Peer-reviewed article
Barriers to orthodontic treatment among rural children in Guangxi, China: a mixed-methods study.
Xiao L, Zhao L, Mai W, Nan L, He H et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined why rural children in Guangxi, China receive orthodontic treatment less often than urban children. Researchers interviewed 42 pairs of children aged 11-12 with bite problems and their parents to understand the obstacles. Financial hardship and lack of knowledge about orthodontics were the main barriers, though the specific concerns varied depending on how severe the bite problem was. The study suggests that improving public awareness about orthodontics and making treatment more affordable could help more rural children access care.
Key points
- Financial pressure and low orthodontic health literacy were the primary barriers to treatment across all groups
- For mild malocclusion, child-centered concerns dominated (difficulty with follow-up, lack of awareness of effects)
- For severe malocclusion, parent-centered factors dominated (parental knowledge gaps, doubts about efficacy and safety)
- As malocclusion severity increased, barriers shifted from individual child concerns to family-level knowledge and trust issues
- Recommended solutions include targeted health education, training primary care dentists, and developing cost-effective treatment strategies
Limitations
The study used purposive sampling of 42 child-parent pairs from rural schools, which may not be representative of all rural children with malocclusion in the region. The study identifies barriers through qualitative interviews but does not test interventions to overcome them.
Abstract
Background Malocclusion represents a major global oral health burden, impairing function, aesthetics, and psychosocial well-being. The rates of treatment of rural children are significantly lower than for urban children. The objective of this study is to find core barriers to orthodontic treatment for these children and analyze how these factors vary by malocclusion severity. Methods In this mixed-methods study, we recruited 42 pairs of 11-12-year-old children with malocclusion and their parents by purposive sampling in 10 rural primary schools in Guangxi, China. Data came from semi-structured interviews; after coding, network analysis was used to find the key barriers to orthodontic treatment and to assess if these barriers varied by malocclusion severity. Results Financial pressure and low orthodontic health literacy were primary barriers to orthodontic treatment. Financial pressure was consistent across all malocclusion groups, but other factors differed. For the definite group, primary barriers were the difficulty of regular follow-up, limited individual awareness of adverse effects, and personal concerns about daily impacts. For the severe group, primary factors were the parental lack of orthodontic knowledge, poor treatment timing awareness, and doubts about efficacy and safety. For the handicapping group, primary barriers were the poor awareness of the treatment time, parental concerns about children's daily life, and doubts about efficacy and safety. With the malocclusion severity increasing, primary factors shifted from child-centered concerns to parent-centered knowledge and trust issues, as individual-level barriers became less and the family-concerned environment factors became more. Conclusions Financial pressure and low orthodontic health literacy were the primary barriers to orthodontic treatment among rural children, with differences across malocclusion severity subgroups. From a public health view, future efforts should be focused on improving orthodontic health literacy with targeted education and awareness campaigns, especially tackling subgroup-specific barriers. Furthermore, training primary care dentists in orthodontics can help spread the related knowledge and handle simpler cases locally. Also, cost-effective treatment strategies should be explored and advanced. These could improve the treatment uptake among the rural children.