Dental Hygiene Entry Level Education: Perceptions of Practicing Hygienists. Thesis

Transcription

1 Dental Hygiene Entry Level Education: Perceptions of Practicing Hygienists Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Dental Hygiene in the Graduate School of The Ohio State University By Lauren Clouse Graduate Program in Dental Hygiene The Ohio State University 2016 Master's Examination Committee: Rachel K. Kearney, RDH, MS, Advisor Dr. Rafat S. Amer, BDS, MS Dr. Joen M. Iannucci, DDS, MS

2 Copyright by Lauren Clouse 2016

3 ABSTRACT Current regulations require a minimum of an Associates Degree from an accredited college or university for entry into the profession of dental hygiene. There are currently 288 programs that offer an Associates Degree, and 56 programs that offer a Bachelor s Degree. Although dental hygiene began like many other healthcare professions, it has failed to implement higher education requirements like these similar fields. The purpose of this study was to evaluate opinions of currently licensed dental hygienists regarding entry level education requirements. Participants answered electronic survey questions via Qualtrics concerning their current degree levels and active practices, in addition to how they thought requiring a Bachelor s Degree would impact the profession. Most participants agreed that a baccalaureate degree would have a positive impact on the profession, and should be the requirement for entry level education. This supports results from similar research and the views of the American Dental Hygienists Association toward advancing the profession. ii

4 ACKNOWLEDGMENTS I would extend my deepest thank you to my committee members for their support and guidance in this research. Your time, perspectives, and suggestions are greatly appreciated. Thank you to Dr. JoAnn Guernlian for allowing the use of the previously used survey instrument in this study. iii

5 VITA Bachelor of Science in Dental Hygiene Major Field: Dental Hygiene FIELD OF STUDY iv

6 TABLE OF CONTENTS Abstract...ii Acknowledgments...iii Vita...iv List of Tables...vi List of Figures...vii Chapter 1: Review of the Literature...1 Chapter 2: Materials and Methods...8 Chapter 3: Results...10 Chapter 4: Discussion...12 References...17 Appendix A: Tables...19 Appendix B: Figures...24 v

7 LIST OF TABLES Table 1. Participant Demographics Table 2. Highest Academic Credential in Dental Hygiene Studies Table 3. Attitudes Towards Statements about the BSDH Table 4. Comparing Opinions Based on Education Levels vi

8 Figure A. Perceived Barriers to the BSDH LIST OF FIGURES vii

9 CHAPTER 1: REVIEW OF THE LITERATURE According to the American Dental Hygienists Association, a dental hygienist is a licensed heath professional with a focus on oral disease prevention, protecting the oral cavity, and promoting total body health. A dental hygienist must graduate from a CODA accredited dental hygiene program, and pass a national board exam and clinical exam (1). This review will examine past research and findings on current dental hygiene education, education requirements in similar health professions, and the future of the dental hygiene profession. Current State of Dental Hygiene Education Entry into the profession of dental hygiene can currently be obtained through certificate, associate degree, and baccalaureate degree programs. As of 2013, there are currently 288 programs offering an associate degree, and 56 programs offering a baccalaureate degree. At this time, 53 educational institutions offer degree completion programs for students to obtain a Bachelor of Science in Dental Hygiene or similar baccalaureate degree. A dental hygiene education requires an average of 84 credit hours for an associate degree or 118 for a baccalaureate degree. The curriculum includes general education courses, such as English and Psychology, general science courses, and dental science courses. There are currently 21 programs granting a Master of Science in Dental Hygiene or similar. The number of dental hygiene education programs has been 1

10 on the rise since 1990, while the number of dental programs has only seen a slight increase (1). The Commission on Dental Accreditation (CODA) currently sets the standards that all dental hygiene programs must meet to be an accredited program, regardless of degree granted. CODA declares their mission as serves the oral health care needs of the public through the development and administration of standards that foster continuous quality improvement of dental and dental related educational programs (2). The commission is comprised of 30 members. Only one of those members is a dental hygienist and is a representative of the ADHA. Currently, there is no difference in accreditation standards between and associate degree program and a baccalaureate degree program. The ADHA supports all levels of dental hygiene education, but declares their intent to establish a baccalaureate degree as the minimum entry level degree to practice dental hygiene (3). Dental hygienists often spend the majority of their educational hours in the clinical setting. Current dental hygiene students and instructors agree that clinical instructors need more clinical experience and instructional courses to maximize effectiveness in clinic (4). Education Requirements in Similar Health Professions Educational models in the healthcare professions continue to drastically change and advance. Expectations for highly trained and educated professionals are increasing, and education curriculum and requirements should reflect this demand (5). The American Physical Therapy Association, or APTA, defines physical therapists as licensed healthcare professionals who treat persons with injuries or illnesses 2

11 that affect their ability to function in their daily lives. The profession of physical therapy originated during World War I and required a certificate, usually from a 3 to 6 month program. In 1936, accreditation guidelines were established for the profession, and entry into the profession began to increase. Education requirements developed to 12 to 24 month programs that required 60 college credit hours or a 2-year degree in physical education or nursing. The number of baccalaureate programs began to increase, while certificate programs were becoming less popular. By 1960, a baccalaureate degree was required for entry into the profession. In 2002, a master s degree was declared the minimum education requirement (5). As of January 2015, a doctorate is required as the entry level degree. Occupational therapists are healthcare professionals that assist individuals in everyday situations, such as home, work, and school. They address all aspects of the body necessary for a high quality of life. In 1931, the first educational standards were developed for occupational therapy. In 1999, it was set that entry into the occupational therapy profession would require post-baccalaureate education by Similar to dental hygiene, there are currently two educational levels accepted as entry level. Unfortunately for the profession of dental hygiene, these two levels are a master s degree or a doctoral degree. As of 2010, 97% of occupational therapy programs grant a master s degree (5). There is no difference in scope of practice between the two degrees, although the doctoral program has additional requirements. A study conducted on the physician assistant (PA) profession reveals that PA students are currently not interested in a doctoral degree as the education requirement (6). First and second year PA students were concerned over cost of a higher degree, as well as 3

12 the confusion patients would experience. Over 70% of students were not in favor of the entry level doctorate, and over half of the students would leave the profession rather than pursue necessary requirements to obtain the doctorate. The American Nurses Association, or ANA, defines nursing as the protection, promotion and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response and advocacy in the care of individuals, families, communities and populations (7). The nursing profession began with individuals being trained in healthcare settings in the late 1800s. Until 1950, nursing professionals could enter the field with a diploma from a hospital-based training program or a baccalaureate degree from a larger nursing program. Due to a shortage of nurses, an associate degree program was developed around The Comprehensive Nurse Training Act of 1964 increased the quality of nursing education and limited the number of degree granting programs. With scholarship money as an incentive, it was recommended that a baccalaureate degree be required for entry into the nursing profession. Currently, three levels of education can be obtained for entry into the profession: diploma, associate s degree, and bachelor s degree (5). The nursing profession also includes the licensed practice nurse (LPN) and licensed vocational nurse (LVN). These nurses are typically trained in a 12-month program, and serve in nursing homes and long-term care facilities. They became more in demand during World War I and World War II, when there was a shortage of nurses. They were needed to aid in civilian hospitals, although their training programs go back to the 19 th century. They obtain basic knowledge through educational programs, but are not 4

13 trained to make independent decisions. With additional education, they can expand their scope of practice closer to that of a registered nurse (8). Similar Research Two authors conducted a study in 2009 to evaluate the opinions of Wichita State University dental hygiene graduates about the BSDH as entry level (9). They surveyed alumna of the program using a survey they adapted from a study of PA students. Wichita State granted an associate degree until 2009 when they became the only baccalaureate degree program in Kansas. Therefore, most of these participants held an associate degree (73.8%). Over 70% of respondents felt that an associate degree was sufficient in preparation for challenges in private practice, and only 30-40% were in favor of the BSDH as the entry level degree. One study surveyed current dental hygienists in New York regarding their perceptions of a baccalaureate degree for entry level education (10). This study found that 51% of respondents felt that a BSDH should be the entry level degree for practice, and 71% felt increased education requirements were necessary to elevate the status of the profession. A majority of the respondents agreed that a BSDH would offer more career opportunities and increase self-esteem. Future of the Dental Hygiene Profession Looking at the ADHA s Focus on Advancing the Profession, six focus areas have been established: research, education, practice and technology, licensure and regulation, public health, and government. Dental hygiene is a science-based profession, and revolves around evidence-based research findings and practice. Dental hygienists need to continue researching new ways to treat patients and achieve their professional duties of 5

14 overall health for patients and disease prevention. Research is an alternative career path for dental hygienists. Requiring a minimum of a baccalaureate degree, the research field is not the most chosen career path for a dental hygienist. In the future, the ADHA would like to increase the number and quality of dental hygiene researchers. To achieve this, the ADHA aims to educate and prepare students with the proper training, provide research agreements that facilitate entrance into graduate school, and develop research development training workshops (11). With education as one of the six focuses for the future, entry level into the profession must be questioned. Historically, dental hygiene education requirements aligned with similar healthcare professions. As those professions have advanced in requiring advanced degrees for entry, dental hygiene has not changed. Failure to standardize entry level has put the profession behind in expanding the body of knowledge and advancement. One of the biggest challenges in advancing the profession and standardizing entry level dental hygiene is that the accreditation standards are not set by the profession. These standards are set by CODA. While other allied health professions control their own accreditation processes and standards, dental hygiene is still controlled by committee members outside of the dental hygiene profession. From this document, developed in 2005, one aim was to require a baccalaureate degree as entry level by Recommendations were made to develop articulation agreements and degree completion programs to allow associate degree programs to continue to be fully maximized. From that point, another recommendation was a 10-year plan to implement a master s degree as entry level into the profession. The final education aim in this plan was creating a doctoral degree in dental hygiene. There were recommendations to create curriculum in 6

15 both the professional and academic side of the doctoral degree. As the need for advanced level practitioners increases, the knowledge and skills of dental hygienists will need to increase, as well (11). The dental hygiene faculty shortage is an increasing issue within dental hygiene education. Lack of awareness is one of the major suspected causes of this shortage. Students in undergraduate dental hygiene programs need to be given the opportunity to explore alternative career paths beyond clinical dental hygiene. Elective courses in teaching and research are one suggested way of encouraging dental hygiene students to look into the academic world (12). Dental hygiene is an expanding profession, and the education requirements need to keep pace with this rapid growth. With similar allied health professions advancing to higher standards, the profession of dental hygiene is falling behind in the healthcare world. To advance the profession, there needs to be a focus on changing entry level and expanding the scope of practice. 7

16 CHAPTER 2: MATERIALS AND METHODS Methodology This study assessed the attitudes and opinions of registered dental hygienists regarding the entry level education for dental hygienists. Surveys were designed and ed to dental hygienists registered with the American Dental Hygienists Association, with instructions and a link to the survey. Participants were queried about opinions regarding requiring a baccalaureate degree for licensure and how it would impact the profession. Survey results were compiled and analyzed. Sample 2,500 dental hygienists from Connecticut, Georgia, Missouri, Oregon, Colorado, Illinois, and Virginia were asked to participate in this study. s with a survey link and instructions were sent to participants by the ADHA. Measurement/Instrumentation To survey dental hygienists on their perceptions of entry level education requirements, the ADHA sent an initial to dental hygienists with a link to the electronic survey to gather the self-reported data. The survey instrument included closeended and open-ended questions seeking to obtain categorical descriptive data and information regarding their current education status, employment status, wages, etc. The survey also included Lickert-type questions, which were coded as follows: strongly disagree (1), disagree (2), neutral (3), agree (4), and strongly agree (5). 8

17 Detailed Study Procedures This survey was a one-time data collection event. An initial was sent to participating dental hygienists with a cover letter and electronic link to the survey. One additional reminder to all participating dental hygienists was sent after the initial to ensure an adequate response rate. The second was sent fifteen days after the initial . Both s were sent to all participants since data was collected anonymously. Qualtrics (survey software) was used to administer the online survey. Participants had 22 days to complete the survey. Internal Validity The survey used was obtained from a previous study conducted in New York. Questions were modified based on the study population. Permission was granted by Dr. JoAnn Gurenlian to use and adapt the previously used survey. Data Analysis An exploratory analysis including measures of central tendencies, descriptive frequencies, t-tests were performed. Spearman s rho was used to check for correlation between age and attitudes toward the BSDH. The Kruskal-Wallis test was used to identify differences between degrees held by participants and opinions about the baccalaureate degrees being required for entry into the profession. 9

18 CHAPTER 3: RESULTS Demographics A sample population of 2,500 participants were ed a survey and asked to complete it within 18 days. Of those 2,500 participants, 267 (10.68%) responses were received, and of those, 262 were valid and used for analysis. Participants could choose not to answer any question, resulting in varied n values. The majority of respondents (71.6%) were ages 39 and above. The mean years since graduation was 23.06, with a standard deviation of and a median of 25 years. Thirty-eight percent of respondents were from Connecticut, Georgia, Missouri, and Oregon. Most respondents (65.8%) did not have a post high school degree prior to entering a dental hygiene program. The majority of participants (n=142, 48.5%) practiced in a solo or group private dental practice, with 15.4% (n=45) working in an educational setting. Almost all respondents were members of the ADHA (n=255, 99.2%). Detailed demographics are represented in Table 1. As displayed in Table 2, 34.4% of participants held an associate degree, whole the other 65.6% held a degree higher than the required level. This question asked the highest academic credential in dental hygiene studies, but was interpreted as highest academic credential, due to the option of a doctoral degree. Opinions Toward the BSDH As seen in Table 2, respondents were almost evenly divided when asked if an associate degree was sufficient in preparing hygienists for practice, with 123 respondents (48.6%) choosing strongly disagree/disagree, and 101 (39.9%) answering strongly 10

19 agree/agree. The majority of participants (n=145, 57.3%) agreed or strongly agreed that a baccalaureate degree should be the required education level for entry into the profession of dental hygiene, with 65 (25.7%) strongly disagreeing/disagreeing. An overwhelming number of respondents (n=186, 73.8%) felt that a BSDH is necessary to elevate the profession to that of other mid-level healthcare providers, and that a BSDH would improve professional recognition by other professions (n=188, 75.2%). The majority of participants thought requiring a BSDH would offer more career opportunities (n=185, 73.1%), improve professional competency (n=141, 56.6%), and increase self-esteem (n=184, 73.9%). The perceived barriers to participants without a baccalaureate degree in pursuing further education were no increase in clinical competency (n=44, 16.1%), lack of time (n=30, 11.0%), and cost (n=12, 4.4%). Other unspecified reasons were other barriers (n=62, 22.7%). Correlation Between Demographics and Opinions There was no correlation between age and attitude toward a BSDH being required for entry level education (p=0.289). There was also no correlation between age and attitude about the BSDH being necessary to ensure highest standards of service delivery in the field of dental hygiene (p=0.234). Table 3 represents any correlation between degree level and opinions towards statements about the baccalaureate degree. Figure A shows perceived barriers to pursing a baccalaureate degree. 11

20 CHAPTER 4: DISCUSSION In this study, participants of all ages and years of practicing agreed that increasing education requirements would have a positive impact on the profession, and that it is a necessary change for the future. Because the survey was distributed by the ADHA to gain access to the population, the data cannot be generalized to hygienists who are not members of the ADHA. According to the ADHA Annual Report of the President (13), the organization currently represents about 18,400 dental hygienists across the country. As of May 2015, there are approximately 200,550 employed dental hygienists (14), which means the ADHA only represents about 9.2% of hygienists. With most participants being members of ADHA (99.2%), these results and attitudes cannot be generalized to the general population of dental hygienists. Many members of the organization are actively seeking to improve themselves and the profession. Active members may be more likely to pursue higher education and stand with the ADHA on their views for the future. This data varies greatly from the previously mentioned 2009 survey querying Wichita State graduates. The majority of participants in this study (65.6%) held a baccalaureate degree or higher, exceeding entry level requirements. There was over a 20% increase in number of respondents in favor of the BSDH as entry level, and a decrease in participants agreeing that an associate degree was sufficient. When comparing this data to that from the study on which this one was modeled out of New York, many similarities can be found. The majority of participants in both 12

21 studies were over the age of 40 and practiced in private dental offices or academic settings. In the original survey, participants were divided almost evenly in having an associate degree compared to a bachelor s degree or higher. In this study, the majority of participants (n=170, 63.9%) help a minimum of a baccalaureate degree. Respondents in both studies agreed that a baccalaureate degree should be minimum education requirement. Strong opinions in both studies support the BSDH as necessary for elevating the status of the profession, increasing career opportunities, and improving professional recognition by other similar professions. Although both studies found that there is a split opinion regarding an associate degree being sufficient for the challenges of private practice, they do not assess the opinions of an associate degree being enough for the future direction of the profession. The ADHA recently released a landmark white paper, Transforming Dental Hygiene Education and the Profession for the 21 st Century (15). This paper discusses the future of the dental hygiene profession and the education changes needed to treat the 21 st Century patient. The paper emphasizes the issues that the general population face in accessing dental care, and how increasing the scope of practice for dental hygienists can address these issues. According to the paper, there are currently 46 million people in the United States living in dental health professional shortage areas, and by 2025, there will be an even larger shortage of dentists. It is necessary for dental hygienists to be able to treat these patients and reach out into these areas to prevent dental diseases in both children and adults. The Commission on Dental Accreditation (CODA) removed the dental hygiene diagnosis standard from the accreditation standards for dental hygiene programs. The 13

22 dental hygiene diagnosis is crucial for all dental hygienists, but especially for mid-level provider programs that allow dental hygienists to merge the gap in access to care. The paper also discusses the one downfall of the dental hygiene profession as lack of selfregulation and a professional accreditation bodies. The profession began similar to other healthcare professions, such as nursing, pharmacy, and physicians assistants, but cannot make changes due to this limitation. There is currently a focus on advanced education and training within interprofessional teams. Expanding the scope of practice for a dental hygienist would allow hygienists to enter non-traditional dental facilities, such as medical offices, to provide care to patients who may otherwise not seek dental treatment. Pediatrician offices would increase access to children, and long-term care facilities or nursing homes offer opportunities to care for the rapidly increasing elderly population. While more curriculum is being packed into associate degree programs, accreditation standards and awarded degree levels are not changing. Associate programs control what extras they include in their curriculum, such as practicum experience and research level. With the ADHA intending to add more topics into the dental hygiene programs, there needs to be more time allotted for the material. By requiring a baccalaureate degree, there are additional credit hours available to include these topics. However, without CODA changing the accreditation standards, these topics cannot be declared necessary in dental hygiene programs. There are barriers for dental hygienists to pursing higher education. This study found that time and no increase in clinical competency were the most common barriers to pursuing higher education. When this data is compared to a study regarding barriers to graduate education, cost was less of a factor in pursing a baccalaureate degree compared 14

23 to a graduate education. Cost was found as the major barrier in the study regarding graduate education, with family responsibilities next (16). This may have been one of the barriers in this study, as indicated by other. The barriers to graduate education survey found that respondents would appreciate cost assistance or scholarships and online programs. The average cost of an associate degree is $22,692, while a bachelor s degree averages $36,382 (17). The average cost of a graduate degree is about $30,421. The second most frequent suggestion from respondents to facilitating graduate education mentioned the value or benefits of furthering their education. Comparing that response to the responses in this study, current dental hygienists do not see the benefits of further education, whether it is a baccalaureate degree or a graduate degree. Hygienists may not be able to see the value in spending over $30,000 when there may be no change in their earnings or clinical competency. Limitations A major limitation of this study is that it is designed to assess attitudes from dental hygienists across the country, but actually only includes a limited population of hygienists. Most participants were members of the ADHA. Therefore, it is not generalizable to the rest of the population. Further studies should be conducted to include licensed hygienists who are not members of the ADHA. The survey was originally designed for distribution in Connecticut, Georgia, Missouri, and Oregon. To further assess the data, respondents were asked their state of licensure. To include more participants, three additional states were added shortly before the survey was distributed and the survey could not be edited. This limited the ability to assess the data based on region of the country. 15

24 The survey design itself was a limitation in this study. Respondents were not able to explain their feelings or reasons behind their responses. An interview or group discussion study may also work in this situation and help address these limitations. The wording of questions may have guided participants in their responses. Suggestions for Future Research Similar studies should be conducted to evaluate the opinions of dental hygiene educators and dentists on the BSDH as the entry level degree. Research should also be done comparing clinical performance outcomes of associate degree hygienists and baccalaureate degree hygienists to assess any difference in skill level. Conclusion Overall, dental hygienists from different areas of the country are in favor of advancing the profession and requiring a baccalaureate degree as entry level education. They are in agreement that a BSDH would elevate the status of the profession and improve interprofessional relationships, as well as provide more career opportunities. The findings of this study support the ADHA in transforming the profession and better treating the 21 st century patient. 16

25 REFERENCES 1. ADHA [Internet]. Chicago, IL: American Dental Hygienists Association; c Dental Hygiene Education; 2014 Oct 21 [cited 2015 Jan 01]; Available from: 2. American Dental Association [Internet]. Chicago, IL: Commission on Dental Accredidation; c2016. Accreditation Standards for Dental Hygiene Education Programs; 2013 Jan 01 [2016 June 24] Available from: 3. ADHA [Internet]. Chicago, IL: American Dental Hygienists Association; c Policy Manual; 2015 June 22 [2016 June 24] Available from: 4. Paulis MR. Comparison of dental hygiene clinical instructor and student opinions of professional preparation for clinical instruction. J Dent Hyg Fall;85(4): Byleston ES, Collins MA. Advancing our profession: are higher educational standards the answer? J Dent Hyg Summer;86(3): Swanchak LE, Levine AM, Arscott KE, Golden MA. Physician assistant students' perceptions of an entry-level doctorate degree. J Physician Assist Educ. 2011;22(1): ANA [Internet]. Silver Springs, MD: American Nurses Association; c2016. What is Nursing?; 2016 [cited 2015 June 01] 8. Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington (DC): National Academies Press (US); E, Undergraduate Nursing Education. Available from: 9. Anderson KL, Smith BS. Practicing dental hygienists' perceptions about the bachelor of science in dental hygiene and the oral health practitioner. J Dent Educ Oct;73(10): Rogers C, Johnson TB, Gurenlian JR. New York State Dental Hygienists' Perceptions of a Baccalaureate Degree as the Entry-Level Degree Required for Practice. J Dent Hyg Jun;89 Suppl 2: ADHA [Internet]. Chicago, IL: American Dental Hygienists Association; c Focus on Advancing the Profession; 2005 [cited 2015 June 01]; Available from: Carr E, Ennis R, Baus L. The dental hygiene faculty shortage: causes, solutions and recruitment tactics. J Dent Hyg Fall;84(4): Rethman J.ADHA [Internet]. Chicago, IL: American Dental Hygienists Association; c Annual Report of the President; [2016 June 24] Available from: 17

26 14. Bureau of Labor Statistics [Internet]. Washington, DC: U.S. Department of Labor; 2016 Mar 30. Occupational Employment and Wages, May Dental Hygienists; 2016 [2016 June 24] Available from: ADHA [Internet]. Chicago, IL: American Dental Hygienists Association; c Transforming Dental Hygiene Education and the Profession for the 21 st Century; 2013 [2016 June 24] Available from: Boyd LD, Bailey A. Dental hygienists' perceptions of barriers to graduate education. J Dent Educ Aug;75(8): ADEA [Internet]. Washington, DC: American Dental Education Association; c2015. Program Costs; 2015 [2016 June 24] Available from: 18

27 APPENDIX A: TABLES 19

28 Table 1. Participant Demographics Age n=261 Percent % 18 to 28 years 29 to 38 years 39 to 48 years 49 to 58 years 59 years and over Post high school degree prior to DH program n=260 Percent No Yes Attended a DH program in state they currently live n=257 Percent No Yes Currently enrolled in a degree completion program n=253 Percent No Yes Interested in a degree completion program n=256 Percent No Yes Member of the ADHA n=257 Percent No Yes State of licensure n=275 Percent Connecticut Georgia Missouri Oregon Other Current primary practice n=293 Percent setting (all that apply) Independent DH practice Group dental practice Solo dental practice Multi-specialty clinic Public Health Agency Community health clinic Long term care/nursing home School-based health/dental clinic Academic/University/College Managed care/insurance company Industry business/corporation Not in clinical practice Other

29 Table 2. Highest Academic Credential in Dental Hygiene Studies Academic Degree n=259 Percent % Associate Degree: Dental Hygiene Bachelor s Degree: Dental Hygiene Bachelor s Degree: Non-Dental Hygiene Master s Degree: Area of Concentration Doctorate: Area of Concentration

30 Table 3. Attitudes Towards Statements about the BSDH Statement An Associate Degree in dental hygiene is sufficient preparation for the challenges of practicing DH in today s healthcare settings A BSDH should be the entry-level degree for practicing dental hygiene The BSDH degree is necessary to ensure the highest standards of service delivery in the field of dental hygiene The BSDH degree is necessary to elevate the status of the dental hygiene profession to that of the other midlevel health care providers A requirement for a BSDH degree might further limit diversity within the profession Those who are financially disadvantaged may not be able to afford the BSDH degree A BSDH degree offers more career opportunities Clinical experience is a better indicator of clinical competency than degree held A BSDH would increase professional recognition by other professionals A BSDH would improve overall professional competency A BSDH would increase individual self-esteem A BSDH would increase salary level for dental hygienists Strongly Disagree/Disagree n (%) Neutral 123 (48.6) 29 (11.5) 101 (39.9) 65 (25.7) 43 (17) 145 (57.3) 93 (36.8) 41 (16.2) 119 (47.1) 40 (15.9) 26 (10.3) 186 (73.8) 109 (43.3) 57 (22.6) 86 (34.1) 84 (33.2) 54 (21.3) 115 (45.5) 37 (14.7) 31 (12.3) 185 (73.1) 47 (18.7) 54 (21.4) 151 (60) 36 (14.4) 26 (10.4) 188 (75.2) 60 (24.1) 48 (19.3) 141 (56.6) 21 (8.4) 44 (17.7) 184 (73.9) 86 (34.5) 65 (26.1) 98 (39.4) Strongly Agree/Agree 22

31 Table 4. Comparing Opinions based on Education Levels Statement Associate Degree Bachelor s Degree Master s Degree Doctoral Degree p-value An Associate Degree in dental hygiene is sufficient preparation for the challenges of practicing DH in today s healthcare settings A BSDH should be the entry-level degree for practicing dental hygiene The BSDH degree is necessary to ensure the highest standards of service delivery in the field of dental hygiene The BSDH degree is necessary to elevate the status of the dental hygiene profession to that of the other mid-level health care providers A requirement for a BSDH degree might further limit diversity within the profession Those who are financially disadvantaged may not be able to afford the BSDH degree A BSDH degree offers more career opportunities Clinical experience is a better indicator of clinical competency than degree held A BSDH would increase professional recognition by other professionals A BSDH would improve overall professional competency A BSDH would increase individual self-esteem A BSDH would increase salary level for dental hygienists 3.30± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ± ±

32 APPENDIX B: FIGURES 24

33 Figure A. Perceived Barriers to the BSDH Perceived Barriers to the BSDH Cost Time No Increase in Clinical Competency Other 25