Adherence to dental treatment of adolescents in social vulnerability situation: qualitative and quantitative approaches

Author(s)

Jaqueline Vilela Bulgareli

• Document type: Doctoral Thesis
• Press: Piracicaba, SP.
• Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Odontologia de Piracicaba
• Defense date: 2016-02-19

Examining board members

Antonio Carlos Pereira; Sílvia Helena de Carvalho Sales Peres; Silvio Yasui; Egberto Ribeiro Turato; Nelson Filice de Barros

• Advisor: Antonio Carlos Pereira

Abstract

This analytic longitudinal study and qualitative research was conducted in Piracicaba, São Paulo, between 2013 and 2015 and aimed to assess adherence to dental treatment of underprivileged adolescents, and their relationship to the individual variables, contextual, family and quality of life. In the initial phase was conducted clinical examination for the condition of caries and periodontal disease information. Included a probabilistic random sample of 1179 adolescents of 34 Family Health Units (USF). In the final phase of the study (revaluation) the sample consisted of 476 adolescents referred for treatment of caries and / or periodontal disease in health facilities during the initial phase. After 18 months were assessed 325 individuals to investigate whether they adhered to the dental treatment proposed in the initial phase of the study (n = 164 adherence, n = 161 non-adherence). Individual, contextual, behavioral and psychosocial variables were collected using socioeconomic questionnaires, OIDP, WHOQOL, interviews and focus groups. Data analysis of individual and contextual variables with adherence to dental treatment was estimated in the multilevel logistic regression models and by using generalized linear models (PROC GENMOD the SAS program). We evaluated the association between quality of life (WHOQOL) and dental social impact (OIDP) in two stages studied (first and last). In the qualitative phase, interviews and focus groups were recorded and transcribed; data grouped into categories and identified the key issues allowing the thematic analysis and the phenomenological. There was a non-adherence rate to high treatment in our sample (49.5%). In the first article, variables, family income neighborhood and crowding were associated with non-adherence to dental treatment. As for the second item, the quality of life of vulnerable adolescents improved in two stages studied (first and last measured by WHOQOL). In turn, there was a greater impact of daily activities (OIDP) in participants who did not adherence to dental treatment and, consequently, poor quality of life. For qualitative research (third article), the health care that the family has with the teenager were related to "compliance / non-compliance with health rules," as well as "adherence / non-adherence to treatment." In the fourth article, the meanings of health and illness attributed by adolescents were grouped into four themes: "conceptions of health and disease"; "Determinants and conditioning factors in health and disease"; "Dental health" and "Human relations, feelings and health." It concludes that the variables related to underprivileged adolescents condition may lead competitors to join situations and difficult dental treatment. At the same time, the greatest impact on daily activities of non-adherence corroborates the fact that oral health is an inseparable part, decisive and important in quality of life. Family care for those with teenage children can influence the important decisions regarding adherence. Finally, understanding the feelings, ideas and behaviors of adolescents regarding your health and illness, reframes issues that strengthen health promotion, emphasizing intersectoral and multidisciplinary articulation (AU)

• FAPESP's process: 13/17340-9 - Vulnerability in oral health: qualitative and quantitative approaches in adolescents
• Grantee: Jaqueline Vilela Bulgareli
• Support Opportunities: Scholarships in Brazil - Doctorate