.................... ARTICLE
.........................................
Richard A. Abrams, DDS, MPH, MEd; Curt S. Ayers, DDS, MPH; Patrick M. Lloyd, DDS, MS
Attitudes of older versus younger adults toward dentistry and dentists A total of 426 adults were interviewed by telephone to gauge their attitudes toward dentistry and dentists. Attitudes of those age 55 and older were compared with those younger than age 55. It was found that 72%of those 55 and older had not visited a dentist in the previous 2 years because they felt it was not necessary; 38.5%of respondents younger than 55 gave this reason. Only 15%of those 55 and older reported that high costs kept them away from the dentist.
he underutilization of dental services by adults 55 and older is one of the paramount problems confronting dentistry.7-2Older adults have a perception that they do not As Kiyak' obneed dental served, "Older people's attitudes toward oral health may be a reflection of their general acceptance of poor health, and their criterion of good health as the ability to perform basic activities of daily living. Chronic dental disease may be perceived to be a natural outcome of aging." Most older adults are nonusers of dental services, yet they have a demonstrated need for dental services. In the United States, older adults are the fastest growing segment of the population, the group with the most discretionary income, and the group with the most available time for dental appointments. One way to increase dental utilization by older people may be through marketing. Marketing has gained respectability with dental patients and practitioners To be successful, dental marketing should modify patient desire for care to make it coincide with the need for care. Meanwhile, the increase in the number of dentists in the United States relative to the demand for dental care has increased competition. As a result of this competition, the importance of marketing has grown. Dentists are using marketing techniques far more often than in the past. Most dentists not only continue to rely on word of mouth to promote their practices, but are taking extraordinary measures to ensure that the passed word will be favorable. The age of the consumer has arrived in denti~try.~~
Methods This study, which was based on a larger study,I0measured the attitudes of people younger than age 55 and those age 55 and older toward dentists and dentistry, compared them, and measured differences between the two age groups. The primary survey focus areas determined reasons why people do not visit the dentist, the importance of various factors in choosing a dentist, how patients select their dentist, consumers' views on the issue of advertising fees, and nonclinical services consumers would like to have their dentists provide. The information needed for analysis was collected by a pretested telephone questionnaire which was administered in 1986 by two individuals trained in interviewing techniques and standards. Telephone interviews were conducted during a 1-month period. During that time, 1,177 telephone calls were made from a larger randomly selected list of telephone numbers from the Milwaukee Metropolitan White Pages; each interview took from 6 to 10 minutes to complete. Telephones were not answered for 423 (35.9%)of the numbers called; 63 (5.4%)of the telephones were no longer in service; and 77 (6.5%)of the telephones had a busy signal. To maximize the number of participants, under each of these three circumstances the interviewer proceeded to the next telephone number on the call list. One-hundred ninetyeight (16.8%)phone calls were answered by people who refused to participate; 416 (35.3%)of the telephones were answered by subjects who responded to the interview. Of those responding, 123 (29.6%)were age 55 and
Special Care in Dentistry, Vol 12 No 2 1992 67
older, 293 (70.4%)were younger than age 55.
cult to get an appointment, fear of pain, and/or haven't felt it was necessary." The results of these questions Results are shown in Table 1.The x2 findings A total of 27.6%of those age 55 and in Table 1 reflect a single comparison older, and 20.1% of those younger than of the primary responses to the ques55 replied "no" to the question: "Have tion, between the over and under 55 you visited a dentist in the last 2 age groups..Of those who did not visit years?" Of those who had not visited a the dentist within the last 2 years, the dentist within the previous 2 years, the primary reason stated for both those 55 interviewer asked, "What factors may and older and those younger than 55 have kept you from seeing a dentist was, "Haven't felt it was necessary." more regularly? Please say whether Almost twice as many respondents 55 any of the following kept you away: and older, than those younger, cited this reason. inconvenient hours, high costs, diffiA comparison of various marketing strategies and their efTable 1. Primary factors that kept respondents fectiveness on patient under age 55 and 55 and older from visitlng a selection of a dentist dentist regularly. amears in Table 2. Al1 1 though some statistiRespondents cally significant differYounger Than Age 55 and Factor ences exist between the Older(%) N Age55(%) N two age groups, these differences are quanti38.5 35 72.5 29 Felt not necessary tatively small. For exHigh costs 27.5 25 15.0 6 ample, "prompt emerInconvenient hours 20.9 19 2.5 1 gency care" was rated 9.03 by those younger Fear of pain 13.2 12 7.5 3 than age 55, while Difficult to get 0 0 2.5 1 those 55 and older an appointment rated it 8.83 (on a 10= 15.67; p < .005; df = 4. point scale, with 10 being "most important"). The factors that apTable 2. Reasons for selectlng dental offlces. pear to be important in Respondents, Mean Importance* selecting a regular dentist were of particular Younger Than Age 55 and Category Label interest to the investiAge55(%) N Older(%) N gators. The results 263 8.83 105 shown in Table 3 indiPrompt emergency caret 9.03 Personal attention 8.57 265 8.99 105 cate that both groups ask their family or of the dentist' Preventive care' 8.70 264 8.32 102 friends for referrals. "Convenient location" Convenient hourst 8.60 265 8.34 106 was twice as important Friendly staff 8.49 265 8.58 106 to the older group, Rapid service 8.43 265 8.40 105 compared to the Low fees" 7.67 265 7.41 104 younger group, indicating that transportation Near home or business 7.34 265 7.59 106 is a consideration. The Bonding - cosmetics' 7.00 216 5.01 81 x2 findings in Table 3 Credit available 6.08 262 5.13 101 reflect a single comNitrous oxide 5.03 228 3.12 76 parison of the responses to the question, Stereo earphones 3.75 247 2.04 84 between the over and under age 55 groups. * Scored on a 10-point scale, where 1 = not important; 10 = most Consumers' attiimportant. P < ,005 (t-test on mean values). ' P < .05 (t-test on tudes toward dentists' mean values).
xz
+
68 Special Care in Dentistry, Voi 12 No 2 1992
advertising of fees (Table 4) varied between those 55 and older and those younger than 55. Both groups were about equal in their desire to have dentists "post fees in the dentist's reception room." The notion of listing fees in a directory and advertising was acceptable to most respondents younger than 55; however, most respondents 55 and older were reluctant to accept either method. The responses to questions (Tables 4 and 5) were based upon a priori hypotheses; the authors believed that there would be differences between the two age groups, therefore, no adjustment of significance levels was performed. For services consumers would like their dentists to offer (Table 5), some differencesbetween age groups were revealed. Although "educational programs" were favored by both groups, the proportion of favorable responses was greater in those younger than age 55. "Child care services at the dental office" were also selected more often by those younger than age 55.
Discussion There are certain limitations inherent in any telephone survey. Researchers often are concerned about the overall response rate in a ~urvey;~J'J* in this study, it was 35.3%.Also, in this study, the noncontact rate (the total of nonresponse not attributed to direct refusals from potential respondents) was 47.8%.13Reaching respondents is often a challenge with a telephone survey, and is reflected in the noncontact rate. A review of 182 telephone surveys found that the median noncontact rate was 39.1%.13 A significant observation from the findings was that almost threequarters of older people have not sought dental care within the previous 2 years because they "felt it was not necessary" (Table 1).Of those younger than age 55, only 38.5%believed that dental care was not necessary. Similar observations have been noted in other ~tudies.'~-'~Marketing or educational intervention efforts directed toward older people may encourage more to seek out dental care on a regular basis. In Table 5,61.7%of respondents age 55 and older wanted "educational programs," as compared with 72.9%of
55, compared with Table 5. Services consumers would like their those age 55 and older. dentist to offer. The differences were Respondents in Favor greatest in the categoYounger Than Age 55 and ries, "listing of fees in a Factor Older(%) N Age55(%) N directory with all other local dentists" and 72.9 212 61.7 74 Educational programs* "advertisement in 49.1 143 16.7 20 Child care services at the newspapers, radio dental office' and/or TV." Financial barriers 16.5 48 25.8 31 Transportation to and from dental office" were not found to be a major factor that kept older persons from * X2 = 5.02;p = .025. t X' = 37.44; p < ,001. X' = 4.77; p = ,029. visiting the dentist in people feel that little can be done to this study. Only 15%of those age 55 improve their dental health. Older and older indicated that "high costs" Americans are the least likely to seek kept them away from the dentist dental services; almost 40% of those (Table 1). Cost was not as significant a marketing factor for older persons as it age 65 and older indicated that they had not gone to a dentist in the past 5 was for persons younger than 55 years.IJ4Marinelli and others19found (Table 2). that oral health was not considered to In a review article, Gooch and be an important health matter by older BerkeyI8examined the literature on people. Branch and othersz0found, on demand for dental care by older perexamination,that approximately 70% sons. The conclusion Table 3. Primary factors stated by respondents of older people had dental needs, yet of numerous studies under age 55 and 55 and older for selection only 25% to 40% of those found to indicated that the priof regular dentist. have a dental need actually thought mary reason older people do not seek out they had a dental need. Respondents To address and correct the lack of dental care is a lack of Younger Than Age 55 and perceived need. Gooch perceived need for dental services Cutegoy Age 55 (%) N Older(%) N and Berkey concluded among older people, dental professionals should focus their attention on that dental problems Referred by friend 70.1 206 71.2 88 this problem, and actively seek out crerelated to the irreversor family ative solutions. The assumption that ible process of aging 10.0 29 20.3 25 Convenient location one's natural dentition will not last a may be perceived as 3.4 4 7.6 22 Yellow PagesN unavoidable, and thus, lifetime is gradually disappearing. The .8 1 Accepts insurance as 5.8 17 may not be interpreted older person must be educated about dental diseases which do not solely infull payment as actual dental disvolve teeth; periodontal disease is a ease by the patient. 14 1.7 2 Referred by dental society 4.8 primary threat to this group. Vigorous A Health Resources Newspaper advertisement 1 .O 3 .8 1 measures should be taken to educate and Services AdminisNo response .7 2 .8 1 older people, to convince them that tration report14indidental problems are not an inevitable cated that most older X' = 18.65;p = .OG94;df = 6. result of the aging process. This could be accomplished with a marketing Table 4. Consumer's attitudes toward dentlsts' advertising of fees. program. However, it would be more realistic to approach older people with Respondents in Favor an educational intervention message Category Label Younger Than Age 55 and that would reinforce the fact that there Older(%) N Age55(%) N is a continual, and perhaps increasing need for dental care throughout life.
those younger than age 55. Because older people may be less interested in educational intervention, marketing and advertising approaches toward their age group should focus on their perceived need, and emphasize that optimal dental health is a life-long goal requiring a continual partnership between the dentist and the patient. Only 25.8% of those 55 and older, and 16.5%of those younger than 55 desired transportation to and from the dental office (Table5). However, because the study population lived in a city with an excellent public transportation system available, patients desiring transportation in suburban or rural areas elsewhere may be higher. The data in Table 4 suggest that older persons may be less comfortable with advertising by professionals than are adults younger than 55. In the three categories listed, advertising was more acceptable to those younger than
~
Posting of fees in the dentist's reception room
64.8
186
60.5
72
Listing of fees in a directory with all other local dentists*
52.1
150
37.5
45
Advertisements in newspapers, radio and/or TVt
51.6
148
35.8
43
*
x'
= 7.21; p = .007. t
x* = 8.41; p < .004.
Dr. Abrams is head, curriculum in community health; Dr. Ayers is associate professor, School of Dentistry, Marquette University,604 N 16th St, Milwaukee 53233. Dr.Lloyd is coordinator, geriatric dental programs, Department of Veterans Affairs, 5000 W National Ave,
Special Care in Dentistry, Voi 12 No 2 1992 69
Milwaukee 53295. Address requests for reprints to Dr. Abrams.
1. Kiyak H. Impact of patients’ and dentists’ attitudes on older persons’ use of dental services. Gerodontics 4 : 331-5,1988. 2. Kiyak H. Explaining patterns of dental service utilization among the elderly. J Dent Educ 50 679-87,1986. 3. Evanshwick C, Conrad D, Lee F. Factors related to utilization of dental services by the elderly. Am J Public Health 72:1129-35, 1982. 4. Hawes J. What patients want. J Dent Pract Admin 3:4-7, 1986. 5. Barnes N. Out of the mouths of patients. J Dent Pract Admin 346-51,1986. 6. Duke P. Dentists step up services and marketing as competition increases in crowded field. Wall Street Journal 21031,1987. 7. American Dental Association. Consumer attitudes and how they affect your practice. American Dental Association, Chicago, 1991.
70 Special Care in Dentistry, Vol I 2 No 2 1992
8. American Dental Association. Interim report of the American Dental Association’s special committee on the future of dentistry. Issue papers on dental research, manpower, education, practice and public and professional concerns. American Dental Association, Chicago, 1982. 9. American Dental Association. Special committee to study the future of dentistry. Resource papers on dental research, dental education, dental practice, dental manpower, public and professional concerns. American Dental Association, Chicago, 1986. 10. Ayers C, Abrams R. Attitudes of consumers toward dentistry and dentists. J Dent Pract Admin 6: 22-7,1989. 11. Babbie E. Survey research methods. Wadsworth, Belmont, CA; 1973. 12. Babbie E. The practice of social research. Wadsworth, Belmont, CA; 1979. 13. Frey JH. Survey research by telephone. Sage Publications, Beverly Hills, 1983.
14. Health Resources and Services Adminislration. National study of dental health outcomes related to prepayment. Rockville, Maryland: HRSA Report, 1987. 15. Antczak A, Branch L. Perceived barriers to the use of dental services by the elderly. Gerodontics I:194-8,1985. 16. Gambucci J, Martens L, Meskin L, Davidson, G. Dental care utilization patterns in older adults. Gerodontics 211-5, 1986. 17. Kiyak H, Miller R. Age differences in oral heaIth attitudes and dental service utilization. J Public Health Dent 42:29-41,1982. 18. Gooch B, Berkey D. Subjective factors affecting the utilization of dental services by the elderly. Gerodontics 3:65-9,1987. 19. Marinelli R, Sreebny I, Kamen S. Percep tion of dental needs by the well elderly. Spec Care Dentist 2:161-4,1982. 20. Branch L, Antczak A, Stason W. Toward understanding the use of dental services by the elderly. Spec Care Dentist 6:38-41,1986.
.........................................
Richard A. Abrams, DDS, MPH, MEd; Curt S. Ayers, DDS, MPH; Patrick M. Lloyd, DDS, MS
Attitudes of older versus younger adults toward dentistry and dentists A total of 426 adults were interviewed by telephone to gauge their attitudes toward dentistry and dentists. Attitudes of those age 55 and older were compared with those younger than age 55. It was found that 72%of those 55 and older had not visited a dentist in the previous 2 years because they felt it was not necessary; 38.5%of respondents younger than 55 gave this reason. Only 15%of those 55 and older reported that high costs kept them away from the dentist.
he underutilization of dental services by adults 55 and older is one of the paramount problems confronting dentistry.7-2Older adults have a perception that they do not As Kiyak' obneed dental served, "Older people's attitudes toward oral health may be a reflection of their general acceptance of poor health, and their criterion of good health as the ability to perform basic activities of daily living. Chronic dental disease may be perceived to be a natural outcome of aging." Most older adults are nonusers of dental services, yet they have a demonstrated need for dental services. In the United States, older adults are the fastest growing segment of the population, the group with the most discretionary income, and the group with the most available time for dental appointments. One way to increase dental utilization by older people may be through marketing. Marketing has gained respectability with dental patients and practitioners To be successful, dental marketing should modify patient desire for care to make it coincide with the need for care. Meanwhile, the increase in the number of dentists in the United States relative to the demand for dental care has increased competition. As a result of this competition, the importance of marketing has grown. Dentists are using marketing techniques far more often than in the past. Most dentists not only continue to rely on word of mouth to promote their practices, but are taking extraordinary measures to ensure that the passed word will be favorable. The age of the consumer has arrived in denti~try.~~
Methods This study, which was based on a larger study,I0measured the attitudes of people younger than age 55 and those age 55 and older toward dentists and dentistry, compared them, and measured differences between the two age groups. The primary survey focus areas determined reasons why people do not visit the dentist, the importance of various factors in choosing a dentist, how patients select their dentist, consumers' views on the issue of advertising fees, and nonclinical services consumers would like to have their dentists provide. The information needed for analysis was collected by a pretested telephone questionnaire which was administered in 1986 by two individuals trained in interviewing techniques and standards. Telephone interviews were conducted during a 1-month period. During that time, 1,177 telephone calls were made from a larger randomly selected list of telephone numbers from the Milwaukee Metropolitan White Pages; each interview took from 6 to 10 minutes to complete. Telephones were not answered for 423 (35.9%)of the numbers called; 63 (5.4%)of the telephones were no longer in service; and 77 (6.5%)of the telephones had a busy signal. To maximize the number of participants, under each of these three circumstances the interviewer proceeded to the next telephone number on the call list. One-hundred ninetyeight (16.8%)phone calls were answered by people who refused to participate; 416 (35.3%)of the telephones were answered by subjects who responded to the interview. Of those responding, 123 (29.6%)were age 55 and
Special Care in Dentistry, Vol 12 No 2 1992 67
older, 293 (70.4%)were younger than age 55.
cult to get an appointment, fear of pain, and/or haven't felt it was necessary." The results of these questions Results are shown in Table 1.The x2 findings A total of 27.6%of those age 55 and in Table 1 reflect a single comparison older, and 20.1% of those younger than of the primary responses to the ques55 replied "no" to the question: "Have tion, between the over and under 55 you visited a dentist in the last 2 age groups..Of those who did not visit years?" Of those who had not visited a the dentist within the last 2 years, the dentist within the previous 2 years, the primary reason stated for both those 55 interviewer asked, "What factors may and older and those younger than 55 have kept you from seeing a dentist was, "Haven't felt it was necessary." more regularly? Please say whether Almost twice as many respondents 55 any of the following kept you away: and older, than those younger, cited this reason. inconvenient hours, high costs, diffiA comparison of various marketing strategies and their efTable 1. Primary factors that kept respondents fectiveness on patient under age 55 and 55 and older from visitlng a selection of a dentist dentist regularly. amears in Table 2. Al1 1 though some statistiRespondents cally significant differYounger Than Age 55 and Factor ences exist between the Older(%) N Age55(%) N two age groups, these differences are quanti38.5 35 72.5 29 Felt not necessary tatively small. For exHigh costs 27.5 25 15.0 6 ample, "prompt emerInconvenient hours 20.9 19 2.5 1 gency care" was rated 9.03 by those younger Fear of pain 13.2 12 7.5 3 than age 55, while Difficult to get 0 0 2.5 1 those 55 and older an appointment rated it 8.83 (on a 10= 15.67; p < .005; df = 4. point scale, with 10 being "most important"). The factors that apTable 2. Reasons for selectlng dental offlces. pear to be important in Respondents, Mean Importance* selecting a regular dentist were of particular Younger Than Age 55 and Category Label interest to the investiAge55(%) N Older(%) N gators. The results 263 8.83 105 shown in Table 3 indiPrompt emergency caret 9.03 Personal attention 8.57 265 8.99 105 cate that both groups ask their family or of the dentist' Preventive care' 8.70 264 8.32 102 friends for referrals. "Convenient location" Convenient hourst 8.60 265 8.34 106 was twice as important Friendly staff 8.49 265 8.58 106 to the older group, Rapid service 8.43 265 8.40 105 compared to the Low fees" 7.67 265 7.41 104 younger group, indicating that transportation Near home or business 7.34 265 7.59 106 is a consideration. The Bonding - cosmetics' 7.00 216 5.01 81 x2 findings in Table 3 Credit available 6.08 262 5.13 101 reflect a single comNitrous oxide 5.03 228 3.12 76 parison of the responses to the question, Stereo earphones 3.75 247 2.04 84 between the over and under age 55 groups. * Scored on a 10-point scale, where 1 = not important; 10 = most Consumers' attiimportant. P < ,005 (t-test on mean values). ' P < .05 (t-test on tudes toward dentists' mean values).
xz
+
68 Special Care in Dentistry, Voi 12 No 2 1992
advertising of fees (Table 4) varied between those 55 and older and those younger than 55. Both groups were about equal in their desire to have dentists "post fees in the dentist's reception room." The notion of listing fees in a directory and advertising was acceptable to most respondents younger than 55; however, most respondents 55 and older were reluctant to accept either method. The responses to questions (Tables 4 and 5) were based upon a priori hypotheses; the authors believed that there would be differences between the two age groups, therefore, no adjustment of significance levels was performed. For services consumers would like their dentists to offer (Table 5), some differencesbetween age groups were revealed. Although "educational programs" were favored by both groups, the proportion of favorable responses was greater in those younger than age 55. "Child care services at the dental office" were also selected more often by those younger than age 55.
Discussion There are certain limitations inherent in any telephone survey. Researchers often are concerned about the overall response rate in a ~urvey;~J'J* in this study, it was 35.3%.Also, in this study, the noncontact rate (the total of nonresponse not attributed to direct refusals from potential respondents) was 47.8%.13Reaching respondents is often a challenge with a telephone survey, and is reflected in the noncontact rate. A review of 182 telephone surveys found that the median noncontact rate was 39.1%.13 A significant observation from the findings was that almost threequarters of older people have not sought dental care within the previous 2 years because they "felt it was not necessary" (Table 1).Of those younger than age 55, only 38.5%believed that dental care was not necessary. Similar observations have been noted in other ~tudies.'~-'~Marketing or educational intervention efforts directed toward older people may encourage more to seek out dental care on a regular basis. In Table 5,61.7%of respondents age 55 and older wanted "educational programs," as compared with 72.9%of
55, compared with Table 5. Services consumers would like their those age 55 and older. dentist to offer. The differences were Respondents in Favor greatest in the categoYounger Than Age 55 and ries, "listing of fees in a Factor Older(%) N Age55(%) N directory with all other local dentists" and 72.9 212 61.7 74 Educational programs* "advertisement in 49.1 143 16.7 20 Child care services at the newspapers, radio dental office' and/or TV." Financial barriers 16.5 48 25.8 31 Transportation to and from dental office" were not found to be a major factor that kept older persons from * X2 = 5.02;p = .025. t X' = 37.44; p < ,001. X' = 4.77; p = ,029. visiting the dentist in people feel that little can be done to this study. Only 15%of those age 55 improve their dental health. Older and older indicated that "high costs" Americans are the least likely to seek kept them away from the dentist dental services; almost 40% of those (Table 1). Cost was not as significant a marketing factor for older persons as it age 65 and older indicated that they had not gone to a dentist in the past 5 was for persons younger than 55 years.IJ4Marinelli and others19found (Table 2). that oral health was not considered to In a review article, Gooch and be an important health matter by older BerkeyI8examined the literature on people. Branch and othersz0found, on demand for dental care by older perexamination,that approximately 70% sons. The conclusion Table 3. Primary factors stated by respondents of older people had dental needs, yet of numerous studies under age 55 and 55 and older for selection only 25% to 40% of those found to indicated that the priof regular dentist. have a dental need actually thought mary reason older people do not seek out they had a dental need. Respondents To address and correct the lack of dental care is a lack of Younger Than Age 55 and perceived need. Gooch perceived need for dental services Cutegoy Age 55 (%) N Older(%) N and Berkey concluded among older people, dental professionals should focus their attention on that dental problems Referred by friend 70.1 206 71.2 88 this problem, and actively seek out crerelated to the irreversor family ative solutions. The assumption that ible process of aging 10.0 29 20.3 25 Convenient location one's natural dentition will not last a may be perceived as 3.4 4 7.6 22 Yellow PagesN unavoidable, and thus, lifetime is gradually disappearing. The .8 1 Accepts insurance as 5.8 17 may not be interpreted older person must be educated about dental diseases which do not solely infull payment as actual dental disvolve teeth; periodontal disease is a ease by the patient. 14 1.7 2 Referred by dental society 4.8 primary threat to this group. Vigorous A Health Resources Newspaper advertisement 1 .O 3 .8 1 measures should be taken to educate and Services AdminisNo response .7 2 .8 1 older people, to convince them that tration report14indidental problems are not an inevitable cated that most older X' = 18.65;p = .OG94;df = 6. result of the aging process. This could be accomplished with a marketing Table 4. Consumer's attitudes toward dentlsts' advertising of fees. program. However, it would be more realistic to approach older people with Respondents in Favor an educational intervention message Category Label Younger Than Age 55 and that would reinforce the fact that there Older(%) N Age55(%) N is a continual, and perhaps increasing need for dental care throughout life.
those younger than age 55. Because older people may be less interested in educational intervention, marketing and advertising approaches toward their age group should focus on their perceived need, and emphasize that optimal dental health is a life-long goal requiring a continual partnership between the dentist and the patient. Only 25.8% of those 55 and older, and 16.5%of those younger than 55 desired transportation to and from the dental office (Table5). However, because the study population lived in a city with an excellent public transportation system available, patients desiring transportation in suburban or rural areas elsewhere may be higher. The data in Table 4 suggest that older persons may be less comfortable with advertising by professionals than are adults younger than 55. In the three categories listed, advertising was more acceptable to those younger than
~
Posting of fees in the dentist's reception room
64.8
186
60.5
72
Listing of fees in a directory with all other local dentists*
52.1
150
37.5
45
Advertisements in newspapers, radio and/or TVt
51.6
148
35.8
43
*
x'
= 7.21; p = .007. t
x* = 8.41; p < .004.
Dr. Abrams is head, curriculum in community health; Dr. Ayers is associate professor, School of Dentistry, Marquette University,604 N 16th St, Milwaukee 53233. Dr.Lloyd is coordinator, geriatric dental programs, Department of Veterans Affairs, 5000 W National Ave,
Special Care in Dentistry, Voi 12 No 2 1992 69
Milwaukee 53295. Address requests for reprints to Dr. Abrams.
1. Kiyak H. Impact of patients’ and dentists’ attitudes on older persons’ use of dental services. Gerodontics 4 : 331-5,1988. 2. Kiyak H. Explaining patterns of dental service utilization among the elderly. J Dent Educ 50 679-87,1986. 3. Evanshwick C, Conrad D, Lee F. Factors related to utilization of dental services by the elderly. Am J Public Health 72:1129-35, 1982. 4. Hawes J. What patients want. J Dent Pract Admin 3:4-7, 1986. 5. Barnes N. Out of the mouths of patients. J Dent Pract Admin 346-51,1986. 6. Duke P. Dentists step up services and marketing as competition increases in crowded field. Wall Street Journal 21031,1987. 7. American Dental Association. Consumer attitudes and how they affect your practice. American Dental Association, Chicago, 1991.
70 Special Care in Dentistry, Vol I 2 No 2 1992
8. American Dental Association. Interim report of the American Dental Association’s special committee on the future of dentistry. Issue papers on dental research, manpower, education, practice and public and professional concerns. American Dental Association, Chicago, 1982. 9. American Dental Association. Special committee to study the future of dentistry. Resource papers on dental research, dental education, dental practice, dental manpower, public and professional concerns. American Dental Association, Chicago, 1986. 10. Ayers C, Abrams R. Attitudes of consumers toward dentistry and dentists. J Dent Pract Admin 6: 22-7,1989. 11. Babbie E. Survey research methods. Wadsworth, Belmont, CA; 1973. 12. Babbie E. The practice of social research. Wadsworth, Belmont, CA; 1979. 13. Frey JH. Survey research by telephone. Sage Publications, Beverly Hills, 1983.
14. Health Resources and Services Adminislration. National study of dental health outcomes related to prepayment. Rockville, Maryland: HRSA Report, 1987. 15. Antczak A, Branch L. Perceived barriers to the use of dental services by the elderly. Gerodontics I:194-8,1985. 16. Gambucci J, Martens L, Meskin L, Davidson, G. Dental care utilization patterns in older adults. Gerodontics 211-5, 1986. 17. Kiyak H, Miller R. Age differences in oral heaIth attitudes and dental service utilization. J Public Health Dent 42:29-41,1982. 18. Gooch B, Berkey D. Subjective factors affecting the utilization of dental services by the elderly. Gerodontics 3:65-9,1987. 19. Marinelli R, Sreebny I, Kamen S. Percep tion of dental needs by the well elderly. Spec Care Dentist 2:161-4,1982. 20. Branch L, Antczak A, Stason W. Toward understanding the use of dental services by the elderly. Spec Care Dentist 6:38-41,1986.
