LAY REFERRAL SYSTEMS AND THE USE OF DENTAL SERVICES

ARTHUR JOHN BONITO, Purdue University

Abstract

This study tested three hypotheses about the differential use of dental services by people living in the Baltimore, Maryland SMSA. A key construct is Friedson's notion of lay referral systems. Lay referral systems refer to the organization of the non-medical relationships and groups in which an individual is involved. They structure an individual's socio-cultural environment and influence his behavior including the use of health services. It was hypothesized that: (1) an individual's dental health status was the single most important direct determinant of dental service utilization; (2) the proportion of people using dental services in a year varied directly with the type of lay referral system in which they were involved; and (3) the relative importance of various social and economic attributes of individuals, as determinants of dental services utilization, varied from one lay referral system to another. Data for this study were collected through personal interviews conducted with a sample of household residents in 1969. A sample of 3,872 households was selected according to a self-representing, multistage, area probability design. An 89.9 percent response rate was obtained. The interview schedule solicited information on demographic characteristics, socioeconomic status, health care utilization, attitudes and reported social behavior. Data on the occupational distribution and residential ownership for census tracts containing respondents were obtained from the 1960 U.S. Census in order to characterize lay referral systems. Goodman and Kruskal's Gamma statistic was used to evaluate the association between predictor variables and the use of dental services in bivariate tabular analyses. The Automatic Interaction Detector (AID) procedure was used in the multivariate analysis of dental utilization. Results of the multivariate analyses indicated that: (1) while dental health status was an important determinant of dental service utilization, it was not the single most important; (2) the rate of dental service utilization varied according to type of lay referral system, but not in the way expected; and (3) the relative importance of social and economic variables varied across the four lay referral systems and none of them resembled the results of an analysis performed on the sample as a whole.

Degree

Ph.D.

Subject Area

Welfare

COinS