Barriers to Care in Treating HIV

Dentists are pragmatic and conscientious health care professionals who are often willing to respond to oral care needs. This very pragmatism may mean that they are less likely to resort to theory or models to guide their decisions.

Models offer great advantages in health services research. By providing ‘theoretically sound, comprehensive and systematic approaches’, they can inform the design of our studies and the analysis and interpretation of data. They can guide us in identifying the most useful types of interventions and how they may be evaluated. Models have not been widely used in oral health services research in relation to people with HIV infection, yet it could be illuminated by this approach.

Andersen’s Behavioural Model of Health Services Use was first developed in the 1960s and has been constantly refined ever since. It is a theoretically and empirically informed framework that considers the factors involved in healthcare usage, indicating how these factors may be related. Later versions of the model include predisposing (demographic and social characteristics), enabling (organisational characteristics of health services) and treatment need at the group and individual level. The effects of these factors on health are mediated by health behaviours. The incorporation of health as an outcome in a model of access is important. The link between access and health is an assumption or truism, which may be why it is rarely explored. Its inclusion allows the incorporation of the notion of ‘ineffective access’, where health is not improved.

Whilst most research of access to oral care for people with HIV has been ad hoc, it can be applied post hoc to this model to overview of current understanding of the field. It is hoped that the application of the model will increase the rigour of future research and value of future interventions in this area.