Applying “Stages of Readiness to Change” Model to Dentists’ Decisions to Participate in Medicaid: An Exploratory Study
Date
2021-08-11
Authors
Kateeb, Elham
McKernan, Susan C
Askelson, Natoshia
Momany, Elizabeth
Damiano, Peter
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Abstract
Background: The Stages of Readiness to Change (SOC) behavioral model describes
behavior change as a process and distinguishes individuals based on their current behavior
and readiness to change that behavior. SOC can be used to improve dentists’ participation in
a state public dental benefit program (Medicaid) by targeting them at different SOC with
interventions, strategies, and tools tailored to those stages. Therefore, this study assessed the
usefulness of using SOC to describe dentists’ attitudes towards and participation in
Medicaid. Dentists’ participation in Medicaid is of interest to policymakers, and this study
demonstrates a method to identify potential opportunities for intervention.
Methods: A modified SOC algorithm used data from a periodic survey of Iowa Dentists to
categorize dentists (N=514) into: 1) pre-contemplation, 2) considering participation (SOC
contemplation and preparation), 3) acting (SOC action and maintenance), and 4) risk of
relapse (at risk for discontinuing participation). The four SOC stages were compared using
ANOVA and post hoc Tukey’s test among: practice characteristics, Dentists Altruism scale,
Attitude about Program Administration scale, Attitude about Medicaid patients scale and
Perception of Importance of Medicaid Problems scale.
Results: Among survey respondents, 36% were categorized as pre-contemplation, 6% were
considering Medicaid participation, 12% were acting as Medicaid providers with minimal
risk of relapse, and 46% were participating and at risk of discontinuing. Dentists’ attitudes
towards program administration, Medicaid patients, and access to care varied across the SOC
cycle.
Conclusion: Nearly, 46% dentists in this analysis were identified as at risk of discontinuing
participation – a much larger proportion than dentists considering Medicaid participation.
Categorizing dentists using this approach has important implications for programmatic
interventions. For example, policymakers targeting our study population could focus their
efforts on reducing the likelihood of dentists dropping out of the program, with less emphasis
targeting dentists in the precontemplation stage.
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Keywords
dentists , surveys and questionnaires , transtheoretical model , stages of change , Medicaid