Acceptability of Chairside Screening for Racial/Ethnic Minority Older Adults: A Qualitative Study

Abstract

An aging and more racially and ethnically diverse population, coupled with changes in the health care policy environment, is demanding that the dental profession both redirect and expand its focus. Challenges include providing comprehensive care for patients with complicated medical needs while improving access to care for underserved groups. The purpose of this study is to examine the acceptability of screening for hypertension and diabetes in the dental setting for African American, Puerto Rican, and Dominican older adults who attend senior centers in northern Manhattan, New York City. Focus groups were conducted with 194 racial/ethnic minority men and women aged 50 y and older living in northern Manhattan who participated in 1 of 24 focus group sessions about improving oral health for older adults. All groups were digitally audio-recorded and transcribed for analysis. Groups that were conducted in Spanish were transcribed first in Spanish and then translated into English. Analysis of the transcripts was conducted using thematic content analysis. Five themes were manifest in the data regarding the willingness of racial/ethnic minority older adults to receive hypertension and diabetes screening as part of routine dental visits: 1) chairside screening is acceptable, 2) screening is routine for older adults, 3) the interrelationship between oral and general health is appreciated, 4) chairside screening has perceived benefits, and 5) chairside screening may reduce dental anxiety. Reservations centered on 4 major themes: 1) dental fear may limit the acceptability of chairside screening, 2) there is a perceived lack of need for dental care and chairside screening, 3) screening is available elsewhere, and 4) mistrust of dental providers as primary care providers. This study provides novel evidence of the acceptability of screening for hypertension and diabetes in the dental setting among urban racial/ethnic minority senior center attendees. Knowledge Transfer Statement: The results of this study may be used by oral health providers when deciding whether to conduct chairside screening for medical conditions such as hypertension and diabetes that could affect, or be affected by, the oral health of their patients. Patient experiences of care-along with clinical outcomes, avoidable hospital admissions, equity of services, and costs-are important outcomes to consider in meeting the needs of an aging and racially and ethnically diverse US population.

Keywords: African Americans; Hispanic Americans; aging; diabetes; hypertension; oral health.

Figure 1.

Factors that influence chairside screening, by level. This graphic is derived from the conceptual model, factors that influence disparities in access to care and quality of health care services, by level, created from the analysis of findings from systematic reviews by Purnell et al. (2016). The focus in this simplified schematic as well as in this article is on factors at multiple levels that result in patient experiences of care resulting from chairside screening of primary care sensitive conditions.

Figure 2.

Focus groups conducted with racial/ethnic minority older adults. This graphic by research team member Susan Kum displays the 24 focus groups conducted with racial/ethnic minority older adults in New York from 2013 to 2015, segmented by race/ethnicity (African American/Dominican/Puerto Rican), sex (women/men), with or without a dental visit in the past year (with dental/no dental), and language (where EN = English and SP = Spanish). Printed with permission of Susan Kum.