Journey to the Dental Office: Illness Behaviour in Delhi, India

Objectives: To study the dental illness behaviour exhibited by adult men of working age attending state run and private dental services in Delhi, India, and assess the impact of socioeconomic status on illness behaviour.

Methods: A qualitative study was conducted to explore the ways in which people make sense of and react to symptoms of dental disease. Use of State and Private dental services; education; occupation; and dental insurance were taken as approximations of socioeconomic-status and a purposive sample of 20 men of working age was derived from the population of people visiting each type of clinic within the city limits of the state of Delhi, India. In-depth semi-structured interviews were conducted, transcribed and analysed using Framework analysis.

Results: Men attending private clinics were more likely to actively react to initial symptom experience; more likely to engage in both allopathic and alternative self-care behaviour and more likely to give tooth specific explanations for the symptoms experienced. In addition they were more likely to acknowledge agency and responsibility for disease development, and to exercise choice in attending dental services before pain became unbearable. Both groups used a complex system of lay referral involving both family and colleagues, and both groups were referred for allopathic treatment by this network. Men from the lower socio-economic group were referred to general state dental services whilst men from the higher socio-economic group were referred to specific dental practitioners. Both groups favoured allopathic care to alternative healing for dental illness. The majority of the men from the lower socio-economic group had used unlicensed dental practitioners however due to problems with accessing qualified practitioners outside the working day.

Conclusions: Attempts to understand illness behaviour needs to look beyond utilisation of dental services at the series of decisions and choices which occur on the road to the surgery. Differences in behaviour are exhibited according to socioeconomic group throughout the decision making process and actions which occur prior to utilisation of services.