Original Articles
 

By Dr. Rajbhushan Dande , Dr. Abhisek Rajagopal R Sayini , Dr. Md Shakeel Anjum , Dr. Hari P Gone , Dr. Vamshi Nizampuram , Dr. Pranay Hanumandla
Corresponding Author Dr. Rajbhushan Dande
Department of Public Health Dentistry, Meghna Institute of dental sciences,Nizamabad, Telangana., H. no. 2-199, venkateshwara colony, jillelaguda, balapur - India 500097
Submitting Author Dr. Rajbhushan Dande
Other Authors Dr. Abhisek Rajagopal R Sayini
Department of Conservative dentistry and Endodontics,Meghna institute of dental sciences, Nizamabad, Telangana. , - India

Dr. Md Shakeel Anjum
Department of Public health dentistry,Sri Sai college of dental surgery,Vikarabad, Telangana. , - India

Dr. Hari P Gone
Department of public health dentistry, Government dental college, Hyderabad,Telangana. , - India

Dr. Vamshi Nizampuram
Department of public health dentistry, Government dental college,Hyderabad, Telangana., - India

Dr. Pranay Hanumandla
Department of public health dentistry, Government dental college,Hyderabad, Telangana., - India

DENTISTRY

Factors; dental hospital; dentist; Hyderabad, Consumer's choice, selection.

Dande R, Sayini AR, Anjum M, Gone HP, Nizampuram V, Hanumandla P. Factors considered by patients for selection of a dental hospital and consumer's choice of dentist in Hyderabad city- A cross sectional study.. WebmedCentral DENTISTRY 2019;10(3):WMC005553

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Submitted on: 11 Mar 2019 10:13:45 AM GMT
Published on: 29 Mar 2019 07:23:56 AM GMT

Abstract


Introduction: A successful oral health care service system is required for providing quality service and it is important to put efforts into improving the quality of dental services delivered.  Therefore it is necessary to explore the factors considered by patients for selection of a dental hospital and patient’s choice of a dentist to plan a successful oral health care service system.    Aim: To determine the factors considered by patients for selection of a dental hospital and dentist. Materials and methods: A cross-sectional study was conducted among patients attending dental clinics situated in Hyderabad city. Cluster sampling technique was followed to collect data from different zones of Hyderabad city. A 25 item pretested, self-administered questionnaire was used. Descriptive statistics were calculated using SPSS version 20.0. Categorical variables were assessed using Chi-square test (p< 0.05) Results: A total of 402 patients participated in the study. Majority of the patients considered factors like distance from home to clinic (88.4%) and a recommendation made by relatives, friends about clinic (86.3%), only 31% of patients considered the online review in selection of a dental clinic. Dentist’s degree (80%), fame of the dentist (82%), clinic atmosphere (76.6%), dentist’s explanation of procedures to patients (87.5%), charges of dentist i.e. either expensive or reasonable (79.2%) are the factors considered by majority of the patients in choosing a dentist. Conclusion: Most of the patients relied on word of mouth while selecting a clinic. Dentist’s behavior and communication skills were important factors for selection of a dentist.

Introduction


Every society provides a distinct platform for a health-care provider to develop. India is a land of civilizations, unique in factors such as social mindset, prevalent beliefs and customs. All through the ages Indian societies in its attitude toward oral health has been giving less importance as compared to general health. There has been a lack of identification of oral health deterioration by the people and extensive acceptance of morbidity which lead to widespread prevalence of oral diseases. Attitude of an individual is framed by their beliefs and the common belief of most of the people has been that dental treatment is unbearably painful; this has led to people ignoring their oral health to an extent.[1] The other factor i.e. awareness about oral health and its impact on general health and well-being has been over looked. This has largely been made possible by continual non-availability of oral health services in their proximity and lack of elementary education in such matters.[2]

The situation in which a person reaches the clinic in Indian setting is as a last option and not as a first reaction. This is mostly due to the expensive care and medicine which usually surpass the paying capacity of the patient. Patient may apprehend to reach the clinic or nursing care initially due to fear of money loss and most of the time they wait for themselves to heal on their own. When people understand that the health problem is not going to subside on its own by other "Desi Nuskhas"(local belief about the disease and its cure and using herbs and other local products in search of relief) only then they try to approach a clinic nearby. Due to delay in reaching a clinic, there is added morbidity to the patient which in turn leads to added costs and the vicious cycle of “the perception that the treatment is expensive” continues. This attitude is more observed with dental health related behavior.

These factors should not be given a passive glance and should be traversed carefully giving importance to each factor's background and its progress to the present status in modern dental practice.[1]

The dental diseases have come down over the last decade in developed countries. But this reduction has not been observed in most developing countries and the cost of dental services has been increased. Therefore it is a challenge to upgrade the oral health care delivery system to improve the people's oral health.[3] Regular dental attendance leads to better oral health outcomes and improves people's quality of life.[4] However, Individuals’ utilization of dental services depends on a variety of factors, including access to care (like distance from patient home to clinic), financial problems, recommendation  about clinic from friends, relatives, dentist’s patience in explanation of procedures, dentist’s degree, fame of the dentist and people’s attitudes toward dental care etc. Socio-economic, racial, and age variables also affect access to dental health services. These factors may vary with geographic location and demographic data.[5]

Understanding peoples’ health care seeking behavior, what they expect from such facilities, and what prevents them from expressing their needs, are the key factors to plan a good oral health care system. Therefore the purpose of the present study is to determine the factors considered by patients for selection of a dental hospital and the factors that influence in choosing a dentist.

Methodology


A cross-sectional study was conducted among patients attending dental clinics situated in Hyderabad city, Telangana, India to determine the factors considered by them for selection of a dental hospital and a dentist. The data collection tool used was a self-administered questionnaire. The questionnaire was constructed based on previous literature and objectives of the study. Demographic details included gender, age and education of the patient. Questionnaire was pretested (Cronbach α=0.8, Content validity ratio=1) in the pilot study, on 30 subjects, to ensure the ease of understanding, clarity and their sequential flow. Initial questionnaire consisted of 22 questions. Necessary modifications like addition of more options and reframing of 2-3 questions were made to design the final questionnaire which consisted of 22 questions itself. Sample size was estimated to be 384 (rounded off to 400) based on results of the pilot study.

Area sampling procedure was followed to reach the final sample for the study.  Considering the 5 zones of Hyderabad constituting 150 wards, the sample was divided equally as 80 dental patients from clinics located in each zone. From each zone 5 wards were randomly picked and the clinics in those particular areas were included in the study to reach the desired sample size of 16 from each ward.

The study was conducted for a period of two months in 2016. Ethical clearance was obtained from the institutional review board and informed consent (verbal) was obtained from the patients who were willing to participate prior to the study. The purpose of the study was explained to the patients and only those who were willing to participate were given the questionnaires. Sufficient time was given to them to fill the questionnaires anonymously and it was collected back on the same day. Interview method was followed in case of patients who were illiterate.

Statistical analysis was done using descriptive statistics in a statistical package for social sciences (SPSS) version 20.0. Microsoft word and excel were used to generate tables and figures. Chi square test was done to know association between categorical variables and factors considered in selection of a dental hospital and a dentist. (p< 0.05).

 

 

Results


A total of 402 patients participated in the study. Out of them 224 (57.1%) were males,              178 (45.4%) were females. The mean age of the participants was 38.4 years. Majority of the participants had an education status of graduation (47.1%) and post-graduation (18.11%).

It is surprising to note that about 58.14% of patients admitted that they visit the dentist when they experience pain and about 21.4% of them admitted that they visit the dentist once in every 1-2 years. The frequency of dental care visits was significantly associated with an education level of the patients (p=0.058).  

 Most (77.2%) of the patients admitted that they did not consider the gender of the dentist when they chose the dentist but the opinion was significantly different based on gender (p=0.034) and education status (p= 0.033) of the patients.

Table 1 shows the factors considered by patients in the selection of a dental hospital. Majority of patients considered the distance from home to the clinic (86.7%) and the recommendation made by someone known about the clinic (88.52%). About 69.8% of participants admitted that they wish to get treated from an established dental clinic and about 67.6% of patients considered working hours of a clinic in the selection of a dental hospital.

Only 36.9% of participants admitted that they select a dental hospital based on advertisements about the clinic and it was significantly associated with the education status of the patients. About 31.63% of patients have considered online information/review for selection of a dental hospital.

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Table 2 shows the factors considered by the patients in choosing a dentist for getting themselves treated. Majority of the patients considered dentist’s degree (82.3%), the fame of the doctor (84.18%), clinic atmosphere (78.5%),explanation of  procedures by dentist or dentist’s patience(89.7%), fee charged by dentist whether expensive or reasonable(81.12%) in choosing a dentist.

Factors like dentist’s degree, fame and specialization were significantly associated with an education level of the patients.

Table:1 Factors considered by patients while selecting a dental hospital

Factors considered while choosing the clinic

I do consider

N(%)

Uncertain

N(%)

I don’t consider

N(% )

Gender

P value

Education

P value

 Do you consider the distance from home to clinic

340(86.7%)

15(3.8%)

47(11.98%)

.409

.479

Advertisements about clinic (magazines/newspapers/pamphlets)

145(36.9%)

119(30.3%)

138(35.2%)

.806

.002

Recommendation made by someone you know(word of mouth) about clinic

347(88.5%)

18(4.8%)

36(9.1%)

.769

.076

Working hours of Clinic

265(67.6%)

68(17.3%)

69(17.6%)

.392

.366

Online  information/review on clinic

124(31.6%)

97(24.7%)

181(46.1%)

.302

.100

Established clinic/ New clinic

274(69.8%)

56(14.2%)

72(18.36%)

.288

.062

Multispeciality clinics /single owned practice

236(60.2%)

74(18.8%)

92(23.46%)

.814

.323


 

Table 2: Factors considered by patients while choosing a dentist   

Factors considered while choosing the dentist

I consider

 

N(%)

Uncertain

N(%)

I don’t consider

N(%)

Gender

P value

Education

P value

Name of the dentist

226(57.6%)

28(7.1%)

148(37.7%)

.396

.442

Dentist’s degree

323(82.3%)

33(8.4%)

46(11.7%)

.690

.001

Do you consider the age of the dentist (i.e,younger or older in age)

215(54.8%)

42(10.71%)

145(35.7%)

.604

.530

Fame of the doctor

330(84.18%)

17(4.33%)

55(14.03%)

.583

.056

Dentist’s specialization

254(64.8%)

65(16.5%)

83(21.17%)

.401

.000

Dentist’s appearance

129(32.9%)

47(11.9%)

226(57.6%)

.754

.101

Clinic atmosphere

308(78.5%)

48(12.24%)

46(11.7%)

.185

.331

Explanation of procedures  to patients by dentist/ dentist’s patience

352(89.7%)

27(6.8%)

23(5.8%)

.714

.124

Equipment in dental clinic

211(53.8%)

121(30.6%)

70(17.8%)

.142

.385

Charges of dentist-either expensive/reasonable

318(81.12%)

38(9.6%)

46(11.7%)

.455

.537

Dentist’s availability

298(76%)

56(14.2%)

48(12.2%)

.621

.942

Parking Space available near the  clinic

144(36.7%)

60(15.3%)

198(50.5%)

.308

.116

Past experience of dentist in government sector

193(49.2%)

57(14.5%)

152(38.7%)

.055

.047

 

 

 

 

 

 

Discussion


Oral health problems are a major health issue with a greater disease burden in India. Unfortunately these problems are often overlooked. Not only do these problems affect oral health but also compromise the quality of life. When it comes to consulting a dentist, several factors are considered by the patient before he/she chooses a dental service provider.[5]

The purpose of the present study was to determine a) the factors considered by patients for selection of a dental hospital, b) the factors that influence patients in choosing a dentist. Understanding how, patients choose their services and what they expect from such services may help in planning a good oral health care system.

Over the last few decades, women and men have been said to be equal in any field. But still gender stereotyping is showing its effect on everyday decisions we make. In the current study, majority (77.29%) of the patients have admitted that they did not have any gender preference while choosing a dentist to get treatment. These findings were consistent with the study done by Ibrahim and Amooda.[6] The possible reason for this could be patients might have felt both female and male dentists were equally committed to the profession. Selection of dentist based on his/her gender was significantly associated with education status and gender of patients.

Regular, preventive dental attendance is a contributor to the oral health status of people of all ages. Studies have shown that preventive dental care leads to better oral health outcomes and gains in quality of life. But there is evidence that many people do not attend the dentist regularly.[7] In the present study when respondents were asked about frequency of usual dental visits majority of them admitted that they visit dentist when they have tooth pain only. Similarly in a study conducted by Ungureanu et al large proportion of respondents admitted that they visit their dentist only when they experience toothache (27.85%).[8] This type of attitude in people may be due to lack of elementary education in oral health related matters, fear of money loss and most of the people try to use local products or home remedy for oral health problems.

There is a difference between what is circulated by a certain dentist about his practice positively and advice received from known and trusted persons like friends, relatives. In the present study majority (88.52%). of patients considered recommendation made by someone known about clinic in selection of a dental facility or hospital. Similarly in a study conducted by Ungureanu et al majority (20.56%) of the study subjects considered word of mouth as an important factor in choosing a dentist.[8] This result is a confirmation of the fact that word-of-mouth still represents a strong marketing mechanism for dental services promotion. In the present study patients felt it is better to follow advice of friends and relatives in choosing a dentist rather than blindly getting treated from unknown dentist.[8]

There is a widespread belief that the likelihood of dental service utilization will increase if the clinics were located nearby. In the present study majority (86.7%) of the participants considered the distance from their home to clinic as a vital factor in selection of a dental clinic. On the contrary in a study conducted by Moshkelgosha et al distance of the dental clinic from participants’ homes, was found to have less impact on people's decision.[3] In the current study patients considered distance from home to clinic as it is difficult to attend for appointments in a clinic at a longer distance in a city like Hyderabad due to traffic jams and crowded streets.

Generally dental procedures are time taking and patients may ignore oral health problems due to various reasons. One of the reasons for ignoring oral problems was that they are unable to make time due to their busy schedule. In the current study majority (67.6%) of the patients admitted that they consider working hours of the clinic in selection of a dental clinic. These findings are in concordance with a study done by Kim et al.[9] As the study was conducted in urban area and most of the study participants were employed they might have felt it is better to visit a clinic suitable for their working hours.

Magazines, news-papers are the easily and economical information sources for the public since decades. In the present growing world, internet usage has been increased exponentially and peoples’ dependence on online information has also increased. But on the contrary in the current study majority of the patients did not consider the advertisements about clinic in magazines/newspapers/ pamphlets and online review on clinic in selection of a dental clinic. This indicates that people still depend on the traditional sources like world of mouth.

India has always been considered a culturally rich country with diverse food habits, traditions, beliefs, social customs, attire, language, festivals, etc. All major religions of the world are practiced here such as Hinduism, Jainism, Islam, Sikhism, Christianity and Buddhism. Name of the individuals represent the religion, caste and sometimes native place of the dentist.  In the current study about 57.6% of patients considered name of the person in choosing a dentist. This indicates that some of the patients are inclined towards the caste and nativity of the dentist.

Dentistry is more of art than science. There are various specializations in dentistry like oral medicine, oral pathology, prosthodontics, pedodontics, endodontics, periodontics, oral surgery, public health dentistry and implantology etc. Many diploma courses have been developed over time as well. In the present study majority of the patients admitted that they take into account whether a dentist has bachelor’s degree or master’s degree (82.3%) and specialization of dentist (64.8%) while choosing a dentist. This is in concordance with study done by Bornstein, Marcus and Classidy.[10] As the present study was conducted in metropolitan city of Hyderabad, most of the patients might have awareness about dentistry and its specializations. Preference of dentist’s degree (p=0.001)) and specialization (0.000) by patients are strongly associated with education of the patients. This suggests that participants who are educated are considering degree and specialization of dentist.

Several studies stated that for a health care professional to be successful reputation and competence are the key factors. In the present study most of the patients considered reputation of the dentist (84.1%) as an important factor. This is in agreement with study done by Kim et al.[9] The possible reason for this finding could be patients might have felt it was better to approach a doctor who was well known rather than taking risk by consulting unknown.

Literature has been revealed that one of the reasons for underutilization of dental services by the public was anxiety and fear of dental treatments due to sounds made by drills, suction etc in the dental operatory.[11] In the current study about 78.5% of participants considered clinic environment as an important factor in making choice of dentist. Similarly in a study conducted by Iqbal et al majority considered the pleasant and friendly clinical environment in choosing a dentist.[5] Friendly environment may reduce the anxiety in patients.

In the present study majority (89.7%) of participants considered explanation of   procedures by dentist or dentist’s patience in choosing a dentist. Similarly in a study conducted by Ungureanu et al considered dentist’s patience as one of the factors.[8] As most of the patients are not aware of dental procedures they may expect dentists to explain about the procedures.

Utilization of dental services generally related to socio-economic status of the individual in a developing country like India where dental insurance systems were not well established.[12]   In the current study about 81.12% considered the amount charged by a dentist i.e, either expensive or reasonable as an important factor in choosing a dentist.  Similarly in a study conducted by Moshkelgosha when asked about the most important factor stopping or discouraging them from going to a specific dental clinic, "high tariffs" was mentioned by more than half (54.75%) of the participants.[3] So the cost of treatments was markedly more important than any other reason for not choosing a dental clinic. .

The present study has some limitations. First, as the study was conducted only on patients attending private clinics the study results cannot be generalized. Second, as the study was conducted in urban region the opinions of patients may vary in rural areas.

The results of the current study are relevant to the provid­ers of dental education, who should consider shaping their curricula to ensure they train future dentists in a manner that will contribute to meeting patients’ expectations and attaining the highest patient satisfaction levels.

Conclusion


Most of the patients relied on distance from home to clinic and word of mouth while selecting a clinic. Dentist’s behavior and communication skills, fame of the doctor and dentist’s degree were important factors considered by patients in choosing a dentist. The results of the current study are relevant to the provid­ers of dental education, who should consider shaping their curricula to ensure they train future dentists in a manner that will contribute to meeting patients’ expectations and attaining the highest patient satisfaction levels.

 

References


References:

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  2. 2.      Grewal N, Kaur M. Status of oral health awareness in Indian children as compared to Western children: A thought provoking situation (a pilot study). J Indian Soc Pedod Prev Dent 2007;25:15-9.  
  3. 3.      Moshkelgosha V, Mehrzadi M, Golkari A. The Public Attitude Towards Selecting Dental Health Centers. J Dent Shiraz Univ Med Sci., September 2014; 15: 129-134.
  4. 4.      McGrath C, Bedi R. Can dental attendance improve quality of life? Br Dent J 2001; 190: 262-265.
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  11. 11.  Bommireddy VS, Koka KM, Pachava S, Sanikommu S, Ravoori S, Chandu VC. Dental service utilization: Patterns and barriers among rural elderly in Guntur district, Andhra Pradesh. J Clin Diagn Res. 2016 Mar;10:43-7
  12. 12.  Toor RS, Jindal R. Dental insurance! Are we ready? Indian J Dent Res. 2011;22:144-7.

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