Parents' descriptions of barriers faced and strategies used to obtain dental care.

~ i ~ h ~ ~ d ~ ~ has compiled a comprehensive bibliogaphical review of studies which describe factors related to the utilization of dental services in the United States and other countries. Examples of variables described in the differential use of dental services include financing, anxiety and fear, past experiences, perceptions and personalities of both providers and recipients of dental services, awareness of need for treatment, and factors affecting availability, accessibility, and acceptability of dental services. Richards Points Out that utilization of dental services is a complex product of both present and Past factors, and includes differences in the social, economic, and demographic characteristics of the population studied. Utilization in any society, hence, is dependent on a variety of factors, some of which may be rooted in previous practices, cultural values, and familial traditons. The financial barrier is but one of the many types of barriers which may face families who seek dental care. Other barriers, perhaps less obvious than the financial one, but equally as great an impediment to utilization, may be psychological, environmental, cognitive, or sociological. For example, Nikias’ calls attention to the importance of social class as a factor which affects utilization even when cost as a barrier is removed. She states that social class maintains a strong correlation even when ability to pay for services no longer is a problem. A model of utilization for dental treatment, presented by Young and Striffler,’ describes a common way of looking at utilization by a population. This model assumes that need for dental care is nearly universal. Three possible responses to this need for care then are defined in the model: (1) persons who demonstrate an unqualified desire for dental care plus the ability to obtain dental services are said to be responding with effective demand, inasmuch as they want the care and are able to obtain it; (2) persons who may have the desire for dental care but who are not able to obtain services are said to be responding with potential demand, because they want the care but for Some do not obtain it; and ( 3 ) persons who may choose deliberately not to obtain care are considered to demonstrate no demand because they may not be aware of their need or they may not desire dental services. Studies of utilization of dental care appear to have focused mainly upon families who represent the effective demand a~ defined by Young and Striffler. Less information is available about the families with potential demand and those who demonstrate no &nand. It is not easy to identify the factors which influence the decisions to seek care by the last two categories because the families are unknown and hidden within the