Author ORCID Identifier

https://orcid.org/0000-0003-2984-8649

Semester

Fall

Date of Graduation

2023

Document Type

Dissertation

Degree Type

PhD

College

College of Applied Human Sciences

Department

Counseling, Rehabilitation Counseling & Counseling Psychology

Committee Chair

Lisa F. Platt

Committee Co-Chair

Daniel W. McNeil

Committee Member

Jeff Daniels

Committee Member

Linda A. Alexander

Abstract

This dissertation is a study of the implications of racism in oral health care settings for dental care-related fear/anxiety, and dental care utilization. One in five adults in the US have experienced discrimination while receiving health care. Even though racism is the most reported type of discrimination in health care, little is known about its impact on dental outcomes. There is a paucity of prior studies measuring experiences of racism in dental settings. The current study proposed the application of Krieger’s Ecosocial Theory of Health Equity to explore relationships among racism in oral health care settings, dental care-related fear/anxiety, and dental care utilization among African American/Black women residing in Appalachia. Data from the Center for Oral Health Research in Appalachia (COHRA) Smile cohort was used in this study. The results of this study indicate racism occurs in oral health settings and is positively related to dental anxiety. Age, education, and income also predicted dental care-related anxiety/fear. Dental care-related fear/anxiety was also found to predict less frequent dental care utilization; experiences of racism in oral health care settings did not moderate the relationship between dental care-related anxiety/fear and dental care utilization. Exploratory analyses revealed geographic location differences in experiences of racism in dental settings and identified dental fear/anxiety as a mediator between experiences of racism in oral health care settings and dental care utilization. Findings suggest Black women desire to be listened to, respected and provided equal services like other people in dental care settings. It also suggests that racism in oral health care settings may trigger dental care-related fear/anxiety among Black women. Clinically assessing and addressing past experiences with racism in dental settings may help reduce dental anxiety/fear among Black women.

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