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Type: Thesis
Title: Dentist-patient relationships and oral health-related quality of life
Author: Song, Youngha
Issue Date: 2020
School/Discipline: School of Dentistry
Abstract: The clinical encounter remains a key component of the healthcare service. Despite drastic/massive changes thanks to social and technical development, a therapeutic relationship between clinician and patient is still at the centre of healthcare encounters. As such, dentist-patient relationships (DPR) also play a pivotal role in dental encounters. There are, however, limited numbers of studies where predictors of DPR variables have been thoroughly analysed for their association with oral health outcomes. These studies were commonly based on the extrapolation from medicine or generic healthcare, leaving the dentistry-specific context uncharted. For the rationale to fill the gap of previous research findings, the aim of the thesis was to investigate associations between variables in DPR and oral health-related quality of life (OHRQoL). Four papers in the thesis were to explore the topic from a specific construct of trust in DPR to the general associations and extensive framework including psychosocial factors and structural validity. This thesis adopted two general approaches: reverse/inverted funnel structure and sequential hypotheses of articles. A comprehensive mapping review on a specific subtopic of trust led the theme to a wider scope of empirical analyses for the aim of the thesis. Among three empirical studies, the initial hypothesis tested in the first paper induced subsequent hypotheses for the second and culminated with examining the expansive causal model in the last. The data for the empirical analyses were sourced in self-complete questionnaires from the Dental Care and Oral Health study with a random sample of 12,245 adults aged 18 years or over living in South Australia in 2015-2016. Variables collected from multi-item scales were analysed in multivariable linear regression, exploratory/confirmatory factor analyses, cluster analysis, and structural equation modelling. The mapping review found three frameworks for the relevant concepts of trust in DPR: the continuum, beneficiaries, and transformational model of trust. Three thematic findings from the review were multidisciplinary approach, patient-centred care and quality of care, and insufficient empirical evidence. Empirical study 1 found general associations asked in the aim of the thesis – better DPR, mainly higher satisfaction and less dental fear, are associated with higher OHRQoL, presenting lower oral health impact. The significant association was consistent between favourable DPR and improved OHRQoL after adjusting for putative confounders. In empirical study 2, the analyses on factor structure showed that trust and satisfaction in dental care settings are unidimensionally different but highly correlated factors concurrently. The final model from structural validity suggested both scales with revision be applied together for further studies on DPR. The last empirical study indicated that psychosocial factors and DPR variables are associated with OHRQoL in both unique and mediated effects. Starting from psychosocial factors via DPR variables to OHRQoL, the ‘distal-to-proximal’ framework was empirically substantiated by the model. In conclusion, variables related to better DPR are associated with higher OHRQoL in both direct and indirect paths along with psychosocial factors. The biopsychosocial model of oral health with better DPR should be applied to improve health promotion as is justified by the theoretical and empirical findings from the thesis.
Advisor: Brennan, David
Luzzi, Liana
Dissertation Note: Thesis (Ph.D.) -- University of Adelaide, Adelaide Dental School, 2020
Keywords: dentist-patient relations
health-related quality of life
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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