Factors Influencing Oral Health Service Utilization in Lusaka: A Case of Kalingalinga Health Centre

Factors Influencing Oral Health Service Utilization in Lusaka: A Case of Kalingalinga Health Centre | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Influencing Oral Health Service Utilization in Lusaka: A Case of Kalingalinga Health Centre SIGNAL NG'ANDU, Luckson Muwandia, Salome Moyo This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8266739/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose This study evaluated factors influencing oral health service utilization at Kalingalinga Health Centre in Lusaka, Zambia. Oral diseases are among the most neglected public health issues in low- and middle-income countries despite their significant burden on quality of life. Materials and Methods A descriptive cross-sectional study design was adopted. Data were collected using structured questionnaires and interviews from 130 participants, 110 patients and 20 dental professionals. Quantitative data were analyzed using descriptive statistics, while qualitative data were thematically analyzed. Findings: The study found that only 38% of patients sought preventive dental care, while 62% sought services only during pain. The main barriers to service utilization included high treatment costs (58%), fear of dental procedures (46%), and long waiting times (40%). Health system challenges such as inadequate staffing (60%) and shortages of dental equipment (55%) also hindered access. Awareness of oral health was moderate (68%), though preventive behavior remained low. Implications to Theory, Practice and Policy: The findings align with the Health Belief Model, indicating that perceived barriers and low self-efficacy significantly affect health-seeking behavior. The study recommends community-based oral health promotion, affordable dental services, and strengthened public oral health systems. Health Economics & Outcomes Research Dentistry Oral Health Service Utilization Preventive Care Health Systems Zambia Figures Figure 1 Figure 2 Figure 3 1.0 INTRODUCTION Oral health is defined as a state of being free from mouth and facial pain, oral and throat cancers, oral birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay, tooth loss, and other conditions that affect the oral cavity (WHO, 2010). Globally, oral diseases are a significant public health burden, with dental caries and periodontal diseases remaining the two most prevalent conditions (Petersen et al., 2005 ). Tooth decay is the most common chronic disease across all ages, while periodontal disease, which begins as reversible gingivitis, continues to affect 5%–20% of adults worldwide (FDI, 2015; Petersen, 2009 ). Reliable global data on oral health remain limited, as most low- and middle-income countries lack integrated surveillance systems (FDI, 2015). In Zambia, although oral diseases are largely preventable, over 80% of the population is affected by dental caries, periodontal disease, malocclusion, and oral infections (Ministry of Health [MOH], 2012). The high HIV prevalence has further compounded the burden of oral lesions and infections (Shary et al., 2018 ). Despite the country’s growing non-communicable disease (NCD) challenge, oral health remains a neglected aspect of health care planning. Globally, about 3.5 billion people experience oral pain or tooth-related conditions (WHO, 2020). In Europe, over 50% of adults have periodontitis, and more than 10% suffer severe disease (Patel, 2020 ). Sub-Saharan Africa, already heavily affected by HIV/AIDS, faces a dual burden of infectious and oral diseases. Periodontal disease is now linked with systemic conditions such as cardiovascular disease and diabetes, further amplifying public health risks (Petersen et al., 2005 ). In Zambia, oral health services are mainly provided at referral and district hospitals, with little to no coverage at primary health centres where most citizens seek care (MOH, 2012). Dental clinics are often under-resourced, lacking essential equipment, materials, and skilled personnel. The few existing dental practitioners are concentrated in urban areas, leaving peri-urban and rural populations underserved. Kalingalinga Health Centre, located in a densely populated urban settlement in Lusaka, reflects this national challenge. The facility faces shortages of dental staff and equipment, while patients tend to seek care only for emergencies such as extractions. Oral health services, by definition, include curative, preventive, promotive, and rehabilitative interventions delivered by qualified professionals to relieve pain, restore function, and prevent disease (MOH, 2012). However, the high cost of treatment, user fees, and limited access to preventive education continue to limit utilization. In contrast to general outpatient services, which are free at health centres, dental care often carries a charge, discouraging early health-seeking behavior. Therfore, this study examined the factors influencing oral health service utilization at Kalingalinga Health Centre. By identifying the barriers from both patient and provider perspectives, it aims to inform targeted interventions and strengthen Zambia’s oral health delivery system. 1.1 Problem Statement Across much of Africa, access to proper oral health care remains severely limited. Dental professionals are few and largely concentrated in urban centers, while the majority of the population, particularly those in peri-urban and rural areas—lack affordable, accessible, and preventive dental services (Vanek, 2017 ). In Zambia, although the national oral health program aims to provide curative, preventive, promotive, and rehabilitative care, service utilization remains extremely low. Most patients seek care only when dental problems have advanced to severe stages, often requiring tooth extraction as the only option. According to the Ministry of Health (2018), more than 80% of Zambians are affected by oral health problems such as dental caries, periodontal disease, malocclusion, facial injuries, halitosis, and oral tumors. However, only a small fraction utilize available dental clinics in their communities. Oral health, though closely linked to general well-being and non-communicable diseases such as diabetes and cardiovascular conditions, continues to receive minimal attention compared to diseases like HIV/AIDS, tuberculosis, and malaria (Ndiaye, 2010 ). The lack of a clear national oral health policy (Mukena, 2010), inadequate dental infrastructure, high treatment costs, and insufficient community awareness exacerbate this situation. Consequently, most dental services in Zambia are reactive rather than preventive. The populations most affected are low-income communities, such as those served by Kalingalinga Health Centre, where delayed treatment often leads to preventable tooth loss, pain, and infection. Despite the visible burden of disease, the underlying reasons for poor oral health service utilization have not been systematically studied in Zambia. This knowledge gap limits policymakers’ ability to design effective, equitable, and sustainable interventions. Therefore, this study investigated the factors influencing oral health service utilization at Kalingalinga Health Centre by exploring the perspectives of both patients and oral health providers, with the goal of informing strategies to improve service access and utilization across the country 2.0 LITERATURE REVIEW Oral health is an essential component of general health and well-being, affecting nutrition, communication, and quality of life. Poor oral health can lead to pain, infection, tooth loss, and systemic complications, while also contributing to social and economic disadvantage. The global distribution of oral diseases reveals sharp disparities between and within countries, largely influenced by income, education, and access to preventive care. Understanding these disparities helps contextualize Zambia’s situation within the broader public health framework. Global Perspective Globally, oral diseases remain among the most prevalent non-communicable diseases, collectively affecting 3.5 to 4 billion people, more than half of the world’s population (WHO, 2020). Dental caries in permanent teeth remains the single most common health condition worldwide. Periodontal disease, severe tooth loss, and oral cancers also contribute significantly to disability-adjusted life years (DALYs). The Global Burden of Disease Study (Marcenes et al., 2013 ) showed that oral health problems increased in absolute numbers between 1990 and 2010 due to population growth and ageing, even though their proportional burden declined slightly. High-income countries have seen marked improvements in oral health because of fluoride use, improved hygiene, preventive programs, and better access to care. In contrast, most developing countries continue to face a double burden, rising rates of dental decay alongside limited access to professional dental care. The cost of dental treatment often exceeds the total health expenditure available per person in many low- and middle-income settings, making prevention the most practical approach (FDI, 2015). Regional Perspective (Africa) In Africa, oral health problems remain a neglected public health issue. Studies across the continent reveal a consistent pattern of low service coverage, shortage of dental professionals, and limited preventive care (Thorpe, 2006 ; Petersen, 2003 ). The African region is characterized by an overall low to moderate prevalence of dental caries, but this is expected to rise due to increased urbanization, higher sugar consumption, and reduced natural fluoride exposure (Moynihan & Petersen, 2004 ). Rural and peri-urban communities often have no access to dental services other than emergency extractions. Serious oral conditions such as noma (cancrum oris), acute necrotizing gingivitis, and oral manifestations of HIV/AIDS still occur in many parts of Sub-Saharan Africa (Thorpe, 2006 ). Oral cancers are also on the rise, often diagnosed at advanced stages due to lack of screening and awareness. The shortage of dental professionals is severe: some countries have ratios as low as 1 dentist per 150,000 people, compared to 1:2,000 in high-income nations (Vanek, 2017 ). Oral health ranks low among government priorities, with most available resources directed toward life-threatening diseases such as HIV/AIDS, tuberculosis, and malaria (Ndiaye, 2010 ). Cultural reliance on traditional healers further complicates service utilization. In many communities, herbal remedies are used to treat oral pain or infections, delaying professional intervention (Agbor & Naidoo, 2015 ). Zambia’s Context In Zambia, oral health services remain limited and concentrated in urban referral and district hospitals. Over 80% of the population is estimated to suffer from oral conditions such as dental caries, gum disease, malocclusion, facial trauma, halitosis, and oral tumors (MOH, 2012). Despite this high prevalence, most people only visit dental clinics when pain becomes severe, resulting in high extraction rates and very few preventive or restorative procedures (Mukena, 2010). There is no standalone national oral health policy, and oral health is integrated only superficially within the broader primary health care framework. Most health centres, particularly in peri-urban and rural areas, lack dental equipment, materials, and trained personnel. Oral health education and community outreach are minimal. The HIV epidemic has also compounded the oral disease burden, with increased prevalence of oral lesions among immunocompromised individuals (Shary et al., 2018 ). The Kalingalinga Health Centre in Lusaka exemplifies these challenges: high patient volumes, limited staff, inadequate equipment, and services mainly restricted to extractions. Preventive and promotive programs are rare, reflecting the general national pattern of low oral health service utilization. The reviewed literature highlights that oral health is a global concern, with low- and middle-income countries bearing a disproportionate share of the burden. In Africa, and particularly in Zambia, oral health remains an overlooked component of public health, constrained by limited policy attention, inadequate human resources, and economic barriers. Despite the preventable nature of most oral diseases utilisation of available services is low. 2.1 Theoretical Review Two behavioural theories principally underpin this study: the Health Belief Model (HBM) and the Andersen Behavioral Model of Health Services Use. Health Belief Model (HBM)- Rosenstock ( 1974 ) The HBM posits that health-seeking behaviour is determined by individuals’ perceptions of: (a) susceptibility to a health problem, (b) severity of the condition, (c) benefits of the recommended action, and (d) barriers to action. Self-efficacy (confidence in one’s ability to act) and cues to action (triggers to prompt behaviour) were later added. Applied to oral health, HBM explains why many people delay dental visits until pain appears: perceived susceptibility and severity may be low, perceived barriers (cost, fear, time) are high, and cues to action (health education, screening) are weak. This model guided the present study’s exploration of patient beliefs, perceived barriers (economic, psychological, cultural) and the role of health promotion as a cue to preventive behaviour. Andersen Behavioral Model of Health Services Use Andersen ( 1968 ) Andersen’s model organizes determinants of service use into three domains: predisposing factors (demography, education, health beliefs), enabling resources (income, insurance, service availability), and need (perceived and evaluated need). The model emphasises that even when need exists, utilisation depends on enabling resources and socio-cultural predispositions. For Kalingalinga, Andersen’s framework helped structure investigation of how socio-economic status, service availability, and perceived need interact to produce low utilisation of preventive dental services. Together, HBM and Andersen’s model provide a comprehensive lens: HBM focuses on individual cognitive drivers (beliefs, fears, perceived benefits/barriers), while Andersen situates those drivers within structural and resource contexts (availability, affordability, organization of services). The study uses HBM to probe individual attitudes and Andersen to interpret system-level constraints- enabling a mixed analysis of demand- and supply-side factors influencing oral health service utilization. 2.2 Conceptual Framework INDEPENDENT VARIABLES 2.3 Research Gaps Existing literature documents many drivers of low oral health service utilisation in low- and middle-income countries (cost, fear, access), but there is limited context-specific evidence for peri-urban Lusaka settings such as Kalingalinga. Notably, gaps exist regarding: (a) how community beliefs and reliance on traditional remedies interact with perceived need and affordability, (b) the relative weight of system-level constraints (equipment, staffing) versus individual barriers in public health centre contexts, and (c) actionable policy-relevant recommendations that reflect both patient and provider perspectives. This study addresses these gaps by collecting linked quantitative and qualitative data from patients and dental staff at Kalingalinga Health Centre. 3.0 MATERIAL AND METHODS This study adopted a descriptive cross-sectional design with both quantitative and qualitative approaches to assess factors influencing oral health service utilization at Kalingalinga Health Centre in Lusaka, Zambia. The study was conducted within the health centre’s catchment area, which serves a large peri-urban population with diverse socioeconomic backgrounds. The study population comprised adult patients aged between 18 and 65 years attending the dental clinic, and dental professionals providing oral health services at the facility. A total of 130 participants were included 110 patients and 20 dental professionals, selected using a convenience sampling technique based on availability and willingness to participate during the study period. Data collection was conducted using structured questionnaires for patients, capturing demographic details, knowledge, perceptions, and utilization patterns, while interview guides were used for dental professionals to obtain qualitative insights into health system challenges and service delivery constraints. All responses were checked for completeness prior to analysis. Quantitative data were analyzed using descriptive statistics such as frequencies and percentages and presented in tables and figures, whereas qualitative data were analyzed thematically to identify emerging patterns and explanations. Results from both data sources were integrated to provide a comprehensive understanding of the determinants influencing oral health service utilization at Kalingalinga Health Centre. Questionnaire Origin The questionnaire used in this study was developed specifically for this research to assess awareness, perceptions, barriers, and utilization of oral health services among patients attending Kalingalinga Health Centre and has never been used elsewhere. An English-language version of the questionnaire has been attached. 4.0 FINDINGS The results are organized based on responses from patients, health center nurses, and dental professionals. Table 1 Response Rate Response Frequency Percent Returned 130 86.7% Unreturned 20 13.3% Total 150 100% Research Survey Data-2025 Comment The study achieved an 86.7% response rate, with 130 out of 150 questionnaires returned. Table 2 Awareness of Oral Health Services Level of Awareness Frequency Percent Low Awareness 34 26% Moderate Awareness 89 68% High Awareness 7 6% Total 130 100% Research Survey Data-2025 Comment Most respondents (68%) had moderate awareness of oral health services, while 26% had low awareness and 6% had high awareness. Table 3 Purpose of Dental Visit Reason for Visit Frequency Percent Preventive Care 49 38% Pain/Curative Treatment 81 62% Total 130 100% Research Survey Data-2025 Comment A majority of patients (62%) sought dental care only when in pain, while 38% visited for preventive reasons. Research Survey Data-2025 Comment The leading barriers were high treatment costs (58%), fear of dental procedures (46%), and long waiting times (40%). Table 5 Health System Challenges Identified by Providers Health System Barrier Frequency Percent Inadequate Staffing 12 60% Shortage of Dental Equipment 11 55% Limited-Service Range 7 35% Total 20 100% Research Survey Data-2025 Comment The main system-related challenges reported were inadequate staffing (60%) and shortages of dental equipment (55%). Research Survey Data-2025 Comment Curative visits accounted for 62% of dental attendance, while preventive visits accounted for 38%. 5.0 CONCLUSION AND RECOMMENDATIONS 5.1 Conclusion This study aimed to evaluate the factors influencing oral health service utilization at Kalingalinga Health Centre in Lusaka, Zambia. The findings show that 62% of patients sought dental care only when experiencing pain, while only 38% utilized services for preventive purposes, indicating a predominantly curative pattern of health-seeking behavior. Although 68% of respondents reported moderate awareness of oral health services, this knowledge did not translate into preventive action. Several barriers contributed to low utilization of dental services. The most commonly reported obstacle was high treatment cost (58%), followed by fear of dental procedures (46%), and long waiting times (40%). From the health system perspective, 60% of dental professionals identified inadequate staffing as a major challenge, while 55% cited shortages of dental equipment as a barrier affecting both service delivery and patient access. The results reveal that oral health service utilization at Kalingalinga Health Centre is significantly influenced by a combination of individual, socio-economic, and structural factors. Despite moderate awareness, preventive dental visits remain low, and the presence of financial, psychological, and system-related constraints continues to shape reactive rather than proactive oral health behaviors within the community. 5.2 Recommendations Based on the findings of the study, several measures are needed to improve oral health service utilization at Kalingalinga Health Centre. First, sustained community education programs should be implemented to strengthen awareness of preventive dental care and promote early health-seeking behavior. Second, strategies to reduce financial barriers, such as subsidized services or flexible payment mechanisms, should be considered to make dental care more accessible to low-income households. The health center should also prioritize improvements in staffing levels and ensure consistent availability of essential dental equipment to enhance service delivery efficiency. At the policy level, integrating oral health into routine primary health care activities and strengthening referral pathways may contribute to better oral health outcomes. Declarations Ethics Approval and Consent to Participate Ethical approval for this study was obtained from the Tropical Diseases Research Centre Research Ethics Committee (TDRC-REC). All procedures involving human participants were conducted in accordance with the Declaration of Helsinki (2013 revision). Written informed consent was obtained from all participants prior to data collection. Data confidentiality and anonymity were strictly maintained throughout the study. Consent for Publication Not applicable. The manuscript does not contain any individual person’s identifiable data (images, names, or personal details). Availability of Data and Materials The datasets generated and analyzed during the current study are available from the corresponding author upon request. Competing Interests The authors declare that they have no competing interests. Funding This research received no external funding. Authors’ Contributions Signal Ng’andu: Conceptualization, study design, data collection, data analysis, and drafting of the manuscript. Luckson Muwandia: Methodological guidance, supervision, manuscript review and editing. Salome Moyo: Data interpretation, validation, and critical revision of the manuscript. All authors read and approved the final manuscript. Acknowledgments The authors would like to express gratitude to the management and staff of Kalingalinga Health Centre for their cooperation and support during data collection. Special thanks to the patients and dental professionals who participated in the study. Appreciation is also extended to colleagues and family members for their encouragement throughout the research process. References Agbor AM, Naidoo S (2015) Knowledge and practices of traditional healers on oral health in Cameroon. J Ethnobiol Ethnomed 11:43. https://doi.org/10.1186/s13002-015-0024-9 Andersen RM (1968) A behavioral model of families’ use of health services. University of Chicago, Center for Health Administration Studies FDI World Dental Federation (2015) The challenge of oral disease: A call for global action. The oral health atlas (2nd ed.). FDI World Dental Federation. https://www.fdiworlddental.org/sites/default/files/2021-03/complete_oh_atlas-2.pdf Marcenes W, Kassebaum NJ, Bernabé E, Flaxman A, Naghavi M, Lopez A, Murray CJL (2013) Global burden of oral conditions in 1990–2010: A systematic analysis. J Dent Res 92(7):592–597. https://doi.org/10.1177/0022034513490168 Ministry of Health (MOH) (2012) Zambia National Health Policy. Ministry of Health, Lusaka Ministry of Health (MOH) (2018) Report on the burden of oral diseases in Zambia. Ministry of Health, Lusaka Moynihan P, Petersen PE (2004) Diet, nutrition and the prevention of dental diseases. Public Health Nutr 7(1A):201–226. https://doi.org/10.1079/PHN2003589 Ndiaye C (2010) Oral health in the African region: Progress and perspectives of the regional strategy. Afr J Oral Health 2(1):1–9 Patel R (2020) The state of oral health in Europe. Platform for Better Oral Health in Europe Petersen PE (2003) The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century. Commun Dent Oral Epidemiol, 31 (Suppl. 1) Petersen PE (2009) Oral health in the developing world: Global Oral Health Program, chronic disease and health promotion. World Health Organization Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C (2005) The global burden of oral diseases and risks to oral health. Bull World Health Organ 83(9):661–669. https://www.who.int/bulletin/volumes/83/9/661.pdf Rosenstock IM (1974) Historical origins of the Health Belief Model. Health Educ Monogr 2(4):328–335 Shary S, Nzala S, Baboo KS (2018) Evaluation of oral hygiene services in selected public health facilities in Lusaka district of Zambia. J Public Health Afr 9(2):820. https://doi.org/10.4081/jphia.2018.820 Thorpe S (2006) Oral health issues in the African region: Current situation and future perspectives. J Dent Educ, 70 (11 Suppl) Vanek C (2017) The state of oral health on the African continent. Liberty University World Health Organization (2010) Oral health . https://www.who.int/health-topics/oral-health World Health Organization (2020) Oral health: Key facts . https://www.who.int/news-room/fact-sheets/detail/oral-health Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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08:44:36","extension":"xml","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":59080,"visible":true,"origin":"","legend":"","description":"","filename":"rs82667390structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8266739/v1/008711c5dd8f1f3db0caca98.xml"},{"id":97422741,"identity":"645a86d2-38f5-4e77-86d5-1ca3214b61e5","added_by":"auto","created_at":"2025-12-04 08:44:36","extension":"html","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":69474,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8266739/v1/6a8128f05ce0df46619bfb23.html"},{"id":97422744,"identity":"193a6771-f3c2-443b-a450-6196ebd48892","added_by":"auto","created_at":"2025-12-04 08:44:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":97942,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eConceptual Framework Showing Determinants of Oral Health Service Utilization\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSource; \u003c/em\u003eResearcher’s conceptualization, adapted from Rosenstock (1974) and Andersen (1968)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8266739/v1/d9657608bc16d05740dfd041.png"},{"id":97422729,"identity":"51bc68e6-59d6-40bd-bbdb-1dbc82742e07","added_by":"auto","created_at":"2025-12-04 08:44:36","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":195629,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 3: Prevalence of Reported Barriers to Dental Service Utilization\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8266739/v1/9ec6cc01ee74104e74eb273f.png"},{"id":97422735,"identity":"eee2a4a4-3d2f-463e-8212-a197ef494ce2","added_by":"auto","created_at":"2025-12-04 08:44:36","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":355940,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 1: Distribution of Dental Service Utilization\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8266739/v1/4eb15e1cef86ad4622bfd6e6.png"},{"id":97677692,"identity":"6970c240-a9bf-4ca1-a039-adc97b5f75e6","added_by":"auto","created_at":"2025-12-08 09:54:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1257137,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8266739/v1/c5953d4f-14ac-4f13-b5b9-014cbf03f6db.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eFactors Influencing Oral Health Service Utilization in Lusaka: A Case of Kalingalinga Health Centre\u003c/p\u003e","fulltext":[{"header":"1.0 INTRODUCTION","content":"\u003cp\u003eOral health is defined as a state of being free from mouth and facial pain, oral and throat cancers, oral birth defects such as cleft lip and palate, periodontal (gum) disease, tooth decay, tooth loss, and other conditions that affect the oral cavity (WHO, 2010). Globally, oral diseases are a significant public health burden, with dental caries and periodontal diseases remaining the two most prevalent conditions (Petersen et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Tooth decay is the most common chronic disease across all ages, while periodontal disease, which begins as reversible gingivitis, continues to affect 5%\u0026ndash;20% of adults worldwide (FDI, 2015; Petersen, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eReliable global data on oral health remain limited, as most low- and middle-income countries lack integrated surveillance systems (FDI, 2015). In Zambia, although oral diseases are largely preventable, over 80% of the population is affected by dental caries, periodontal disease, malocclusion, and oral infections (Ministry of Health [MOH], 2012). The high HIV prevalence has further compounded the burden of oral lesions and infections (Shary et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Despite the country\u0026rsquo;s growing non-communicable disease (NCD) challenge, oral health remains a neglected aspect of health care planning.\u003c/p\u003e\u003cp\u003eGlobally, about 3.5\u0026nbsp;billion people experience oral pain or tooth-related conditions (WHO, 2020). In Europe, over 50% of adults have periodontitis, and more than 10% suffer severe disease (Patel, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Sub-Saharan Africa, already heavily affected by HIV/AIDS, faces a dual burden of infectious and oral diseases. Periodontal disease is now linked with systemic conditions such as cardiovascular disease and diabetes, further amplifying public health risks (Petersen et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2005\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn Zambia, oral health services are mainly provided at referral and district hospitals, with little to no coverage at primary health centres where most citizens seek care (MOH, 2012). Dental clinics are often under-resourced, lacking essential equipment, materials, and skilled personnel. The few existing dental practitioners are concentrated in urban areas, leaving peri-urban and rural populations underserved. Kalingalinga Health Centre, located in a densely populated urban settlement in Lusaka, reflects this national challenge. The facility faces shortages of dental staff and equipment, while patients tend to seek care only for emergencies such as extractions.\u003c/p\u003e\u003cp\u003eOral health services, by definition, include curative, preventive, promotive, and rehabilitative interventions delivered by qualified professionals to relieve pain, restore function, and prevent disease (MOH, 2012). However, the high cost of treatment, user fees, and limited access to preventive education continue to limit utilization. In contrast to general outpatient services, which are free at health centres, dental care often carries a charge, discouraging early health-seeking behavior.\u003c/p\u003e\u003cp\u003eTherfore, this study examined the factors influencing oral health service utilization at Kalingalinga Health Centre. By identifying the barriers from both patient and provider perspectives, it aims to inform targeted interventions and strengthen Zambia\u0026rsquo;s oral health delivery system.\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003e1.1 Problem Statement\u003c/h2\u003e\u003cp\u003eAcross much of Africa, access to proper oral health care remains severely limited. Dental professionals are few and largely concentrated in urban centers, while the majority of the population, particularly those in peri-urban and rural areas\u0026mdash;lack affordable, accessible, and preventive dental services (Vanek, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). In Zambia, although the national oral health program aims to provide curative, preventive, promotive, and rehabilitative care, service utilization remains extremely low. Most patients seek care only when dental problems have advanced to severe stages, often requiring tooth extraction as the only option.\u003c/p\u003e\u003cp\u003eAccording to the Ministry of Health (2018), more than 80% of Zambians are affected by oral health problems such as dental caries, periodontal disease, malocclusion, facial injuries, halitosis, and oral tumors. However, only a small fraction utilize available dental clinics in their communities. Oral health, though closely linked to general well-being and non-communicable diseases such as diabetes and cardiovascular conditions, continues to receive minimal attention compared to diseases like HIV/AIDS, tuberculosis, and malaria (Ndiaye, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe lack of a clear national oral health policy (Mukena, 2010), inadequate dental infrastructure, high treatment costs, and insufficient community awareness exacerbate this situation. Consequently, most dental services in Zambia are reactive rather than preventive. The populations most affected are low-income communities, such as those served by Kalingalinga Health Centre, where delayed treatment often leads to preventable tooth loss, pain, and infection.\u003c/p\u003e\u003cp\u003eDespite the visible burden of disease, the underlying reasons for poor oral health service utilization have not been systematically studied in Zambia. This knowledge gap limits policymakers\u0026rsquo; ability to design effective, equitable, and sustainable interventions. Therefore, this study investigated the factors influencing oral health service utilization at Kalingalinga Health Centre by exploring the perspectives of both patients and oral health providers, with the goal of informing strategies to improve service access and utilization across the country\u003c/p\u003e\u003c/div\u003e"},{"header":"2.0 LITERATURE REVIEW","content":"\u003cp\u003eOral health is an essential component of general health and well-being, affecting nutrition, communication, and quality of life. Poor oral health can lead to pain, infection, tooth loss, and systemic complications, while also contributing to social and economic disadvantage. The global distribution of oral diseases reveals sharp disparities between and within countries, largely influenced by income, education, and access to preventive care. Understanding these disparities helps contextualize Zambia\u0026rsquo;s situation within the broader public health framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGlobal Perspective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGlobally, oral diseases remain among the most prevalent non-communicable diseases, collectively affecting 3.5 to 4\u0026nbsp;billion people, more than half of the world\u0026rsquo;s population (WHO, 2020). Dental caries in permanent teeth remains the single most common health condition worldwide. Periodontal disease, severe tooth loss, and oral cancers also contribute significantly to disability-adjusted life years (DALYs). The Global Burden of Disease Study (Marcenes et al., \u003cspan class=\"CitationRef\"\u003e2013\u003c/span\u003e) showed that oral health problems increased in absolute numbers between 1990 and 2010 due to population growth and ageing, even though their proportional burden declined slightly.\u003c/p\u003e\n\u003cp\u003eHigh-income countries have seen marked improvements in oral health because of fluoride use, improved hygiene, preventive programs, and better access to care. In contrast, most developing countries continue to face a double burden, rising rates of dental decay alongside limited access to professional dental care. The cost of dental treatment often exceeds the total health expenditure available per person in many low- and middle-income settings, making prevention the most practical approach (FDI, 2015).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegional Perspective (Africa)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Africa, oral health problems remain a neglected public health issue. Studies across the continent reveal a consistent pattern of low service coverage, shortage of dental professionals, and limited preventive care (Thorpe, \u003cspan class=\"CitationRef\"\u003e2006\u003c/span\u003e; Petersen, \u003cspan class=\"CitationRef\"\u003e2003\u003c/span\u003e). The African region is characterized by an overall low to moderate prevalence of dental caries, but this is expected to rise due to increased urbanization, higher sugar consumption, and reduced natural fluoride exposure (Moynihan \u0026amp; Petersen, \u003cspan class=\"CitationRef\"\u003e2004\u003c/span\u003e). Rural and peri-urban communities often have no access to dental services other than emergency extractions.\u003c/p\u003e\n\u003cp\u003eSerious oral conditions such as noma (cancrum oris), acute necrotizing gingivitis, and oral manifestations of HIV/AIDS still occur in many parts of Sub-Saharan Africa (Thorpe, \u003cspan class=\"CitationRef\"\u003e2006\u003c/span\u003e). Oral cancers are also on the rise, often diagnosed at advanced stages due to lack of screening and awareness. The shortage of dental professionals is severe: some countries have ratios as low as 1 dentist per 150,000 people, compared to 1:2,000 in high-income nations (Vanek, \u003cspan class=\"CitationRef\"\u003e2017\u003c/span\u003e). Oral health ranks low among government priorities, with most available resources directed toward life-threatening diseases such as HIV/AIDS, tuberculosis, and malaria (Ndiaye, \u003cspan class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eCultural reliance on traditional healers further complicates service utilization. In many communities, herbal remedies are used to treat oral pain or infections, delaying professional intervention (Agbor \u0026amp; Naidoo, \u003cspan class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eZambia\u0026rsquo;s Context\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Zambia, oral health services remain limited and concentrated in urban referral and district hospitals. Over 80% of the population is estimated to suffer from oral conditions such as dental caries, gum disease, malocclusion, facial trauma, halitosis, and oral tumors (MOH, 2012). Despite this high prevalence, most people only visit dental clinics when pain becomes severe, resulting in high extraction rates and very few preventive or restorative procedures (Mukena, 2010).\u003c/p\u003e\n\u003cp\u003eThere is no standalone national oral health policy, and oral health is integrated only superficially within the broader primary health care framework. Most health centres, particularly in peri-urban and rural areas, lack dental equipment, materials, and trained personnel. Oral health education and community outreach are minimal. The HIV epidemic has also compounded the oral disease burden, with increased prevalence of oral lesions among immunocompromised individuals (Shary et al., \u003cspan class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe Kalingalinga Health Centre in Lusaka exemplifies these challenges: high patient volumes, limited staff, inadequate equipment, and services mainly restricted to extractions. Preventive and promotive programs are rare, reflecting the general national pattern of low oral health service utilization.\u003c/p\u003e\n\u003cp\u003eThe reviewed literature highlights that oral health is a global concern, with low- and middle-income countries bearing a disproportionate share of the burden. In Africa, and particularly in Zambia, oral health remains an overlooked component of public health, constrained by limited policy attention, inadequate human resources, and economic barriers. Despite the preventable nature of most oral diseases utilisation of available services is low.\u003c/p\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003e2.1 Theoretical Review\u003c/h2\u003e\n\u003cp\u003eTwo behavioural theories principally underpin this study: the Health Belief Model (HBM) and the Andersen Behavioral Model of Health Services Use.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth Belief Model (HBM)-\u003c/strong\u003e Rosenstock (\u003cspan class=\"CitationRef\"\u003e1974\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe HBM posits that health-seeking behaviour is determined by individuals\u0026rsquo; perceptions of: (a) susceptibility to a health problem, (b) severity of the condition, (c) benefits of the recommended action, and (d) barriers to action. Self-efficacy (confidence in one\u0026rsquo;s ability to act) and cues to action (triggers to prompt behaviour) were later added. Applied to oral health, HBM explains why many people delay dental visits until pain appears: perceived susceptibility and severity may be low, perceived barriers (cost, fear, time) are high, and cues to action (health education, screening) are weak. This model guided the present study\u0026rsquo;s exploration of patient beliefs, perceived barriers (economic, psychological, cultural) and the role of health promotion as a cue to preventive behaviour.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAndersen Behavioral Model of Health Services Use\u003c/strong\u003e Andersen (\u003cspan class=\"CitationRef\"\u003e1968\u003c/span\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAndersen\u0026rsquo;s model organizes determinants of service use into three domains: predisposing factors (demography, education, health beliefs), enabling resources (income, insurance, service availability), and need (perceived and evaluated need). The model emphasises that even when need exists, utilisation depends on enabling resources and socio-cultural predispositions. For Kalingalinga, Andersen\u0026rsquo;s framework helped structure investigation of how socio-economic status, service availability, and perceived need interact to produce low utilisation of preventive dental services.\u003c/p\u003e\n\u003cp\u003eTogether, HBM and Andersen\u0026rsquo;s model provide a comprehensive lens: HBM focuses on individual cognitive drivers (beliefs, fears, perceived benefits/barriers), while Andersen situates those drivers within structural and resource contexts (availability, affordability, organization of services). The study uses HBM to probe individual attitudes and Andersen to interpret system-level constraints- enabling a mixed analysis of demand- and supply-side factors influencing oral health service utilization.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003e2.2 Conceptual Framework\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eINDEPENDENT VARIABLES\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003e2.3 Research Gaps\u003c/h2\u003e\n\u003cp\u003eExisting literature documents many drivers of low oral health service utilisation in low- and middle-income countries (cost, fear, access), but there is limited context-specific evidence for peri-urban Lusaka settings such as Kalingalinga. Notably, gaps exist regarding: (a) how community beliefs and reliance on traditional remedies interact with perceived need and affordability, (b) the relative weight of system-level constraints (equipment, staffing) versus individual barriers in public health centre contexts, and (c) actionable policy-relevant recommendations that reflect both patient and provider perspectives. This study addresses these gaps by collecting linked quantitative and qualitative data from patients and dental staff at Kalingalinga Health Centre.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3.0 MATERIAL AND METHODS","content":"\u003cp\u003e This study adopted a descriptive cross-sectional design with both quantitative and qualitative approaches to assess factors influencing oral health service utilization at Kalingalinga Health Centre in Lusaka, Zambia. The study was conducted within the health centre\u0026rsquo;s catchment area, which serves a large peri-urban population with diverse socioeconomic backgrounds. The study population comprised adult patients aged between 18 and 65 years attending the dental clinic, and dental professionals providing oral health services at the facility. A total of 130 participants were included 110 patients and 20 dental professionals, selected using a convenience sampling technique based on availability and willingness to participate during the study period. Data collection was conducted using structured questionnaires for patients, capturing demographic details, knowledge, perceptions, and utilization patterns, while interview guides were used for dental professionals to obtain qualitative insights into health system challenges and service delivery constraints. All responses were checked for completeness prior to analysis. Quantitative data were analyzed using descriptive statistics such as frequencies and percentages and presented in tables and figures, whereas qualitative data were analyzed thematically to identify emerging patterns and explanations. Results from both data sources were integrated to provide a comprehensive understanding of the determinants influencing oral health service utilization at Kalingalinga Health Centre.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eQuestionnaire Origin\u003c/strong\u003e\u003cp\u003eThe questionnaire used in this study was \u003cb\u003edeveloped specifically for this research\u003c/b\u003e to assess awareness, perceptions, barriers, and utilization of oral health services among patients attending Kalingalinga Health Centre and has never been used elsewhere. An English-language version of the questionnaire has been attached.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"4.0 FINDINGS","content":"\u003cp\u003eThe results are organized based on responses from patients, health center nurses, and dental professionals.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResponse Rate\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eResponse\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReturned\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86.7%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnreturned\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eResearch Survey Data-2025\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eComment\u003c/strong\u003e\u003cp\u003eThe study achieved an 86.7% response rate, with 130 out of 150 questionnaires returned.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAwareness of Oral Health Services\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevel of Awareness\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow Awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate Awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh Awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eResearch Survey Data-2025\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eComment\u003c/strong\u003e\u003cp\u003e Most respondents (68%) had moderate awareness of oral health services, while 26% had low awareness and 6% had high awareness.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePurpose of Dental Visit\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReason for Visit\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePreventive Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePain/Curative Treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e62%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eResearch Survey Data-2025\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eComment\u003c/strong\u003e\u003cp\u003eA majority of patients (62%) sought dental care only when in pain, while 38% visited for preventive reasons.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eResearch Survey Data-2025\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eComment\u003c/strong\u003e\u003cp\u003eThe leading barriers were high treatment costs (58%), fear of dental procedures (46%), and long waiting times (40%).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eHealth System Challenges Identified by Providers\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth System Barrier\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInadequate Staffing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e60%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eShortage of Dental Equipment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLimited-Service Range\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e100%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cb\u003eResearch Survey Data-2025\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eComment\u003c/strong\u003e\u003cp\u003eThe main system-related challenges reported were inadequate staffing (60%) and shortages of dental equipment (55%).\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eResearch Survey Data-2025\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eComment\u003c/strong\u003e\u003cp\u003eCurative visits accounted for 62% of dental attendance, while preventive visits accounted for 38%.\u003c/p\u003e\u003c/p\u003e"},{"header":"5.0 CONCLUSION AND RECOMMENDATIONS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e5.1 Conclusion\u003c/h2\u003e\u003cp\u003e This study aimed to evaluate the factors influencing oral health service utilization at Kalingalinga Health Centre in Lusaka, Zambia. The findings show that 62% of patients sought dental care only when experiencing pain, while only 38% utilized services for preventive purposes, indicating a predominantly curative pattern of health-seeking behavior. Although 68% of respondents reported moderate awareness of oral health services, this knowledge did not translate into preventive action. Several barriers contributed to low utilization of dental services. The most commonly reported obstacle was high treatment cost (58%), followed by fear of dental procedures (46%), and long waiting times (40%). From the health system perspective, 60% of dental professionals identified inadequate staffing as a major challenge, while 55% cited shortages of dental equipment as a barrier affecting both service delivery and patient access.\u003c/p\u003e\u003cp\u003eThe results reveal that oral health service utilization at Kalingalinga Health Centre is significantly influenced by a combination of individual, socio-economic, and structural factors. Despite moderate awareness, preventive dental visits remain low, and the presence of financial, psychological, and system-related constraints continues to shape reactive rather than proactive oral health behaviors within the community.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e5.2 Recommendations\u003c/h2\u003e\u003cp\u003eBased on the findings of the study, several measures are needed to improve oral health service utilization at Kalingalinga Health Centre. First, sustained community education programs should be implemented to strengthen awareness of preventive dental care and promote early health-seeking behavior. Second, strategies to reduce financial barriers, such as subsidized services or flexible payment mechanisms, should be considered to make dental care more accessible to low-income households.\u003c/p\u003e\u003cp\u003eThe health center should also prioritize improvements in staffing levels and ensure consistent availability of essential dental equipment to enhance service delivery efficiency. At the policy level, integrating oral health into routine primary health care activities and strengthening referral pathways may contribute to better oral health outcomes.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch3\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Tropical Diseases Research Centre Research Ethics Committee (TDRC-REC). All procedures involving human participants were conducted in accordance with the Declaration of Helsinki (2013 revision). Written informed consent was obtained from all participants prior to data collection. Data confidentiality and anonymity were strictly maintained throughout the study.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eNot applicable. The manuscript does not contain any individual person’s identifiable data (images, names, or personal details).\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author upon request.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eAuthors’ Contributions\u003c/strong\u003e\u003c/h3\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eSignal Ng’andu:\u003c/strong\u003e Conceptualization, study design, data collection, data analysis, and drafting of the manuscript.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eLuckson Muwandia:\u003c/strong\u003e Methodological guidance, supervision, manuscript review and editing.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSalome Moyo:\u003c/strong\u003e Data interpretation, validation, and critical revision of the manuscript.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe authors would like to express gratitude to the management and staff of Kalingalinga Health Centre for their cooperation and support during data collection. Special thanks to the patients and dental professionals who participated in the study. Appreciation is also extended to colleagues and family members for their encouragement throughout the research process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAgbor AM, Naidoo S (2015) Knowledge and practices of traditional healers on oral health in Cameroon. J Ethnobiol Ethnomed 11:43. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13002-015-0024-9\u003c/span\u003e\u003cspan address=\"10.1186/s13002-015-0024-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAndersen RM (1968) A behavioral model of families\u0026rsquo; use of health services. 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J Dent Res 92(7):592\u0026ndash;597. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/0022034513490168\u003c/span\u003e\u003cspan address=\"10.1177/0022034513490168\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMinistry of Health (MOH) (2012) Zambia National Health Policy. Ministry of Health, Lusaka\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMinistry of Health (MOH) (2018) Report on the burden of oral diseases in Zambia. Ministry of Health, Lusaka\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMoynihan P, Petersen PE (2004) Diet, nutrition and the prevention of dental diseases. Public Health Nutr 7(1A):201\u0026ndash;226. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1079/PHN2003589\u003c/span\u003e\u003cspan address=\"10.1079/PHN2003589\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNdiaye C (2010) Oral health in the African region: Progress and perspectives of the regional strategy. Afr J Oral Health 2(1):1\u0026ndash;9\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePatel R (2020) The state of oral health in Europe. Platform for Better Oral Health in Europe\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePetersen PE (2003) The World Oral Health Report 2003: Continuous improvement of oral health in the 21st century. 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Health Educ Monogr 2(4):328\u0026ndash;335\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShary S, Nzala S, Baboo KS (2018) Evaluation of oral hygiene services in selected public health facilities in Lusaka district of Zambia. J Public Health Afr 9(2):820. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4081/jphia.2018.820\u003c/span\u003e\u003cspan address=\"10.4081/jphia.2018.820\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThorpe S (2006) Oral health issues in the African region: Current situation and future perspectives. J Dent Educ, \u003cem\u003e70\u003c/em\u003e(11 Suppl)\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVanek C (2017) The state of oral health on the African continent. Liberty University\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2010) \u003cem\u003eOral health\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/health-topics/oral-health\u003c/span\u003e\u003cspan address=\"https://www.who.int/health-topics/oral-health\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2020) \u003cem\u003eOral health: Key facts\u003c/em\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/oral-health\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/oral-health\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Stump Mission Inc-Chisomo Hospital, Lusaka Zambia","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Oral Health, Service Utilization, Preventive Care, Health Systems, Zambia","lastPublishedDoi":"10.21203/rs.3.rs-8266739/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8266739/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study evaluated factors influencing oral health service utilization at Kalingalinga Health Centre in Lusaka, Zambia. Oral diseases are among the most neglected public health issues in low- and middle-income countries despite their significant burden on quality of life.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA descriptive cross-sectional study design was adopted. Data were collected using structured questionnaires and interviews from 130 participants, 110 patients and 20 dental professionals. Quantitative data were analyzed using descriptive statistics, while qualitative data were thematically analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFindings:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study found that only 38% of patients sought preventive dental care, while 62% sought services only during pain. The main barriers to service utilization included high treatment costs (58%), fear of dental procedures (46%), and long waiting times (40%). Health system challenges such as inadequate staffing (60%) and shortages of dental equipment (55%) also hindered access. Awareness of oral health was moderate (68%), though preventive behavior remained low.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications to Theory, Practice and Policy:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings align with the Health Belief Model, indicating that perceived barriers and low self-efficacy significantly affect health-seeking behavior. The study recommends community-based oral health promotion, affordable dental services, and strengthened public oral health systems.\u003c/p\u003e","manuscriptTitle":"Factors Influencing Oral Health Service Utilization in Lusaka: A Case of Kalingalinga Health Centre","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-04 08:44:31","doi":"10.21203/rs.3.rs-8266739/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"58033630-6ca2-4717-bd01-ccec4f3e42fa","owner":[],"postedDate":"December 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":59071307,"name":"Health Economics \u0026 Outcomes Research"},{"id":59071308,"name":"Dentistry"}],"tags":[],"updatedAt":"2025-12-04T08:44:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-04 08:44:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8266739","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8266739","identity":"rs-8266739","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}