Effects of Patient Race and Sex on Orthodontic Communication: A Pilot Study S. Gajendra*, BDS, MPH, University of Illinois at Springfield, IL, USA R. Fulford, DDS,MS, A. Koerber, DDS, PhD, E. BeGole, PhD and C. Evans, DDS, DMSc, University of Illinois at Chicago, IL, USA

Introduction Effective verbal communication is an important aspect of patient treatment Cultural competency and cross- cultural communication is important Communication has the potential to improve compliance

Objective To explore how differences in patients’ race and sex affect how orthodontic residents communicate with patients.

Literature Review Almost $52 billion are spent in the United States on dental services each year The Surgeon General’s Report in 2000 and Healthy People 2010 focus on reducing disparities in oral health status

Literature Review Patients care about communication (Gerbert, Bleecker and Saub (1994) Provider variables affect racial disparities (van Ryn, 2001) Dentist patient communication is complex Profoundly affected by race and sex (Ong et al, 1995)

Measurement of Communication RIAS method counts utterances Reliable and Valid (Sondell et al., 1998 & Levinson, Roter, et al., 1997) Useful in dental setting (Sondell et al., 1998)

Method Urban Dental College, Orthodontic Department, 1/99-1/01 STUDY SAMPLE –Sixteen orthodontic residents –Seventy new patients between the ages of 8-18 years –Eighty-two sessions recorded –Two types of sessions: records & consult

Method Audio-taping of sessions Roter Interaction Analysis System (RIAS) used to analyze the utterances of the orthodontic residents Inter-rater reliability 0.80 (Cohen’s kappa)

Modifications of RIAS Roter’s 40 utterance categories were modified and grouped into 20 categories Only orthodontists’ utterances analyzed Raters count frequency of types of utterances (utterance=phrase) Examples: Giving Information, Encouraging, Agreeing with Patient

Variables Independent variables: –Patient race (white/non-white) –Patient gender –Records or Consult Session Dependent Variables: –20 types of utterances –Frequencies measured –Time, Warmth, Time Spent Talking with Others

Demographic Characteristics of Sessions

Residents’ Information 6% of sessions with female residents 4 Female Residents 55% of sessions with non-white, mostly Asian residents 1 African-American resident

Statistical Analysis: MANOVA

Significance Confirmed by Mann-Whitney Test

Significant Differences in Types of Utterances Made to Whites

Examples of Communication With No Race Differences

Gender By Type of Session for Total Time

Gender By Type of Session

Gender by Session Differences Concern Empathy

Gender by Session Differences on Gives Instructions

Conclusions The types of differences in utterances found suggest that the residents were less comfortable talking to non-white patients Sex of the patient was also related to differences in communication.

Limitations of the Study Small sample size Low number of orthodontists Residents may be different from general dentists and orthodontists Boys may have had worse malocclusal conditions than girls More sophisticated statistical analysis needed.

Strengths of the Study New area of study in dentistry Important issues of –Compliance –Dentist patient relationships –Provider behavior and oral health disparities

Suggestions for future studies Examine larger sample sizes of patients and dentists More specific racial dentist- patient pairings Examine communication and patient satisfaction & compliance

Suggestions for future studies Include other psychosocial factors such as socioeconomic status Match subjects for age and similarity in malocclusion conditions

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