1. 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

2. 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

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

4. 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

5. 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)

6. 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)

7. 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

8. 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)

9. 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

10. 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

11. Demographic Characteristics of Sessions

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

13. Statistical Analysis: MANOVA

14. Significance Confirmed by Mann-Whitney Test

15. Significant Differences in Types of Utterances Made to Whites

16. Examples of Communication With No Race Differences

17. Gender By Type of Session for Total Time

18. Gender By Type of Session

19. Gender by Session Differences Concern Empathy

20. Gender by Session Differences on Gives Instructions

21. 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.

22. 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.

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

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

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

26. BIBLIOGRAPHY Bartsch A, Witt E & Marks M. (English Abstract). Wirkung von Information und Kommunikation im kieferorthopadischen Beratungs-und Behandlungsgesprach. Teil II: Kommunikationsstil und Compliance. [The influence of information and communication in the orthodontic consultation and treatment visit. II. The communication style and compliance] Fortschr Kieferorthop, Jan 1995, 56(1), pp.7-15. Cooper-Patrick, L., Gallo, J.J., Gonzales, J.J., Vu, H.T., Powe, N.R., Nelson, C. and Ford, D.E.: Race, gender and partnership in the patient-physician relationship. JAMA. 282:583-589, 1999. Gerbert, B., Bleecker, T., Saub, E. (1994, March). Dentists and the patients who love them: professional and patient views of dentistry. Journal of American Dental Association, 125, 265-274. Hall, J. A., Irish, J. T., Roter, D. L., Ehrlich, C. M., Miller, L. H. (1994a). Gender in medical encounters: an analysis of physician and patient communication in a primary care setting. Health Psychology, 13(5), 384-92. Levinson, W., Roter, D., Mullooly, J. P. (1997). The relationship with malpractice claims among primary care physicians and surgeons. Journal of American Medical Association. 277(7), 553-559. Lipkin, M., Putnam, S. M., Lazare, A. (1995). The Medical interview; clinical care, education and research, New York: Springer-Verlag. Ong, L. M., de Haes, C. J., Hoos, A. M., Lammes, F. B. (1995). Doctor-patient communication: a review of the literature. Social Science and Medicine, 40 (7), 903-18. Roter D. (1995). The Roter Method of Interaction Process Analysis, (3 rd ed.) Baltimore, MD: Johns Hopkins University School of Hygiene and Public Health. Roter D, Rosenbaum J, de Negri B, Renaud D, DiPrete-Brown L & Hernandez O. (1998 Mar). The effects of a continuing medical education programme in interpersonal communication skills on doctor practice and patient satisfaction in Trinidad and Tobago. Med Educ, 32(2):181-9. Nestel, D. & Betson, C. (1999). An evaluation of a communication skills workshop for dentists: Cultural and clinical relevance of the patient-centered interview. British Dental Journal, 187(7), 385-388. Sondell, K., Soderfeldt, B., Palmquist S. (1998). A method for communication analysis in prosthodontics. Acta Odontologica Scandinavica.56(1), 48-56. Van Ryn M. (2002 Jan). Research on the Provider Contribution to Race/Ethnicity Disparities in Medical Care. Med Care, 40(1 Supp):140-151.