons with greater education, in-
come,or occupationalstatus withinthe fac-
torymade more preventivevisits than their
oppositenumbers.Finally,it was shownthat
personswho believedin natural ratherthan
fatalistic causation of dental disease, and
personswho were concernedratherthan un-
concernedabout the aesthetic problems of
theirchildren'sdentalneeds made more fre-
quent preventivevisits.
The 1958 studywas a retrospectivestudy
as were almostall of the otherstudieswhich
demonstratethe effectsof barrier factors,
and of the motivationalfactors of suscepti-
bility,seriousnessand benefits.That is, be-
lief data and behavioral data were collected
at the same time. (Heinzelmanngatheredbe-
havioral and belief data at the same time,
thoughthe behaviorconcernedwas ongoing
rheumaticfeverprophylaxis.)The onlypros-
pectivestudy (establishmentof the fact that
the beliefs in question existed prior to the
healthbehaviortheywere supposedto deter-
mine) using these variables was completed
by Rosenstock,
et al.3 in regardto taking
inoculationsforAsian influenza.It was dem-
onstratedin that studythat manymore per-
sons who scored high on an index of sus-
ceptibilityand severityeventuallymade prep-
arations to deal with influenzathan those
persons who rejected notions of their own
susceptibilityto the disease or its severity.
However,therewere veryfew personsfrom
whomsuch data could be collected.
The conceptualization and researchon cog-
nitivedissonanceby Festinger4 pointsto the
dangerof such retrospective analyses.A per-
son's decision to accept or reject a health
servicemay,in and of itself,modifypercep-
tions in areas relevantto that healthaction.
In this sense, persons may give reasons for
theiractionswhichare consonantwiththose
actions.
3. Irwin M. Rosenstock, G. M. Hochbaum, and
S. S. Kegeles, Determinants of Health Behavior.
Prepared for 1960 White House Conferenceon Chil-
dren and Youth. Div. of Dental Public Health and
Resources, Dept. of Health, Education & Welfare,
Washington 25, D.C., 1960.
4. Leon Festinger, Theory of Cognitive Disso-
nance, Evanston, Ill.: Row, Peterson, 1957.
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167
To shedlighton whetherthe originalstudy
data on dentalbehaviorrepresenteda verbal
strivingfor consonance,or a statementof
beliefs which led to health actions, these
same factoryemployeeswere restudiedthree
years afterthe originalinterview(in'1961).
An attemptwas made also to assess whether
having been interviewedmade dental care
more salient to the respondents.
Sample
In addition to the original group of 426
employees(49 supervisorand above and 377
below supervisor level persons), a control
group fromthe same companywas used for
the re-survey.This new sample (455) was
stratifiedby sex and marital status in the
same manneras had been the original sam-
ple of employeesbelow supervisor.An addi-
tional 20 per cent sample was selectedwith
the assumptionthat a smallerresponserate
would be gained from subjects not previ-
ouslyinterviewed.(Since all supervisoryem-
ployees in the factorywere includedin the
original study,no counterpartwas included
in the controlgroup.)
Questionnaireand Data Response
The data in the original study were ob-
tained by personal interviewusing a series
of open-endedquestions. Respondentswere
asked questionsabout theirmostrecentden-
tal visits withinthe three year period pre-
ceding the interview,and about their atti-
tudes,beliefs,and knowledgeconcerningden-
tists, dental health and behavior,health in
general,and the companydental clinic.
The re-studyemployeda very short,self-
administeredquestionnaire,containing six
forced choice questions about the respond-
ents' three most recent dental visits within
the three year period since the original in-
terview.
The questionnairewas mailed to the origi-
nal and the controlrespondentswith an ac-
companyingletter. A follow-upletter was
sent two weeks later, and a telephonecall
was made five weeks later to non-respond-
ents. An 81 per cent response rate was
achievedfromboth the originaland new re-
spondents.A few questionnaireswere not
168 OF HEALTHAND HUMANBEHAVIOR
JOURNAL

usable, reducingthe analysis cases to 79 per ventivelyorientedvisits as compared with

cent of the originalsample. 42.5 per cent of the non-supervisory
re-sur-
vey group.
Seventy-seven per cent of the respondents
FINDINGS
followedthe same behaviorpatterntheyhad
followedearlier. Sixty-nineper cent of the
Effectsof Interviewand Differencesin
original preventively oriented group re-
Dental Behavior in Two Studies
mainedpreventively oriented;87 per cent of
As is seen in Table 1, therewas a slightly the original symptomorientedrespondents
greaterresponserate fromthe supervisory, remainedsymptomoriented.None of these
highereducated,and higherincomegroups. differencesbetweenthe original and resur-
More of the personswho respondedhad been vey data are statisticallysignificant.Past
preventivelyorientedin the originalsample. behaviorseems an excellentpredictionof fu-
However, none of these differencesis sta- turedentalbehavior,and moreover,the orig-
tisticallysignificant. inal interviewseemsto have had littleeffect
on the dentalbehaviorof the respondents.
Table 1
Characteristicsof Respondentsand Non-respondents The Role of MotivatingFactors in Making
to Resurvey Dental Visits
Per cent Per cent All of the independentvariables used for
Characteristic Respondent Non-respondent this study-those concernedwithbeliefsand
Education attitudes-were measuredin the originalin-
High school graduates 34.2 (117) 27.2 (22) terview.The six motivationalvariables (sus-
Less than high school
graduation 65.8 (225) 72.8 (59)
ceptibility,benefits,seriousness,perception
Income of dentaldisease causation,aestheticconcern
6,000 or more 24.4 ( 82) 16.7 (13) about the child,aestheticconcernabout the
Less than 6,000 75.6 (254) 83.3 (65) self) were all related significantlyto seek-
Position ing preventivedental care in the original
Supervisor 12.5 ( 43) 7.3 ( 6)
Non-supervisor 87.5 (301) 92.7 (76)
studywiththe exceptionof aestheticconcern
Original Dental Behavior about the self. That variable was related to
Preventive 56.7 (161) 52.3 (34) the criterionvariable (dental behavior) at
Symptomatic 43.3 (123) 47.7 (31) betweenthe 5 and 10 per cent level of con-
fidence.How do thesepriorbeliefdata relate
The extent of preventive orientation to a threeyear periodof dentalbehaviorsub-
among old respondents5(a respondentwas sequentto the interview?
classifiedas preventivelyorientedif at least Three hundredand forty-nine of the sub-
one of his dentalvisitsin thepast threeyears
jects respondedin ways whichallowed them
had been forcheck-upor cleaning) decreased
from56 per cent in the originalstudyto 45 to be classifiedas preventiveor symptomatic
per cent in the re-survey.6Thirty-nineper in the originalstudy.The findingsto be pre-
cent of the controlrespondents(all of whom sentedherewill be based on the 277 individu-
were non-supervisory personnel) made pre- als (all who remained) for whom criterion
data (dental behavior) were clear for both
5. A copy of the questionnaire is available from
the authors upon request while the supply lasts. the originaland subsequentstudy.
6. There was a greater decrease of preventive There was no relationshipbetween per-
visits among the supervisorygroup than among the ceived seriousnessand preventivelyoriented
non-supervisorygroup (20 per cent to 10 per cent
decrease). This may be accounted for either by a visits in the resurveyno matterwhat vari-
ceiling effect (supervisorygroup had so many more ables were used forcontrolpurposes. (Forty-
preventivevisits than non-supervisorygroup origi-
nally), or by an original over-statementof preven-
eightper centof thosewho saw dentalprob-
tive visits by the supervisorygroup. lems as serious made preventivevisits; 45

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 WHY PEOPLESEEK DENTALCARE
per centof thosewho did notsee dentalprob-
lems as seriousmade preventivevisits.)
Table 2
Per Cent of Individuals Who Made Preventively
Oriented Dental Visits Accordingto Their Beliefs
About Susceptibilityand Benefits About Dental
Actions
Susceptibility
Made Preventive Dental Visits
58.2 per cent of the 79 persons who felt suscepti-
ble.
41.9 per cent of the 129 persons who did not feel
susceptible.
p* (X2 = 5.18) < .05.
Benefits
Made Preventive Dental Visits
47.5 per cent of the 179 persons who saw bene-
ficial dental actions as possible.
44.6 per cent of the 65 persons who did not see
beneficial dental actions as possible.
p = not significant.
Susceptibilityand Benefits
Made Preventive Dental Visits
67.3 per cent of the 55 high susceptible persons
who saw beneficialdental actions as possible.
38.1 per cent of the 21 high susceptible persons
who did not see beneficial dental actions as
possible.
p (X2 [Yates]t = 5.42) < .01.
*Since the hypothesestested indicate the direction
of the expected differences,chi-square tests of sig-
nificance were combined with a sign test, with a
consequent halving of the significance level here
and in subsequent tables. In all tables, chi-square
contingencytests are fourfold,with one degree of
freedom.
tThe rule followedfor testingrelationshipsin this
table and in subsequent tables was: where all ob-
tained cells were 10 or greater, a chi-square was
used; where any obtained cell was between 6 and
10-if the expected frequencyfor that cell was 10
or greater-a chi-square with Yates' correctionwas
used.
Table 2 shows that 58 per cent of the re-
spondentswho feltsusceptible7made preven-
tive dentalvisits,while 42 per cent of those
who did not feel susceptiblemade preventive
dentalvisits. (All data presentedin the text
are at the 5 per cent level of confidenceor
better unless specified otherwise.) Persons
7. A person was categorized as susceptible if he
answered "likely" in any form to the questions:
"How likelydo you thinkit will be that (worst den-
tal problem mentionedthat the respondenthad ex-
perienced) will happen to you again?" and "How
likely do you think it will be that (worst dental
problemwhich he could anticipate) will ever happen
to you?" He was categorized not susceptible if he
answered "unlikely" to both questions.
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169
who saw benefits8fromactions which they
could take did not make a greaternumberof
preventivevisits than their counterpartsin
the resurvey (Table 2). However, among
persons who believedthemselvessusceptible
to dental disease, those who believed that
beneficialactions could be taken to prevent
or alleviatedentalproblemswere morelikely
than thosewho do not believein the efficacy
of such benefitsto make preventivevisits
(Table 2).
It can be seen in Table 3 that 51 per cent
of thosewho believedin naturalcausationof
dental disease made preventivevisits com-
pared with 40 per cent of those who be-
lieved that dental problems"just happened"
or that "nothingcould be done." Fifty-three
per cent of the parents concernedabout the
aestheticsignificanceoftheirchildren'steeth
made preventivevisits. Forty per cent of
thosewho did not expresssuch aestheticcon-
cernmade preventivevisits (Table 3). Fifty-
five per cent of the respondentsconcerned
with the relationof dentalproblemsto their
own "aesthetic appearance" made preven-
tive visits as comparedwith 42 per cent of
those not concerned (Table 3). As in the
original study,this is a trend which is not
significant.
The Role ofBarriersin MakingDental Visits
Table 4 shows that barriersto dental care
were almostas importantin keepingpersons
frommakingpreventivevisits in the resur-
vey as they had been in the original study.
8. Persons were asked the questions (both for
worst dental problem experienced and for worst
dental problemanticipated): "Do you know of any-
thinga person could do that would make it less likely
that he would get (worst dental problem)?" "What
could he do?"; if the individual said "no" to the
first of these questions,he was asked "Do you mean
there is absolutelynothinga person can do to make
it less likely that (worst dental problem) would
happen?"
Persons who specified visits to dentists,brushing
one's teeth, or staying on low sugar diets were
scored as believingin possible benefits.Persons who
stated they didn't know of anything which could
be done, or who mentionedvague activities (avoid-
ing restaurants) were scored as not believingin ben-
efits. A four point scale was derived from the an-
swers to the six questions. Persons in the top two
categories were the high benefits group; persons
scored as low or no benefitswere the low benefits
group.
170 JOURNAL
OF HEALTHAND HUMANBEHAVIOR

Table 3 over half of those who did not expressanxi-

Per Cent of Individuals Who Made PreventivelyOri- ety'0about dentaltreatmentmade preventive
ented Dental Visits According to Their Belief in dentalvisits; 40 per cent of the personswho
Natural Causation, Concern About Aesthetic Prob- expressedanxietyabout treatmentmade pre-
lems of Their Teeth, or Their Concern About Aes- ventivevisits (Table 4). (It shouldbe noted
thetic Problems of Their Children's Teeth
here,as reportedin the originalstudy,that
thereis no relationbetweentreatmentanxi-
Causation ety and fear of pain as measured in the
Made Preventive Dental Visits study.)
51.4 per cent of the 105 persons who believed in
natural causation. However,the relationshiporiginallyfound
39.7 per cent of the 131 persons who believed in betweennegativeattributionof dentistsand
non-natural causation, or in causes about an absence of seekingpreventivedental care
which no actions can be taken. does not hold up in the resurvey(Table 4).
p (X2 = 3.22) < .05.
Aesthetic Concern-Self The Role of Socio-EconomicFactors in
Made Preventive Dental Visits Making Dental Visits
55.1 per cent of the 49 persons with aesthetic con-
cern about own teeth. Three factors-education,income,and su-
42.4 per cent of the 224 persons with no aesthetic pervisorylevel-discriminatedbetweenpre-
concernabout own teeth.
p (X2 = 2.65) <.10.
ventiveand symptomorientedpersonsin the
Aesthetic Concern-Child
original study. Moreover,supervisorylevel
Made Preventive Dental Visits Table 5
53.3 per cent of the 60 persons with aesthetic con- Per Cent of Individuals Who Made Preventively
cern about child's teeth. Oriented Dental Visits Accordingto Education,
39.9 per cent of the 163 persons with no aesthetic Income, or Position
concernabout child's teeth.
p (X2 = 3.19) < .05. Education
Made Preventive Dental Visits
60.0 per cent of the 95 persons who were high
Slightlyover half of those with no fear of school graduates.
pain9 made preventivevisits; 41 per cent of 36.7 per cent of the 180 persons with less than
the personswho expressedsome fear of pain high school education.
made preventivevisits (Table 4). Slightly p (X2 = 13.99) <.001.
Income
Table 4 Made Preventive Dental Visits
45.8 per cent of the 72 persons with incomes of
Per Cent of Individuals Who Made PreventivelyOri-
$6,000 or more.
ented Dental Visits, According to Their Fear of
44.2 per cent of the 199 persons with incomes of
Pain, Anxiety About Treatment,or Appraisal of
Dentist less than $6,000.
p (X2) not significant.
Fear of Pain Position
Made Preventive Dental Visits Made Preventive Dental Visits
40.7 per cent of the 167 persons with fear of pain 70.6 per cent of the 34 persons in supervisorypo-
50.9 per cent of the 110 persons with no fear of sitions.
pain. 41.2 per cent of the 243 persons in non-supervis-
p (X2 = 2.86) < .05. ory positions.
AnxietyAbout Treatment p (X2 = 10.74) <.001.
Made Preventive Dental Visits
39.7 per cent of the 156 persons with anxiety 9. Individuals who gave any indication at all of
about dental treatment. being afraid of pain to any of the twentyquestions
51.2 per cent of the 121 persons with no anxiety in the interview were classified in the "fear of
about dental treatment. pain" group; all others were classified as the "no
p (X2 = 3.75) < .05. fear" group.
Appraisal of Dentist 10. Anxiety about treatment was derived from
Made Preventive Dental Visits responses coded as either expressing anxiety or not
44.3 per cent of the 106 personswho gave negative expressinganxietyfor each of 18 separate questions.
appraisal of dentist. Individuals who gave any indication at all of being
45.0 per cent of the 171 persons who gave positive anxious about treatmentin any of the 18 questions
appraisal of dentist. were placed in the "anxiety" group; all other per-
p (X2) Not significant. sons made up the "no anxiety" group.

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 WHY PEOPLESEEK DENTALCARE
discriminatedmore sharplybetweenpreven-
tive and symptomorientedpersonsthan did
any scale derivedfromthe three variables,
education,income,and supervisorylevel.Ta-
ble 5 shows that educationand supervisory
position discriminate between those who
made preventiveand those who made symp-
tomaticvisits in the resurvey.However, in
the resurvey,persons with higher incomes
did notmake a greaternumberof preventive
visitsthan theircounterparts.
DISCUSSION
What can be said about the original con-
ceptual formulationof health behavior as a
result of this study?There is no simple an-
swer to this question; certain variables did
not predictbehavioraccurately,thoughthey
were expectedto do so; othervariablesfared
well in the resurvey.The attempthere will
be to indicatethe status of each of the vari-
ables assessed, and to come back finallyto
the formulationas a whole.
First, the concept "susceptibility"seems
an accurategauge on whichto predictdental
behavior.Certain personsfeel theyare like-
ly, othersthat theyare not likelyto contract
serious dental problems. Persons who be-
lieve they may be afflictedby dental prob-
lems are more likely to make preventive
dental visits than those who do not have
such beliefs.Further,among the susceptible
group,thosewhobelievethereare preventive
actionsavailable make preventivedentalvis-
its; those who do not see preventiveactions
available are less likelyto make preventive
dentalvisits.A beliefin, and a knowledgeof,
actionswhichcan be takenby the population
to preventor alleviatedentalproblemsseems
not sufficientin and of itselfto producepre-
ventivedental visits. A person needs to be-
lieve that the problem can happen to him
beforehe uses his knowledgeofactionswhich
can be taken.1"
On the otherhand,thereis no relationbe-
tween the perceptionthat problemswill be
seriousif theyoccurand preventivevisits in
the resurvey (a very slight relation was
foundin the originalstudybetweenthe per-
ception that dental problems which might
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171
occurin the futurewouldbe seriousand pre-
ventive visits). In answering the question,
whyare dentalproblemslikelyto be seen as
serious, a separate analysis was made for
any concernabout aestheticdecrementdue to
dental problems.A trend-not significant-
was found between aesthetic concern and
preventivevisits in both the original study
and the resurvey.(A significantrelationship
was found betweenaestheticconcernabout
one's childrenand preventivevisits.) These
data indicatethat a beliefin the seriousness
of dental problems has little motivational
strengthforproducingpreventivedentalvis-
its. However, one must be cautious in gen-
eralizing about reactions to other diseases
from this last finding.Dental diseases are
not veryserious,clinically,as comparedwith
otherdiseases. It is possible that a belief in
the seriousnessof a disease is importantfor
diseases which are serious objectively,and
not for diseases withlittleclinicalseverity.12
The barrierfactors-fear of pain and anx-
ietyabout dentaltreatment-werefoundim-
11. The perceptionthat dental disease is a "natur-
ally caused" disease, and can be helped by "natural"
intervention-e.g., that dental problems are caused
by poor diet or inadequate brushing as opposed to
a belief that dental problemsare caused by the fact
that "persons are born that way"-is related sig-
nificantlyto making preventivevisits. There seems
to be some relationship between the perception of
"Natural causality" and the perceptionof beneficial
actions which can be taken. However, the interde-
pendence of these two variables has not been eluci-
dated clearly yet.
12. Paul R. Robbins, Some Explorations into the
Nature of Anxieties Related to Illness, Genetic Psy-
chological Monographs, 1962, 66-91-141,found that
11 per cent of his respondentsconsidereddental dis-
eases very serious as compared to 30 per cent who
believed tuberculosisvery serious, 39 per cent who
believed polio very serious, 41 per cent who consid-
ered mental illness very serious, 50 per cent who
considered heart disease very serious, and 83 per
cent who consideredcancer very serious.
The first wave of a national panel study now in
the field attempts to relate beliefs concerningthe
seriousness,susceptibility,and benefitsabout cancer,
polio, and loss of teethfor each of 1,500 respondents.
It is hoped that this study will answer,some of the
questions raised in the study reportedhere.
172 JOURNAL
OF HEALTHAND HUMANBEHAVIOR
portantfor predictingdifferencesin dental
behavior. However, despite statistical sig-
nificance,the percentagedifferencesin pre-
ventivevisits of those who feared pain, or
expressedanxietyabout treatment, and their
counterpartswere not very large.
The way in which an individualassesses
dentistsas persons is not as importantas
was originallyexpected.There was no dif-
ferencein the way persons who made pre-
ventive and those who made symptomatic
visits appraised dentistsin the resurvey.In
their study,Kriesberg and Treiman13indi-
cated no relationshipeither; the original
studyof this factorypopulationshowedonly
a slightrelationship.Thus, this variable may
be relativelyunimportant forexplainingden-
tal visits.
In sum,it can be stated,more clearlynow
than before,that the conceptualmodel does
predictbehavior,and is not merelyan after-
the-factrationalizationby respondentsto ex-
plain theirbehavior. Respondentsdo behave
in ways which follow their beliefs rather
than merelychangingtheir verbal behavior
to conformto their prior health behavior.
However, predictive power is weak. One
would be correctin predictingwhetherany
particular person would make preventive
dental visits only slightlymore frequently
than one would be wrong.
On the otherhand, variables of the type
studied here are difficultto measure accu-
rately in a natural situation. Measurement
errors,interviewerrors,and responseerrors
have a great probabilityof appearance in a
survey. A behavioras sharplydefinedas a
preventivedental visit is probably overde-
termined,and based moreon situationalthan
personal factors. Thus, relationshipswhich
appear weak in this study may be very
strongin reality. The arbitrary.05 level of
confidenceused throughthis studymay lead
to throwingout importantdata.
If it is difficultto predictpreventiveden-
tal behaviorfrompersonalbeliefs,how is it
to be predicted? The best predictorof who
would make preventive,and who sympto-
13. Louis Kriesberg and B. Treiman, "Socio-Eco-
nomic Status and the Utilization of Dentists' Serv-
ices," Journal of American College of Dentists,
Sept., 1960, 147-165.
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matic dentalvisits was the past behaviorof
the personsstudied. Almostall of the people
who made symptomvisits in the firststudy
made symptomvisits in the resurvey;most
of the persons who made preventivevisits
originallywere foundto have made preven-
tive visits in the resurvey. One could pre-
dict best a person's future dental behavior
by his past dental behavior.
The two variables-education and position
-were the next best predictors of who
would make preventive,and who sympto-
maticdentalvisits. Kriesbergand Treiman14
found that these variables were most im-
portantin their study of preventivedental
visits. With this in mind, an assessment
(shown as Table 6) was made of the rela-
tive contributionsof socio-economicfactors
(the variables-education, position,and in-
come) and the variable susceptibilityto
makingpreventivevisits.
Table 6
Per Cent of Susceptible and Non-susceptible
Individuals Who Made PreventiveDental Visits
Accordingto Socio-EconomicIndex
Socio-EconomicStatus
Made Preventive Dental Visits
66.7 per cent of the 50 susceptible persons who
were scored high or middle on an index of
education, position,and income.
48.4 per cent of the 27 susceptible persons who
were scored low on an index of education,
position,and income.
p (X2 = 3.32) <.05.
49.3 per cent of the 73 non-susceptiblepersons
who were scored high or middle on an index
of education, position, and income.
35.2 per cent of the 71 non-susceptiblepersons
who were scored high or middle on an index
of education, position, and income.
p (X2 = 2.88) < .05.
Two-thirdsof the persons who believed
themselves susceptible to dental problems
and were mediumor high on the crudeindex
of social class made preventivevisits; 44 per
cent of those who believed themselvessus-
ceptible,but were low on the index of social
class made preventivevisits. The otherhalf
of this comparisonis true as well; 49 per
centof the personswho did notbelievethem-
selves susceptible,and were mediumor high
on the index of social class made preventive
14. Ibid.
 DENTALCARE/AGRICULTURAL
MIGRATION 173

visits; 35 per cent of those who did not be-
lieve themselvessusceptibleand were low on
the index of social class made preventive
visits. (Unfortunately, the small numberof
respondentsdoes not allow furtherstate-
ments about the relative influenceof these
socio-economic factorsand othermotivation-
al or barrier factors studied. Neither was
there any way of assessing the relative in-
fluenceof the motivationaland barrier fac-
tors on preventivevisits.)
However, social class variables allow
"who" answers, and not "why" answers.
The variables fromthe conceptualformula-
tion allow certain "why" answers, but not
veryuseful"who" answers. Furtherstudies
need to be done in order to assess the rela-
tion of certainconcomitantsof social class-
values, early habit patterns,familial train-
ing practices,mobilitypatterns-on preven-
tive dental visits.
In summary,the current study has not
tested the relationof the conceptualformu-
lation to preventivehealthbehavioras com-
pletelyas was hoped. The formulationseems
to be relevant,the variables necessary,but
not sufficient,for explaininghealth behav-
ior. A more explicitstatementof the inter-
relationsbetweenthe variables in the formu-
lationand othersocial variables seemspossi-
ble only throughfuture experimentaland
controlledanalysis,and probablynotthrough
other surveystudies.

AGRICULTURAL MIGRATION AND

MATERNITY CARE*
Travis J. Northcutt,tRobert H. Browning,tand Clarence L. Brumback4
Inadequate maternity care among migrant farm workers has been attributed
largely to difficultiesassociated with theirmobility.A study of maternitycare behavior
of 172 migrantsand 145 non-migrantsof the same racial and socio-economicgroup who
deliveredin Belle Glade (Florida) during a period of one year raises serious questions
regarding the validityof this assumption.Comparisonsof the migrantand non-migrant
groups revealed no significant differenceswith regard to social characteristics,ma-
ternal histories,trimesterduring which prenatal care was sought, number of patient
visits for maternitycare, postpartumexaminations or outcome of pregnancy.

INTRODUCTION not a legal resident. In otherwords,lack of

In recentyears there has been increasing adequate maternitycare has been attributed,
generally,to the mobilityinvolvedin the oc-
concern regarding the maternitycare pat-
cupation. In attemptingto insure adequate
ternsof womenin the migratoryfarmlabor
care formigrantmothers,a concertedeffort
force. Public healthpersonnelfrequentlyre-
has been made to removethe obstacles im-
port that migrantwomen often do not ob-
posed upon them by their mobility. Such
tain medical supervisionuntil the second or
programshave includedthe establishmentof
third trimesterof pregnancy; some receive
special clinicsformigrantsat various points
no prenatal care nor postpartumexamina-
along the migrantstreams,the removal of
tions.
residencyrequirements,in some instances,
Lack of maternitycare among migrants
for receiving maternityservices, the pro-
has been attributedto (1) mobile life, (2)
vision of health service records,and other
lack of clinic facilities at one point or an-
inter-stateprogramsaimed at providingcon-
otherin the migrantstream,or (3) the ever
tinuityof health care.
presentproblemof ineligibilityof the moth-
Seldom mentioned,however,is the possi-
er for services in any state in which she is
bilitythat migrantwomen are no different
in their maternitycare behavior patterns
*The writerswish to acknowledgethe contribution
of the late Earl Lomon Koos to the original study than non-migrantsof the same racial group
design. and similarsocio-economic status. If, in fact,
tFlorida State Board of Health. no differencesdo exist,such a findingwould
$Palm Beach County Health Department. suggestthat maternitycare behaviormay be

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