title: What influences the use of dental services by adults in the UK?
abstract: OBJECTIVE
  Optimizing access to and utilization of dental services remains a major public health challenge. The aim of this study was to use Andersen's behavioural model to investigate the factors that influence utilization of dental services and predict oral health outcomes, and to identify how access could be improved.
  
  
  METHODS
  Secondary analysis was conducted of data from a regional postal survey (n = 10 864) of adults in the UK. Items were chosen to reflect variables of Andersen's behavioural model including predisposing characteristics (deprivation), enabling resources (perceived difficulty accessing a dentist), need (perceived treatment need), health behaviours (reason for attendance and time since the last visit to the dentist) and oral health outcomes (oral health impacts (symptoms, functional limitation and social) and global oral health). Structural equation modelling was used to estimate the direct and indirect pathways between the variables within the model.
  
  
  RESULTS
  When a combination of indirect and direct effects were taken into account, perceived difficulty accessing the dentist was associated with higher perceived treatment need (β = 0.25, P < 0.01), increased oral health impacts (β = -0.23, P < 0.01) and worse global oral health (β = -0.21, P < 0.01). Overall, the variables included within this model explained 17.4% of the variance for dental attendance, 55.4% of the variance for the length of time since people had last visited the dentist, 21.7% of the variance for oral health impacts and 42.9% of the variance for people's global oral health.
  
  
  CONCLUSIONS
  Perceived treatment need and difficulty accessing dental services were found to be key predictors of oral health outcomes. Further research is needed to develop and evaluate effective interventions to improve access to dental services.
authors.affiliation: School of Clinical Dentistry, University of Sheffield, Sheffield, UK. Z.Marshman@sheffield.ac.uk
authors.forename: Zoe
authors.initials: Z
authors.lastname: Marshman
authors.forename: Jenny
authors.initials: J
authors.lastname: Porritt
authors.forename: Tom
authors.initials: T
authors.lastname: Dyer
authors.forename: Ceri
authors.initials: C
authors.lastname: Wyborn
authors.forename: Jenny
authors.initials: J
authors.lastname: Godson
authors.forename: Sarah
authors.initials: S
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003729:Dental Care / Q000706:statistics & numerical data*; D015438:Health Behavior; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D009909:Oral Health; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012737:Sex Factors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult