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Indian Journal of Community Medicine

Assessment of Dental Health Care Attitude Among Urban Population of Nagpur City

Author(s): Vijay V. Doifode*, Nitin N. Ambadekar**, A.G. Lanjewar***

Vol. 25, No. 2 (2000-04 - 2000-06)

*Deptt. of PSM, Lata Manageshkar Medical College, Nagpur. **Medical Officer, Civil Hospital, Yavatmal. ***Deptt. of PSM, Govt. Medical College, Nagpur.


Research question: What is the attitude of community regarding Dental/Oral health care?

Objective: To assess the Dental/Oral health care attitude of urban population of Nagpur city.

Study design: Cross-sectional study.

Setting: Field practice area of Urban Health Training Centre, Nagpur.

Participants: People above 20 years of age.

Statistical analysis: Mean and standard deviation.

Results: Mean scores for cynicism was 38.4, for health concern 37.2, for motivation 18.7, for oral function 30.1, for social aesthetic 21.4, and susceptibility 19.7.

Keywords: Dental health care, People attitude, Urban population, Cross-sectional study


The issue of attitude measurement and attitude-behaviour relationships has long history in social sciences. Attitude of population regarding health care may help understand the behaviour of population concerning health related activities and active participation and co-operation with health care delivery system.

Dental and oral health is an important aspect of health, both in terms of magnitude of dental problems in population and morbidity associated with it1,2. Still dental health is one of the least priority aspect of health care for people. Improvement strategies with regard to people involvement and participation in their dental health care requires information about people needs and feelings towards dentistry. There is scarcity of data regarding this in India. To make the community-wide data available regarding dental health care attitudes in Indian set up the present study was carried out.

For the measurement of attitudes in particular domain LIKERT proposed the method of summated ratings3. Use of LIKERT procedure gives a score that indicates the degree to which a person is favourable or unfavourable with respect to attitude object. In 1984, Stockwell and Banting4 using LIKERT scaling procedure, constructed the 'Dental Attitudes Questionnaire' an instrument for assessing oral health care attitudes. We used the same questionnaire in our study.

Material and Methods:

Present study was the part of overall oral health survey conducted in field practice area of Urban Health Training Centre, Bapunagar, Nagpur city. There were total 5061 participants in the study. Assessment of dental health care attitude was carried in participants above 20 years of age; that included 2597 subjects after exclusion of 18 subjects who either did not participate or gave the incomplete response.

The Dental Attitude Questionnaire comprised of eight subclasses. Each scale contains eight items. Six of the scales were content oriented and last two were validity scales. Description of the eight subclasses. Each scale contains eight items. Six of the scales were content oriented and last two were validity scales. Description of the eight scales are given in Annexure. Six different content oriented scales were used to understand different aspects of attitudes among respondents about dental health care. These are the different aspects which affect either delivery of dental health care or acceptance of it. This approach helps to have insight into specific aspects of attitude which may help to target the strategy to modify the attitude or behaviour in that particular aspect. Last two scales were validity scales. These scales help to validate the results achieved on prior six scales by measuring the character of respondents.

For use in community based setup, each item question in the scale was translated into local language with utmost care not to change the meaning. The 64 items were scored according to the six point answering scale, leading from totally agree (point 1) to totally disagree (Point 6) with no neutral response. Thus the overall scale score ranged from 8 to 48. In every scale, some of the eight items are positive indicators of the scale construct and some are negative indicators. So before the analysis on scale level all items were rescored so that a high score corresponded with agreement towards scale construct.

Results and Discussion:

Table I: Dental attitude questionnaire scale score.

Scales Scores
Mean SD
Cynicism 38.4 5.68
Health concern 37.2 6.72
Motivation 18.7 5.34
Oral function 30.1 6.12
Social aesthetic 21.4 4.17
Susceptibility 19.7 3.81
Halo 20.9 5.71
Infrequency 15.2 3.80

*Scale score ranged from 8 to 48.

Scale scores of Dental Attitude Questionnaire are depicted in Table I. Scales concerned with Cynicism, Health concern, Oral function had higher scores. This probably indicated towards participants doubt regarding the motives of dental professionals and lack of understanding of importance of regular dental check-up and hygiene. Their attitudes seem to be indifferent towards the preventive aspect of oral habits which probably resulted in high score on Health concern scale. Low score on Motivation scale suggest that extrinsic motivation i.e. motivation by other members in the family or social environment stimulate participants to improve their oral/dental health status. Still personal disadvantage posed by had oral status. This has been indicated by fairly high score on Oral Function scale. But at the same time most of the cohort in the present study feels that their social life and interpersonal relationship could not be affected by their dental/oral health status. This has probably resulted in low score on Social aesthetic scale. Moreover, low score on Susceptibility scale points towards the attitude of population which downplays the adverse role of poor oral/dental status on general health of a person.

Halo and Infrequency scales are validity scales. Low scores on these scales indicate that not many subjects in the present study tried to pretend that they were good subjects. Moreover, not many subjects showed extremely deviant behaviour or response.

Observations of the present study suggest that population cohort of the present study has an attitude somewhat non favourable for routine dental check-up and are unenthusiastic about seeking professional help for their problems. Studies from developed countries reported more favourable attitudes 5,6. This may be attributed to more favourable socio-economic and educational factors. Dental/oral health disorders are one of the most prevalent disorder in Indian population 7,8. Most of them are preventable and potentially curable. Though one cannot directly link observed attitude and prevalence of dental health problems in population, knowledge of prevailing attitude in the community may be of some predictive value for dental/oral health status of people. Information, Education and Communication (IEC) plans to motivate people to care for their dental health and health care delivery system should give consideration for attitude of community. For that we need representative data about prevailing attitude in community.

There is scarcity of data regarding dental health care attitude in Indian setup. Our study is one attempt to understand the attitude of Indian people regarding dental/oral care. This data represent the information from a limited geographic area. To develop a sound strategy for improving oral and dental health of Indian population more representative data base should be made available. For this, additional studies are needed, using reliable and indegineously developed attitude scales.


We gratefully acknowledge the personal help of Prof. Dr. Joh. Hoogstraten, University of Amsterdam, Department of Social Dentistry and Dental Health Education in carrying out this study.


  1. Gandhi LK: Oral health in India: Present status and future strategy to combat the problem. Swasth Hind, 1994; 38: 61-3.
  2. Horowitz AM: Effective oral health education and promotion programs to prevent dental caries. Int Dental J, 1994; 33: 171-81.
  3. Abramson JH: Composite scales. Ch. 13, In Survey Methods in Community Medicine. JH Abramson Ed. 4th Edition; Churchill Livingstone, Edinburgh, 1990: 125-30.
  4. Stockwell RG, Banting DW: The Dental Attitudes Questionnaire: an instrument for oral health care attitudes. Can Psychol. 1984; 25: 2a-473.
  5. Hoogstraten J, Broers NJ: The Dental Attitudes Questionnaire: comparing two response formats. Community Dent Oral Epidemiol. 1987; 15: 10-3.
  6. Timmerman EM, Hoogstraten J, Meijer K, Nauta M, Eijkman. On the assessment of dental health care attitudes in 1986 and 1995, using the dental attitude questionnaire. Community Dental Health, 1997; 14: 161-5.
  7. Nagaraja Rao G, Bhai KS, Venkateshwarlu M, Subrahmanyam MV: Oral health status of 500 school children of Udupi, J Ind Dental Assoc, 1980; 52: 367-70.
  8. Dolwani R, Dani R: Prevalence of dental diseases in primary school students of Nashik. J Ind Dental Assoc, 1995; 66: 46-8.


DAQ scale names and descriptions:

Cynicism - High scores show suspicion regarding the motives of dental health care professionals and down play the need for regular dental check-ups and oral hygiene.

Health concern - This scale measures the degree to which persons tend to avoid habits of activities that have a potentially damaging effect on the oral state. For example, high scorers are characterized by persons careful of the foods they ear, avoiding items that stain teeth or promote cavities.

Motivation - High scorers on this dimension are intrinsically motivated to maintain or improve his/her oral state. Low scorers are motivated primarily through the efforts of others (i.e. family, boy/girl friends, etc.)

Oral function - High scorers on this scale recognize that a poor oral state; 1) forces them to choose foods that are easy to chew (over nutritional considerations), 2) prevents the proper chewing of food; possibly interfering with digestion, and 3) affects the culinary enjoyment of food. Social aesthetic - High scorers on this dimension recognize that their oral health (e.g. physical appearance of bad breath) can affect their social life and/or interpersonal relationships.

Susceptibility - High Scorers believe they are more susceptible to health problems than others. In addition they believe that if they were to become ill, it would have considerable impact on their ability to function well. Conversely, low scorers believe that illness is unlikely for themselves. If they do become ill, they look at illness as an inconvenience but just one of those things people have to go through.

Halo - This a validity scale which measures the tendency of persons to endorse items in a manner which suggests they are a "good patient". The items on this scale are heterogeneous with regard to content but are keyed in the "Halo" direction.

Infrequency - This is validity scale consisting of items having extreme-p-values. Random responders or persons with exceptionally deviant attitudes with regard to oral health care will have elevated scores on this scale.

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