Qualitative Research Study Critique

Reviewer's Name: Christina Bay

First Author and Year: Attanasi, Kim, (2020)

Title: Preventive Dental Care Programs for Children: Parental perceptions and participation barriers

Full Citation: Attanasi, K., Margaritis, V., & McDoniel, S. (2020). Preventive Dental Care Programs

for Children: Parental perceptions and participation barriers. Journal of dental hygiene:

JDH, 94(5), 38–43.

Overview of the 4 steps

1) Skim the paper to get an initial impression and overview of the study.

2) Highlight or jot down words or concepts you need to familiarize yourself with. Go back and

look up the definition or try to grasp the concepts.

3) Read the study for comprehension and document the important components of the study. These

may include (depending on the type of study): purpose (research question), hypothesis,

independent and dependent variables, participant characteristics, data collection and analysis,

experimental design, statistical methods, main result, secondary results, and conclusions.

4) Critical review of each component of the research study. What did you agree/disagree with?

What questions do you still have? What is the take-home message?

Initial impressions of the study:

This is a study worthy of exploration. The topic is relevant to clinical care and beneficial for

leaders or dental organizations seeking to impact public health. Children are a vulnerable population

susceptible to the negative impacts of dental disease that can have lasting effects. Therefore, dental

organizations should seek to provide benefits and eliminate barriers to quality preventive dental care.
List unfamiliar words or concepts:

1.) The transtheoretical model: a concept of behavior change introduced in the 1970s by Carlo

DiClemente and J.O. Prochaskahat outlines six stages a person progresses through to change

behavior. (Study.com)

2.) Social cognitive theory: a human social behavior construct posited by Alberta Bandura that

suggests behaviors are learned and chosen through interactions with the environment around

them. Human behaviors result from modeling, experiences, and choices instead of

conditioning.

3.) Self-efficacy: a subdivision of social cognitive theory defined as a person’s confidence in their

ability to act in ways that will achieve specific outcomes or goals.

4.) Title I: A federally funded program for qualifying schools determined by the number of low-

income families. School systems with 40% or more of their students on Free or Reduced

Lunch/breakfast are eligible for Title I funding.

Study Components

Introduction

What is the problem being investigated?

Dental caries is a significant problem in children from low socioeconomic communities.

Dental organizations and schools offer periodic preventive programs such as oral screenings, fluoride

treatments, and dental sealants to help combat this disparity. However, participation in these events is

generally low.

What is the specific purpose of the study?

This study aims to ascertain the reasons, perceptions, and barriers preventing parents or

guardians in low-income communities from taking advantage of free dental services for their children.
What are the hypotheses?

This study was a qualitative research inquiry that did not propose a hypothesis but sought to

find an answer to the problem mentioned.

What is the theoretical foundation for the study?

This study is phenomenological in that it focuses on an observed phenomenon that raises a

question. The phenomenon is that parents in low socioeconomic communities often do not utilize free

preventative dental services offered to their children. Researchers would like to know why this is the

case, so they have designed a study to explore the parents’ or guardians’ feelings about the available

services.

Methods

Who are the study participants?

Participants of this study included parents or caregivers over 18 years of age with one or more

children 5 to 15 years old who were attending a Title I New York City public school. Speaking

English was a requirement for participation. Three study groups were organized from different school

districts: Manhattan, Chinatown, Staten Island, and Brooklyn. Participants were given a $15.00 gift

card and a $5.50 MetroCard

What are the independent and dependent variables?

Since this is a qualitative study, not quantitative, no measurement variable exists to test. The

data collected will be described and analyzed to develop a theory.

What is the experimental study design?

The experimental design is a descriptive case study that focuses on parents’ or guardians’

perceptions of free preventive dental services offered to their children. The samples chosen had one or

more children enrolled in New York City public schools receiving Title I benefits.
What instruments, treatments, and measurement protocols are used?

Instruments used:

1.) an observation form for the principal investigator (PI) to document the participants’ body

language and perspectives on the interviewer, prevent dental programs, and pediatric dental

care

2.) face-to-face interviews with open-ended questions in a setting of the participants’ choice. The

questions were developed using the Social Cognitive Theory and Trans Theoretical Models to

assess self-efficacy determinants.

3.) Audio recordings were made of all interviews.

Measurements:

1.) Timed interviews, 20 minutes or less

2.) Reflective journaling by the principal investigator

3.) Transcription and analysis of audio recordings

What are statistical analysis techniques used?

Selected precoding techniques were used to break down and categorize the data collected.

Further sub-coding was accomplished when transcribed information from the interviews, researchers’

notes, and observations were loaded into a qualitative data coding software program (NVivo 11). This

process connected data by themes, categories, and relationships.

In addition to coding, the triangulation technique and the constant comparative method were utilized to

maintain consistency in data analysis.

Results

What is the main result of the study?

The study revealed nine central themes regarding barriers to participation in free dental care service

events.
 1.) Too busy- based on schedule, transportation, or motivation

2.) Fear of the dentist-either the child or the parent or both

3.) Cultural issues- language barriers/the provider was from a different ethnic background,

4.) Trust issues- a concern that providers are students/ providers did not represent the ethnicity of

the participant/

5.) Lack of knowledge- parents were unaware of the service being offered

6.) Cost

7.) Personal finances

8.) Parent’s negative experiences as a child

9.) No dental insurance

What are the secondary results?

The study highlights that culture and ethnicity play a role in accepting and participating in free

dental services.

Discussion

What are the conclusions of the study?

This study substantiates previous research conclusions that time, money, and fear are leading

concerns for those who do not seek dental services. In addition, parental attitudes towards oral health

care are a significant determinant of child utilization of dental services. Parents who do not see it as a

priority do not take their children to the dentist. Cultural competency in the public health sector

remains a major concern. Providers who reflect the population they are serving, speak the same

language and share the same values induce more trust than those with different ethnic backgrounds.

Finally, dental organizations need to improve their communication strategies. Too many parents

claimed they were unaware of the free dental services for their children. Asking the parents/caregivers

what method of communication they prefer would be a starting point.

What are the stated limitations of the study?

1.) This study was conducted on a small group of parents/guardians in one city in the United

States.

2.) Inability to verify the responders’ answers regarding oral health habits

3.) There was no follow-up to see if the responders who said they would utilize a preventive dental

program did.

Critical Review

What are the main issues that you agree/disagree with?

I agree that there is a tendency for free dental programs in low socioeconomic communities to

be underutilized. Understanding the reasons for this is vital. This study is one step in addressing the

issue but must go further to comprehend all facets of the problem.

I felt that of the nine themes, themes three and four were not fully distinguished or seemed to

overlap. In the Results section, theme three, “cultural differences,” has to do with influences on oral

health care decisions and the hesitancy of parents to go to a provider different from their own ethnic

background. Theme four identified the concerns of lack of trust due to dental professionals not

speaking and looking like them. The two themes address the same overarching theme: “cultural

differences.”

What questions are you left with?

The main questions I’m left with are “How representative is this study?” “Can the data from

this study be generalized?” “What other forms of communication can be utilized?" "How can oral

health education and services be better disseminated to combat dental caries in children in low-

socioeconomic communities?”
What are the future directions for this research?

Future directions for the research could include expanding the scope of the study to multiple

urban cities with culturally diverse and socioeconomically disadvantaged populations. Increase the

number of interviewers. Include follow-up studies to verify the participation of children whose

parents/guardians said they would like their children to use free dental care services. I would like to

see research on the benefits of oral health education in low-income racial/ethnic minority groups and

the impact of it on the utilization of free dental services. The education could be done through

community outreach programs, targeted school events, and even church organizations.

How does this paper contribute to the literature?

This study confirmed much of what previous research had found: that cost of treatment and

time constraints play an essential role in the decision to seek dental care. It also answered other

concerns about why free dental programs are often under-enrolled, namely cultural differences, dental

fears, and trust issues.

What is your take-home message?

The take-home message is that more effort can be made to meet the needs of underserved

communities. More than just showing up with a free program is required. Understanding the parents’

perceptions of oral health care events will help dental organizations structure their programs for the

neighborhoods they seek to serve.