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Type: Thesis
Title: Psychometric properties and structural determinants of oral care performance among children in Australia
Author: Nair, Rahul
Issue Date: 2019
School/Discipline: School of Dentistry
Abstract: There are differences in the dental care system that provide services to children in Australia across its jurisdictions. The policies in these jurisdictions result in significant differences in the organisation of oral care services, the extent and eligibility for public funding, and the availability of service providers of choice. Performance of those differing systems has not been evaluated, particularly as measured in a population. Among the children, the Aboriginal and Torres Straits Islanders (Indigenous children) face a disproportionate burden of oral diseases. Further, those experiencing higher discrimination are more likely to have unfavourable dental visiting patterns. As such, the reasons for such visiting patterns are currently unexplored. This thesis aimed to assess the effect of structural properties of the healthcare system on the performance of oral care and more specifically its role in the inequity in the performance of oral care faced by Indigenous children in Australia. The aims of this thesis were addressed through four inter-related scientific publications. The first paper that critically reviewed patient satisfaction questionnaires that assessed the performance of oral care and found 14 instruments for patient satisfaction of oral care and described its domains and assessed their psychometric properties. This critical review also found that the psychometric properties of the instruments were mostly unassessed, had differing dimensionality, and were only created for adult populations. Following this, the next paper assessed the psychometric properties of a new instrument developed for the National Child Oral Health Study (2012-’14). This 37-item instrument forms the Child Oral-care Performance Assessment Scale (COPAS) that measured the performance of oral 2 care among children, as reported by their parents. It was noted that COPAS had acceptable structural validity, construct validity and internal consistency. With these results, the following paper assessed the variations between states and territories in the performance of oral care delivery for children in Australia. Here the analyses found that smaller states with comparatively significant school dental services (Tasmania and South Australia) had the highest ratings for the performance of oral care, as measured using COPAS. The following paper extended this conceptualisation and assessed the effect of public versus private care on the performance of oral care and the modification of this effect based on the Indigenous status of the children. This paper found evidence of effect modification of private versus public care facilities on the performance of oral care systems with an increased chance of higher performance of oral care in private dental care facilities among non-Indigenous children versus Indigenous children in Australia. Overall, this thesis found evidence that the major structural variabilities in Australia affect the performance of oral healthcare systems available for children and contribute to inequity in the performance of oral care for the Indigenous children.
Advisor: Loc, Giang Do
Dissertation Note: Thesis (Ph.D.) -- University of Adelaide, Adelaide Dental School, 2019
Keywords: Access to care
Paediatric Dentistry
Health Technology Assessment
Quality of Care
Patient Satisfaction
Provenance: This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at:
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