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Susan E. Kelly, PhD, Catherine J. Binkley, DMD, MSPH, William P. Neace, PhD and Bruce S. Gale, MS, MAT

Susan E. Kelly, Catherine J. Binkley, and Bruce S. Gale are with the University of Louisville, Louisville, Kentucky. William P. Neace was with the Pacific Institute for Research and Evaluation Louisville Center, Louisville, at the time of the study.

Correspondence: Requests for reprints should be sent to Susan Kelly, PhD, Department of Sociology, University of Louisville, Louisville KY 40292 (email: skelly{at}louisville.edu).

Objectives. We identified psychosocial, structural, and cultural barriers to seeking dental care among nonutilizing caregivers of Medicaid-enrolled children.

Methods. We used Medicaid utilization records to identify utilizing and nonutilizing African American and White caregivers of Medicaid-enrolled children in Jefferson County, Kentucky. We conducted 8 focus groups (N=76) with a stratified random sample of responding caregivers; transcripts were qualitatively analyzed.

Results. Psychosocial factors associated with utilization included oral health beliefs, norms of caregiver responsibility, and positive caregiver dental experiences. Utilizing groups reported higher education; health beliefs included identifying oral health with overall health and professional preventive dental care with caregiver responsibility for children’s overall health. These beliefs may mediate shared structural barriers, including transportation, school absence policies, discriminatory treatment, and difficulty locating providers who accept Medicaid. Expectation of poor oral health among some low-income caregivers was among factors identified with nonutilization.

Conclusions. Disadvantaged caregivers reported multiple barriers to accessing dental care for their children. Providers, Medicaid administrators, and schools must coordinate steps to encourage caregiver-controlled dental care, build trust, and link professional preventive dental care with caregiver responsibility for children’s overall health.

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