Pathway of Effects of Socioeconomic Status on Rural Left-behind Children to Receive Oral Health Services: A Structural Equation Modeling

Sichen Liu; Virasakdi Chongsuvivatwong; Shinan Zhang; Angkana Thearmontree

doi:10.3390/ijerph20021068

Pathway of Effects of Socioeconomic Status on Rural Left-behind Children to Receive Oral Health Services: A Structural Equation Modeling

Int J Environ Res Public Health. 2023 Jan 7;20(2):1068. doi: 10.3390/ijerph20021068.

Authors

Sichen Liu^{1

2}, Virasakdi Chongsuvivatwong³, Shinan Zhang², Angkana Thearmontree¹

Affiliations

¹ Improvement of Oral Health Care Research Unit, Community Dentistry Division, Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Songkhla 90110, Thailand.
² Department of Dental Public Health, School of Stomatology, Kunming Medical University, Kunming 650000, China.
³ Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.

Abstract

In a rural area with a high proportion of left-behind children (LBC), we aimed to identify the pathway of influence of socioeconomic status (SES) on LBCs to receive oral health services after individualized advice. Between September and October 2020, in a rural area of Yunnan, a survey of 238 LBC and 210 non-left-behind children (NLBC) showed that 91.9% and 94.2% had primary teeth caries, respectively. Their caregivers were advised on (1) dental care: bringing the children to seek professional dental care; and (2) self-care: supervising the children's oral health behaviors. Two to three months later, the children and their caregivers were visited to assess the compliance with these items of advice. Structural equation modeling (SEM) was used to handle the association between SES and compliance with the advice. A heatmap was used to visualize the data of reasons for seeking dental care or not. A total of 183 (87.1%) NLBCs and 206 (86.6%) LBCs were given the above advice; 32.9% of caregivers complied with dental care advice without a statistical difference between the LBC and NLBC group; 69.9% of caregivers of NLBCs complied with self-care advice, statistically more than those LBCs (59.2%). The education of caregivers was significantly associated with compliance with both advice items in univariate analysis. SES had a direct effect on the children being left behind and the level of oral health knowledge and awareness of the caregivers. Being left behind did not have an independent effect on receiving oral health services for children. "Dental disease was not severe" and "having no pain" were the main reasons for not seeking dental care. There was no clear grouping of participants with different background information based on the reasons given for seeking or not seeking dental care. Our study pointed to the importance of SES level. Being left behind alone may not be a risk factor for missing oral health services among rural children.

Keywords: data visualization; dental care; health care utilization; health care-seeking behavior; heatmap; left-behind children; parental migration; structural equation modeling.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Child
China
Health Services
Humans
Latent Class Analysis
Oral Health
Risk Factors
Rural Population*
Social Class*

Grants and funding

This research was funded by Thailand’s Education Hub for the Southern Region of ASEAN Countries (No. TEH-AC 042/2018), Graduate School and Faculty of Dentistry, Prince of Songkla University (670/1332).