Author

Lori L. Woods

Date

June 2013

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Oral health is an important contributor to overall health. Over 500,000 Oregonians need dental care but go without because they cannot pay. Many low income people rely on volunteer dentists in nonprofit organizations such as Medical Teams International (MTI) for urgent care. The purpose of this study was to describe the changes in volunteerism among dentists in the Mobile Dental Program at MTI, to determine the factors affecting volunteer interest and retention, and to recommend steps to increase volunteerism. Growth of the program, measured by hours donated, number of dentists volunteering, and number of clinics held, decreased between 2003 and 2012. The fractional change in number of volunteers showed a consistent negative relationship with time (p=0.012), with an average decline in growth of three percentage points per year. Hours served and clinics held showed similar patterns. Joinpoint regression analysis of monthly data confirmed that growth of the program was positive during the first part of the decade, but was not different from zero during the second part. Relatively few individuals do most of the work in this program: in 2012, 43% of all 214 volunteers served in only one clinic and 20% of the total clinics were covered by five dentists. The fraction of patients who are under 18 fell from 34% to 15% over the past five years (p<0.001). We used focus groups and an electronic survey to assess motivations for and barriers to volunteering. “Making a difference” in patients’ lives and professional responsibility received the highest rankings as motivators. Volunteering in alternative programs was ranked as the #1 barrier (48.8% of respondents ranked this choice #1). Cramped facilities and/or outdated equipment were ranked #2, and a preference for working only with patients of a particular age was ranked #3. In response to Likert-type questions, the fraction of respondents indicating they “strongly agreed” or “agreed” that a factor limited their service was as follows: not having time (34.2%), personal financial commitments (27.0%), volunteering elsewhere (24.3%), preference not to do some procedures (14.4%), need to pay off school loans (12.6%), patient age or other demographics (12.6%), patient needs not urgent (12.5%), facilities (10.8%), uncomfortable with some patients (5.4%), personal health (4.5%), clinic scheduling issues (3.6%), and difficulty working with MTI staff or other volunteers (2.7%). We built a model using logistic regression methods and survey data, using the number of times a dentist volunteered in the past year (≤1 or ≥2) as the dependent variable. We considered eight independent variables: retirement status, age, sex, practice specialty, practice setting, dental school community dentistry experience, and motivation by professional responsibility and religious faith. The final model included only retirement status (OR = 6.59, p=0.025) and faith (OR = 3.51, p=0.004) as significant contributors to volunteerism. The most important contributors to this change in volunteerism are factors external to the program itself and not directly under the control of MTI. However, there are a number of specific changes that can be made that should help to restore program growth for the coming years.

Identifier

doi:10.6083/M4SQ8XF7

School

School of Medicine

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