title: Perceived barriers and facilitators to dental treatment among female caregivers of children with and without HIV and their health care providers.
abstract: OBJECTIVE
  This study sought to identify barriers and facilitators to dental care among families of predominately low socioeconomic status having children with and without HIV.
  
  
  METHODS
  Twelve focus group sessions with African-American and Hispanic caregivers and 18 individual semistructured interviews with key informant health care providers were held at two sites: a hospital-based program (HBP) and a dental school-based program (DSBP), that provide pediatric dental services. SPSS Textsmart software was used to analyze qualitative data within and across group types and sites.
  
  
  RESULTS
  Focus group participants (n = 72, averaging 6 women per group) included: HIV-seropositive biological mothers of HIV-seropositive children (4 groups); HIV-seronegative caregivers of HIV-seropositive children (4 groups); and Medicaid-eligible, HIV-seronegative caregivers of HIV-seronegative children (4 groups). The most commonly expressed barrier to dental care across groups was poor interpersonal communication between dental staff and caregiver/child. HIV-seronegative groups cited health care delivery system factors as barriers to receiving dental care more frequently than HIV-seropositive caregivers who cited shame/anger and family illness as being more important. Common facilitators were positive communication and transportation assistance. Unique facilitators for HIV-seropositive groups were coordination of the dental visits with medical appointments at the HBP. Key informants acknowledged high stress in families having children with HIV/AIDS, cited dental fear among caregivers as a barrier to dental treatment adherence and reported that dental care seemed to be a low priority among many of these families.
  
  
  CONCLUSIONS
  Facilitators and barriers to care included factors in the family, dental care and health care delivery systems as well as interpersonal communication between the dental providers and the families.
authors.affiliation: Department of Community Health, University of Medicine and Dentistry of New Jersey, New Jersey Dental School, Newark, USA. Broder@umdnj.edu
authors.forename: Hillary L
authors.initials: HL
authors.lastname: Broder
authors.forename: Stefanie
authors.initials: S
authors.lastname: Russell
authors.forename: Peter
authors.initials: P
authors.lastname: Catapano
authors.forename: Susan
authors.initials: S
authors.lastname: Reisine
mesh_terms: D017028:Caregivers / Q000523:psychology*; D002675:Child, Preschool; D003142:Communication; D019140:Dental Care for Children / Q000191:economics / Q000523:psychology*; D017742:Dental Care for Chronically Ill / Q000191:economics / Q000523:psychology*; D003797:Dental Staff / Q000523:psychology; D005190:Family / Q000523:psychology; D005260:Female; D017144:Focus Groups; D018023:HIV Seronegativity; D006679:HIV Seropositivity; D006297:Health Services Accessibility; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D009313:National Health Programs; D009519:New York City; D010342:Patient Acceptance of Health Care; D012923:Social Class; D012944:Social Support; D014481:United States