Detroit Dental Health Project Parenting, Social Determinants, Health Services, Quality of Life, and Outcomes Questionnaire CAREGIVER NAME: CAREGIVER ID: INDEX CHILD NAME: INDEX CHILD ID: VISIT DATE: / / TIME AM/PM (circle) MM DD YYYY IWR NAME IWR ID We are interested in understanding your dental health behaviors and how taking care of [INDEX CHILD] affects how you take care of his (or her) teeth and mouth. As a caregiver you may experience hassles in your life and how you cope with them may impact on your ability to promote the dental health of your child. I will also ask you questions about if and why you think it is important to promote the dental health of [INDEX CHILD]. I am also going to ask you about your access to dental care and how you evaluate the quality of your dental health. I will also ask you about your family life. These factors are associated with dental health and should be considered in any program that will be designed in the future to promote the oral health of children. There is no right or wrong answer to the questions that I will soon ask you. The most important thing is to give your opinion. Most questions will be answered with a scale or flipchart. (IWR: Hand respondent the scales so he or she can see what these are.) To make things easier, I ll read each question out loud and I ll tell you what the response alternatives are. You ll say what your answer is, and I ll mark it down in this booklet. Detroit Dental Health Project Wave 1 2002-2003 1
The questions ask about your caregiving relationship with [INDEX CHILD]. Before we begin, let me check one thing. A1. What is the best word to use to describe your relationship with [INDEX CHILD]? Are you the Biological mother Biological father Grandmother Someone else, please specify. Even though these questions are specifically about [INDEX CHILD], we know that you may have other children in your family that you take care of regularly. A2. How many children less than 18 years old do you take care of regularly? Detroit Dental Health Project Wave 1 2002-2003 2
First, I would like to ask you about whether you have access to dental care. Q1. When did you last visit a dentist? Was it? 6 months or less GO TO Q2 more than 6 months but not more than 1 year ago GO TO Q2 more than 1 year ago but not more than 2 years ago GO TO Q2 more than 2 years ago but not more than 3 years ago GO TO Q2 5 more than 3 years ago but not more than 5 years ago GO TO Q2 6 more than 5 years ago GO TO Q3 7 never have been GO TO Q3 Q2. What was the main reason for your last visit for dental care? (IWR: Read each one and check all that apply.) 5 6 7 8 9 Regular checkup GO TO Q4 Teeth cleaning GO TO Q4 To have teeth filled GO TO Q4 To have teeth pulled or other surgery GO TO Q4 Toothache or tooth pain GO TO Q4 To have a denture made or repaired GO TO Q4 Bleeding gums or gum disease GO TO Q4 Loose teeth GO TO Q4 Problems with wisdom teeth GO TO Q4 0 Jaw pain GO TO Q4 1 Some other reason please explain GO TO Q4 Detroit Dental Health Project Wave 1 2002-2003 3
Q3. If you didn t go to a dental clinic in the past 5 years, is it because (IWR: Read each one and check all that apply.) 5 6 7 8 9 I had no dental problems, no need to go I thought the dental problem would go away I was too busy, unable to take time from work Lack of transportation Dental treatment is very expensive I have no insurance or Medicaid I was unable to make an appointment I was unable to leave my child/children so I could go Other reasons, please specify Q4. If you need dental care in the next year, where will you go? Name of dentist/clinic (Iwr: Write first and last name of dentist): Do not know (IWR: This section is for children less than 1 year old. If child is older than 1 year, skip to Q7.) Q5. When do you plan to take [INDEX CHILD] to see a dentist? 5 6 Next month Next three months Next six months [INDEX CHILD] does not need to see a dentist until the age of 3 years. [INDEX CHILD] does not need to see a dentist until the age of 6 years. [INDEX CHILD] will go to see a dentist if he/she has a dental problem. Q6. Does [INDEX CHILD] have at least one baby tooth in his/her mouth? Yes GO TO Q 12 No GO TO Q12 Not sure GO TO Q12 8 Detroit Dental Health Project Wave 1 2002-2003 4
(IWR: This section is for children 1 year old or older.) Q7. Have you taken [INDEX CHILD] to see a dentist? Yes GO TO Q8 No GO TO Q10 Q8. Why did you take [INDEX CHILD] to see a dentist? Reason: Q9. Does [INDEX CHILD] have a regular dentist he/she goes to? Yes, Name of dentist/clinic: -GO TO Q12 No GO TO Q12 Q10. When do you plan to take [INDEX CHILD] to see a dentist? 5 6 7 Next month Next three months Next six months Next year [INDEX CHILD] does not need to see a dentist until the age of 3 years. [INDEX CHILD] does not need to see a dentist until the age of 6 years [INDEX CHILD] will go to see a dentist if he/she has a dental problem. Q11. If [INDEX CHILD] needs dental care in the next year, where will you go? Name of dentist/clinic (Iwr: Write first and last name of dentist): Do not know Q12. Overall how do you rate the availability of dental services/care to you and your family? 5 6 Excellent Very good Good Fair Bad Very bad Detroit Dental Health Project Wave 1 2002-2003 5
Q13. Do you have any health insurance that covers dental care [including all forms of private and government insurance plans]? 8 Yes GO TO Q15 No GO TO Q14 Do not know GO TO Q16 Q14. How long has it been since you last had dental insurance? 5 6 months or less GO TO Q16 More than 6 months, but not more than 1 year ago GO TO Q16 More than 1 year, but not more than 3 years ago GO TO Q16 More than 3 years GO TO Q16 Never GO TO Q16 Q15. What kind of dental insurance do you have? Name of plan/dental insurance: Q16. Is [INDEX CHILD] covered by a health insurance plan that pays for dental care (include Medicaid, MIChild)? 8 Yes GO TO Q17 No - GO TO Q18 Do not know GO TO Q18 Q17. What is the name of the plan? 8 Medicaid MIChild Other, please write name Do not know Q18. Comparing finding a dentist with finding a medical doctor to care for you in the City of Detroit, do you think that? It is easier to find a dentist than to find a medical doctor It is easier to find a medical doctor than a dentist It is NOT easy to find a dentist or a medical doctor It is easy to find both Detroit Dental Health Project Wave 1 2002-2003 6
The next several questions are about the health care system in general. For each one, please tell me if you strongly disagree, disagree, agree or strongly agree. Q19. Racial discrimination in a medical doctor s office is common. Q20. Racial discrimination in a dentist s office is common. Q21. Patients have sometimes been deceived or misled by medical doctors. Q22. Patients have sometimes been deceived or misled by dentists. Q23. Medical doctors have sometimes done harmful experiments on patients without their knowledge. Q24. Dentists have sometimes done harmful experiments on patients without their knowledge. Q25. Rich patients receive better health care than poor patients. Q26. Rich patients receive better dental care than poor patients. Q27. Male patients receive better health care than female patients. Q28. Male patients receive better dental care than female patients. Strongly Disagree Disagree Agree Strongly Agree Now, I will ask you questions about the impact of dental health on your quality of life. Q29. How would you describe the condition of your mouth and teeth? (Including false teeth and dentures)? Would you say? 5 Excellent Very good Good Fair Poor Detroit Dental Health Project Wave 1 2002-2003 7
Q30. Have you had any problem with the following activities because of your dental health or the health of your mouth? No problem at all Minor problem that did not impact my daily life Moderate problem that made me change how I do things Severe problem that has restricted me from enjoying life Chewing hard foods Drinking cold or warm fluids Talking Smiling Laughing Kissing Going to work or school Q31. During the past 3 months, how much pain have your teeth and gums caused you? A great deal of pain Some pain A little pain No pain at all Q32. During the past 3 months, how much have your teeth or gums worried or concerned you? A great deal Somewhat A little Not at all Now I need to ask you similar questions about [INDEX CHILD]. (IWR: If child is less than 1 year old, skip to Q35) Q33. How would you describe the condition of his/her mouth and teeth? Would you say? 5 Excellent Very good Good Fair Poor Detroit Dental Health Project Wave 1 2002-2003 8
Q34. Has [INDEX CHILD] had any problem with the following activities because his/her dental health or the health of his/her mouth? NA No problem at all Minor problem that did not impact his/her daily life Moderate problem that made him/her change this activity for a few days (less than a week) Severe problem that made him/her change this activity for a long time Chewing of foods 8 Breastfeeding 8 Talking 8 Smiling 8 Laughing 8 Playing 8 Going to school or day care 8 Detroit Dental Health Project Wave 1 2002-2003 9
People differ in what they do to keep their teeth and mouth clean. Some people use many methods, others don t. I am going to read a list of things people use to keep their teeth and mouth clean. For each one, tell me if you never, rarely, sometimes or usually use this method to help keep [INDEX CHILD] teeth and mouth clean, including things you do, things [INDEX CHILD] does, or things you ask someone else (an older brother or sister, an aunt or babysitter) to do for [INDEX CHILD]. Some methods are more for older children, others more for younger babies so not all will apply to you. I am also going to ask you the same questions about what you use to keep your teeth or mouth clean? Do you use or [INDEX CHILD] uses or someone else uses the following to keep the teeth and mouth clean? (IWR: If the method cannot be used (such as tooth brushing) a month old infant, check Never ) B1 A cloth to wipe the teeth or mouth 1 NEVER 2 RARELY 3 SOMETIMES 4 USUALLY (IT IS MY USUAL METHOD) [INDEX CHILD] Caregiver B2. Chewing stick to scrape teeth [INDEX CHILD] Caregiver B3. Toothpick [INDEX CHILD] Caregiver B4. Rinse mouth with salt and water or water alone [INDEX CHILD] Caregiver Detroit Dental Health Project Wave 1 2002-2003 10
B5. Brush teeth with a toothbrush without toothpaste [INDEX CHILD] 1 NEVER 2 RARELY 3 SOMETIMES 4 USUALLY (IT IS MY USUAL METHOD) Caregiver B6. Brush teeth with a toothbrush with toothpaste [INDEX CHILD] Caregiver B7. Do you or [INDEX CHILD] use other methods to brush or clean the teeth and mouth? Child: Caregiver: People also differ in when and how often they brush their teeth. There is no right or wrong answer; I just want to know what you usually do. C1. During the last week, did [INDEX CHILD] or you or someone else brush [INDEX CHILD] s teeth? (Iwr: Check all that apply) [INDEX CHILD] brushed his (or her) own teeth (IWR: Skip to C2) Caregiver brushed [INDEX CHILD] s teeth (IWR: Skip to C4) Someone else brushed [INDEX CHILD] s teeth, please specify (IWR: Skip to C4) No one brushed his or her teeth (IWR: Skip to C6) (IWR: If C1 Box #1 is the only box checked skip C4 and C5. If C1 Box #1 and Box#2 or #3 are checked, then ask all the questions starting at C2.) C2. How many times did [INDEX CHILD] brush his (or her) teeth during the last week? (IWR: insert number). C3. Did he (or she) brush at bedtime during the last week? Yes, If yes, how many times during the last week? times No Detroit Dental Health Project Wave 1 2002-2003 11
C4. During the last week, how many times did you or someone else brush [INDEX CHILD] s teeth? C5. Did you or someone else brush his (or her) teeth at bedtime during the last week? Yes, If yes, how many times during the last week? times No C6. How many times did you brush your teeth during the last week? (IWR: write number; if never write 0 and don t ask C7). C7. Did you brush your teeth at bedtime during the last week? Yes, If yes, how many times during the last week? times No People also differ in the way they do things. For example, some people exercise once every day, others do not. There are many reasons for why we differ in our behaviors. We are interested to know your opinion of what things may influence the way you do things. Please rate these statements on whether they will strongly influence you, moderately influence you, maybe influence you, or not at all. D1. TV commercials showing me how to brush my child s teeth before bed. D2. My child s teacher or day care provider informing me about brushing my child s teeth before bedtime. D3. My friends or relatives tell me of the need to brush or clean my child s teeth or mouth before bedtime D4. A dentist or doctor providing me with information on how to keep my child s teeth healthy before bedtime 4 Strong influence 3 Moderately 2 Maybe 1 Not at all ` ` ` ` Detroit Dental Health Project Wave 1 2002-2003 12
D5. Brochures or posters showing me that my child will have bad teeth if he or she does not brush his or her teeth. D6. A dentist or doctor telling me that my child s teeth will have cavities if I do not brush his or her teeth. D8. Pictures showing me how my child can keep his or her teeth free from cavities and healthy. D9. Brochures or posters from people saying that they value people with good teeth. D10. Statements from employers saying that they will hire people with good teeth. D11. A dentist or doctor saying that they like people with good teeth. D12. Posters or brochures telling me that I would be considered a bad parent if my child s teeth are not brushed or cleaned. D13. A dentist or doctor informing me that I am responsible for the health of my child s mouth and teeth. D14. A pastor telling me that I am responsible for the health of my child s mouth and teeth. D15. If my child reminds me to brush his or her teeth before going to bed. D16. A dentist or dental hygienist showing me how to brush my child s teeth. D17. Developing an evening routine to brush my child s teeth before bedtime. D18. Keeping my and my child s toothbrush and toothpaste out in the open. 4 Strong influence 3 Moderately 2 Maybe 1 Not at all ` ` ` ` ` ` ` ` ` ` ` ` ` Detroit Dental Health Project Wave 1 2002-2003 13
Every parent experiences moments (times) when it is difficult to get their children s teeth brushed. For each situation or feeling that I read please indicate how confident you are that you can get your child s teeth brush when it is not automatically done at bed time. When you are (IWR: insert statements from the first column of the Table) how confident are you that you can have your child s teeth brushed before bedtime? 4 Very Confident 3 Moderately Confident 2 Somewhat Confident 1 Not at all Confident E1. under a lot of stress E2. depressed E3. anxious E4. feeling like you do not have the time (too busy) E5. tired E6. worrying about other things in your life E7. bothered by your crying child E8. bothered because your child doesn t stay still when you want him or her to brush E9. told by your child that he/she does not feel like brushing right now Detroit Dental Health Project Wave 1 2002-2003 14
Below are statements some people make about oral health. I will read each one out loud and ask for your opinion. For each one, say whether you strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, or strongly disagree. (IWR: Be sure the respondent is looking at the right scale. Read each item and the response scale out loud.) 5 STRONGLY AGREE 4 SOMEWHAT AGREE 3 NEITHER AGREE NOR DISAGREE 2 SOMEWHAT DISAGREE 1 STRONGLY DISAGREE F1. Most children eventually develop dental cavities. 5 F2. As I get older, I expect I will lose some of my own teeth. 5 F3. Some people get cavities and others don t, there is not much that can be 5 done about it. F4. Some people have healthy teeth, others don t. 5 F5. Even with all the care in the world, some children will have healthy, bright 5 teeth, others won t. F6. Cavities in baby teeth don t matter since they fall out anyway. 5 F7. Keeping baby teeth clean is not very important; after all, they fall out. 5 F8. There is not much I can do to stop [INDEX CHILD] from developing dental cavities. F9. There is not much I can do to help [INDEX CHILD] have healthy teeth. F10. I can tell to brush his/her teeth; it does not mean he/she will actually do it. (IWR: If Index Child is too young now, ask respondent to guess if this would be true when the child is older). F11. When [INDEX CHILD] wants something like a snack or a bottle, I better just do it, because otherwise he/she will fall out (have a temper tantrum). F12. If I try to brush [INDEX CHILD] s teeth (clean or wipe his/her mouth) he/she does not behave. F13. Skin care and care for teeth are basically cosmetic children look nicer when their skin is not dry and their teeth are clean. F14. Brushing a child s teeth is like fixing a child s hair; it helps the child look nice 5 5 5 5 5 5 5 Detroit Dental Health Project Wave 1 2002-2003 15
5 STRONGLY AGREE 4 SOMEWHAT AGREE 3 NEITHER AGREE NOR DISAGREE 2 SOMEWHAT DISAGREE F15. Cleaning a child s teeth or mouth before bed is a hassle; it wakes him/her up. 5 F16. Putting a baby to bed with a bottle helps the child to be better fed. 5 F17. Putting a baby to bed with a bottle helps the child sleep better. 5 F18. Putting a baby to bed with a bottle helps the child to gain weight and grow. 5 F19. There is nothing wrong with putting a baby to bed with a bottle. 5 F20. The best time to give a child a sugary food is after a nap or between meals. 5 F21. Children don t need to brush every day until they get their permanent teeth 5 F22. Children can brush on their own as soon as they can hold the toothbrush. 5 1 STRONGLY DISAGREE F23. Babies cannot get cavities before their teeth come in. 5 F24. It does not matter if the child uses a cup or a bottle; dental cavities are just as 5 likely in either case. F25. Children don t really need their own toothbrush until all their teeth are in. 5 F26. Teeth are part of the body so if a child s teeth have decay; this means the child 5 has a disease. F27. Fluoride is not good for my child s health 5 Detroit Dental Health Project Wave 1 2002-2003 16
Now, I have some questions about your mood in the past week. I will read a statement and you ll tell me how often in the last week you felt this way. I will write down if you felt this way 5 to 7 days last week, 3 or 4 days last week, 1 or 2 days last week, or less than a day last week. (IWR: Show respondent the correct scale, read each item fully including the scale.) In the last week, how many days have you felt as follows: 4 5-7 DAYS LAST WEEK 3 3-4 DAYS LAST WEEK 2 1-2 DAYS LAST WEEK 1 NOT AT ALL OR LESS THAN ONE DAY LAST WEEK G1. I was bothered by things that usually don't bother ` me. G2. I did not feel like eating; my appetite was poor. ` G3. I felt that I could not shake off the blues even ` with help from my family or friends. G4. I felt that I was just as good as other people. ` G5. I had trouble keeping my mind on what I was ` doing. G6. I felt depressed. ` G7. I felt that everything I did was an effort (took ` more energy than before). G8. I felt hopeful about the future. ` G9. I thought my life had been a failure. ` G10. I felt fearful. ` G11. My sleep was restless. ` G12. I was happy. ` G13. I talked less than usual. ` G14. I felt lonely. ` G15. People were unfriendly. ` G16. I enjoyed life. ` G17. I had crying spells. ` G18. I felt sad. ` G19. I felt that people dislike me. ` G20. I could not get going. ` G21. I felt angry. ` Detroit Dental Health Project Wave 1 2002-2003 17
This next set of questions is about situations you may or may not face in your everyday life. In your day-to-day life how often have any of the following things happened to you? Would you say almost everyday, at least once a week, a few times a month, a few times a year, or less than once a year? (IWR: Show respondent the correct scale and read each item fully including the scale.) H1. I was treated with less courtesy than others. Does this happen H2. I was treated with less respect than others. Does this happen H3. I received poorer service than others. Does this happen H4. People acted as if they thought I am not smart. Does this happen H5. People acted as if they were afraid of me. Does this happen H6. People acted as if they thought I am dishonest. Does this happen H7. People acted as if they thought they re better than me. Does this happen H8. I was called names or insulted. Does this happen H9. I was threatened or harassed. Does this happen H10. I was unfairly stopped, searched, questioned or threatened by the police. Does this happen H11. I was unfairly discouraged by a teacher or advisor from continuing my education. Does this happen 6 ALMOST EVERY DAY 5 AT LEAST ONCE A WEEK 4 A FEW TIMES A MONTH 3 A FEW TIMES A YEAR 2 LESS THAN ONCE A YEAR 1 NEVER (IWR, IF VOL) 6 5 6 5 6 5 6 5 6 5 6 5 6 5 6 5 6 5 6 5 6 5 H12. How long have you lived in your neighborhood? (in years. IWR: if less than a year, write the # of months.) H13. How many times have you moved in the past 5 years? Detroit Dental Health Project Wave 1 2002-2003 18
The following questions have to do with things that (Index Child s name) does and ways that you react to him (or her). How often? I1. Do you praise [INDEX CHILD] by saying something like good for you or what a nice thing you did or that s good going!? I2. How often do you and [INDEX CHILD] laugh together? I3. How often do you do something special with [INDEX CHILD] that he (or she) enjoys? I4. How often do you play sports, hobbies or games with [INDEX CHILD] I5. How often have you read a book with [INDEX CHILD] Every day A few times a week Once a Week 1-2 times a month Never 5 5 5 5 5 Detroit Dental Health Project Wave 1 2002-2003 19
Now I want to ask you some questions about feelings you may have in your role as a mother or caregiver for (child/children) now living with you, and how often you experience these feelings. J1. How often do you feel that you have too little time to spend by yourself? J2. How often do you wish you didn t have so many responsibilities? J3. How often would you say that your child gets (or children get) on your nerves? J4. How often do you feel that your (child is/children are) making too many demands on you? J5. Many women (or men) feel that they are not as good a mother (or father) as they would like to be. How often do you feel this way? J6. How often do you find that being a mother (or father) is much more work than pleasure? J7. How often do you feel that you are doing everything you can to give your child(ren) a good life? J8. How often do you feel tired, worn out, or exhausted from raising a family? 5 Almost Always 4 Often 3 Sometimes 2 Rarely 1 Never 5 5 5 5 5 5 5 5 Religious beliefs may impact how people promote their health and seek health care K1. How religious would you say you are --Would you say very religious, fairly religious, not too religious, or not religious at all? Very religious Fairly religious Not too religious Not religious at all Detroit Dental Health Project Wave 1 2002-2003 20
And now some questions about help from others. Is there someone Yes No L1. you could count on to run errands for you if you needed them to? L2. you could count on to lend you some money if you really needed it in a time of financial crisis? L3. you could count on to give you encouragement and reassurance if you really needed it? L4. you could count on to watch your (child/children) for you if you needed them to? L5. you could count on to lend you a car or give you a ride if you needed them to? As the (insert the relationship between the index child and the caregiver from A1) of [INDEX CHILD] please rate the level of support in taking care [INDEX CHILD] that you receive from the following individuals is it very strong, moderate, little support, or no support at all (IWR: Use NA (non-applicable) for relationships that do not apply to the caregiver. For example, use NA if you are interviewing the biological mother for N1 and N2). Relationship to index child 4 3 2 1 Strong Moderate Little No NA support support support support M1. Biological mother 8 M2. Adopted mother (IWR: if applicable) 8 M3. Biological father 8 M4. Adopted father (IWR: if applicable) 8 M5. Aunt(s) 8 M6. Uncles(s) 8 M7. Grandmother(s) 8 M8. Grandfather(s) 8 M9. Your neighbors 8 M10. Your friends 8 M11. Others, please specify 8 Thank you for your time! Detroit Dental Health Project Wave 1 2002-2003 21