Advancing the profession of dental hygiene

Transcription

1 Dental Hygienists Perceptions of Barriers to Graduate Education Linda D. Boyd, R.D.H., R.D., Ed.D.; Angela Bailey, R.D.H., B.S.D.H. Abstract: To advance the profession of dental hygiene, graduate education is necessary to support growth in research, education, administration, and practice in the discipline and to sustain credibility in a climate in which other health professions require entry-level master s and doctoral degrees. The purpose of this study was to explore what dental hygienists perceive as barriers to pursuing a graduate degree. A survey was developed based on the literature and other national surveys. Data were collected from 160 respondents to the survey: 50 percent held an entry-level baccalaureate degree in dental hygiene, while the rest held an entrylevel associate degree (48 percent) or certificate (2 percent) in dental hygiene. All respondents had completed a bachelor s degree. The top five barriers these respondents identified in pursuing graduate education were as follows: 1) cost of graduate education, 2) family responsibilities are too great, 3) concerns about personal funding to pay for graduate education, 4) finding time for graduate school while working, and 5) fear of thesis research. Dental hygiene is one of the few health professions that still have entry-level degrees at the associate and baccalaureate levels. The profession needs to reduce such barriers to enable dental hygienists to pursue graduate education and thus ensure an adequate supply of future leaders, educators, and researchers. Dr. Boyd is Dean and Professor, Massachusetts College of Pharmacy and Health Sciences, Forsyth School of Dental Hygiene; and Ms. Bailey is a graduate student in dental hygiene, Idaho State University. Direct correspondence and requests for reprints to Dr. Linda Boyd, Massachusetts College of Pharmacy and Health Sciences, Forsyth School of Dental Hygiene, 179 Longwood Avenue, Boston, MA 02115; [email protected]. Keywords: graduate education, dental hygiene education, master s degree, dental hygienists Submitted for publication 10/2/10; accepted 1/18/11 Advancing the profession of dental hygiene in the future requires a critical mass of highly educated members of the profession, whether the dental hygienist serves as clinician, educator, researcher, or advocate. The American Dental Hygienists Association (ADHA) specifically expressed this need in its 2005 report Dental Hygiene: Focus on Advancing the Profession. 1 Other health professions such as nursing have demonstrated the need for graduate education to support growth in research, education, administration, and practice. For the same reasons, dental hygienists who hold a baccalaureate degree should be encouraged to pursue a master s degree in a graduate dental hygiene program. Therefore, it is important to gain a better understanding of the barriers dental hygienists perceive to pursuing graduate education. According to the ADHA, there are currently sixteen programs in the United States granting the Master of Science in Dental Hygiene degree and six programs granting related master s degrees (Master of Science, Master of Science in Health Science, Master of Health Science, Master of Science in Allied Health for Dental Hygiene, Master of Science: Oral Health Care Practitioner, and Master of Community Oral Health). 2 The main purpose of these programs is to prepare dental hygienists for career options in the areas of education, administration, and research. 2 A typical master s core curriculum covers topics such as clinical practice, leadership, educational theory, and research methods. A variety of areas of specialization or emphasis are available, including dental hygiene education, community oral health, and administration. Emerging emphasis areas also include mid-level provider models like the advanced dental therapist in Minnesota. 3-5 Despite the current graduate dental hygiene programs available, little is known about the barriers dental hygienists perceive to pursuing graduate education. Historically, education in the profession was accomplished largely by associate-level programs, so access to baccalaureate programs was a barrier for some students; however, the number of baccalaureate completion programs today continues to grow, and these programs offer increased access through online opportunities. 2 The expansion of baccalaureate programs has now set the stage for increasing the number of dental hygienists pursuing master s degrees. Organizations and individuals in various disciplines have conducted research into the barriers students face pursuing graduate education, primarily seeking to understand what prevents them from seeking a master s degree. The Maternal and Child Health Bureau under the U.S. Department of Health and Human Services investigated the need for graduate education of those working in maternal and child 1030 Journal of Dental Education Volume 75, Number 8

2 health. 6 This study found that a graduate education is valued in the profession, but also identified factors influencing whether individuals pursued a graduate degree. The most frequently reported barriers were cost of the graduate program, amount of time required for degree completion, and potential loss of income from not being able to work full-time while attending the program. In another study, the California Library Association conducted a survey study to identify the difficulties students faced in pursuing a master s degree in library and information science. 7 The top two barriers were job prospects and program cost; other challenges identified were need for childcare, course load, entrance requirements, commuting requirements, need for computer literacy, and concerns about impact on family. In a study evaluating barriers to completing a nursing degree, a survey of bachelor and associate degree students in a Mississippi nursing school found lack of financial support and family issues to be the top barriers students faced. 8 Even though this survey addressed challenges to completing undergraduate degrees, these barriers are pipeline issues since applicants to master s nursing programs must hold a bachelor s degree. The same survey was distributed to all faculty members in a nursing school; these respondents reported that lack of funds, no flexible courses, family needs, cost of education, and child care were challenges for their students. Other studies have discovered barriers to pursuing graduate education although it was not their main research purpose. Keating et al. s study to identify barriers to expanding the number of nurse practitioners in emergency departments found that the cost of the graduate program was a barrier for students. 9 Among other purposes, Sran and Murphy s study sought to assess the barriers physiotherapists face in pursuing a clinical master s degree. They found lack of time, family commitments, cost of pursing graduate education, lack of financial support, and geographical location were the top barriers for those students. 10 Our evaluation of this literature revealed that more valid studies are needed to help educators understand the barriers students face in acquiring a graduate degree. Such information will help graduate programs that are considering changes in curriculum, learning methods, and delivery of instruction; development of online graduate degree programs; and ways to serve nontraditional students. Since there have been no studies of the barriers dental hygienists face in pursuing a graduate degree, research is needed in order to move the profession forward, address the shortage of oral health care providers, and continue developing quality faculty members for dental hygiene education programs nationwide. The purpose of this study was therefore to research the barriers dental hygienists perceive in pursuing a graduate degree. Methods This descriptive study was approved by the Idaho State University Human Subjects Committee. The participants were a convenience sample of dental hygienists, half of whom held a baccalaureate degree in an entry-level program or from a bachelor degree completion program. A two-part survey was developed based on the literature and the ACT withdrawing and nonreturning student survey. 11 Our survey consisted of questions concerning respondents demographic, educational, and professional practice information, barriers to pursuing graduate education, and plans for graduate education. The section about barriers consisted of fifty items in five areas: personal, academic, financial, employment, and institutional/program characteristics. The survey also included an open-ended question that allowed respondents to comment on what graduate dental hygiene programs could do to encourage dental hygienists to seek a graduate degree. In addition to the use of relevant literature to ensure content validity, the survey content was evaluated by students enrolled in a graduate dental hygiene program. Additional items identified as possible barriers were added, and the survey was entered into an online survey tool for dissemination. An invitation to participate in the study was disseminated electronically to a list consisting of both practicing dental hygienists and the program directors of U.S. dental hygiene bachelor s degree and degree completion programs. The list included valid addresses of dental hygienists who had contacted a graduate dental hygiene program for information between August 2005 and May 2010 (n=451). Twenty-six program directors (n=26) of bachelor s degree or degree completion programs also agreed to participate by contacting their graduates. We were not able to obtain lists from some bachelor s degree and completion programs because the institutions had concerns about violating the federal Family Educational Rights and Privacy Act (FERPA). The ed recruitment letter explained the purpose of the study and provided instructions about August 2011 Journal of Dental Education 1031

3 the online survey and links to the online consent form and survey instrument. All participants were given approximately two weeks to complete the survey. A reminder was sent one week prior to the survey completion date. Due to the limitation of using a convenience sample, only descriptive statistics (frequencies and percentages) are reported here. Results A total of 160 individuals responded to the survey; this number consists of respondents (n=100) from the group of graduates contacted by dental hygiene program directors and respondents (n=60) from the group of potential students. The majority of respondents were female (98 percent), between the ages of twenty and forty years (62 percent), Caucasian (86 percent), and had no children (61 percent) Table 1. Demographic information on participants in study, by number and percentage of total respondents Number Percentage Gender Male 3 1.9% Female % Age % % % % % % % % 60 or older % Missing data % Race/ethnicity African American or black % Native American % Caucasian or white % Mexican American, Mexican origin % Asian American, Pacific Islander % Puerto Rican, Cuban, other Latino, % or Hispanic Missing data % Number of children residing in the home None % One % Two % Three % Four or more % Missing data % (Table 1). Fifty percent had graduated from a dental hygiene program with an entry-level baccalaureate degree, while the rest had graduated with an entrylevel associate degree (48 percent) or certificate (2 percent) in dental hygiene (Table 2). All respondents without an entry-level baccalaureate degree had completed a bachelor s degree (see Table 3). Twentythree percent (n=37) of the respondents reported they were enrolled in or had completed a master s degree or dental degree program. Of the remaining respondents, 47 percent reported planning to pursue graduate education within one to two years (n=75); 15.6 percent planned to do so in three to four years (n=25); 11.2 percent planned to do so in five or more years (n=18); and 3.2 percent (n=5) did not respond. A ranking from 1 to 5 (greatest barrier=1 to less of a barrier=5) was used to assess the barriers perceived by the respondents (Table 4). Of the total respondents to the survey, 72 percent (n=117) responded to this question. The results showed they perceived the top five barriers to be the following: 1) cost of graduate education, 2) family responsibilities are too great, 3) concerns about personal funding to pay for graduate education, 4) finding time for graduate school while working, and 5) fear of thesis research. The final question asked respondents What could graduate dental hygiene programs do to facilitate your decision to complete a graduate education? Ninety-eight of the respondents provided suggestions. Using thematic analysis, major themes were identified through the use of common words or meaning units, and the number of occurrences of each theme was recorded. The major themes identified in this qualitative data were as follows: more information about the value/benefit of graduate education, cost concerns, and increasing access through online programs. A number of suggestions (n=36) support the idea that cost was the major concern. Examples of these were the following: my only concern is paying for graduate school ; expand financial aid/scholarships ; and unwilling to pay out-of-state tuition. The next most frequently mentioned theme (n=35) related to the value, benefit, and opportunities available to those with a graduate education. Examples included tell me what the benefit would be for me ; I feel unaware of what options and opportunities exist ; and a master s degree in dental hygiene is not as valuable to most people because there are fewer opportunities to advance in the practice of dental hygiene. The third most frequently mentioned theme 1032 Journal of Dental Education Volume 75, Number 8

4 (n=21) was increasing access to online courses/ programs. The word online occurred in every instance, along with the idea that programs needed to be 100% online. Discussion The literature we reviewed reported the top barriers for students pursuing a master s degree in various disciplines were the cost of the program, family responsibilities, and job prospects The results of our study were generally consistent with those findings. The top barrier identified in our study related to the cost of graduate education. Another barrier also appears to relate to cost since finding time for graduate school while working suggested dental hygienists would need to continue working to pay their education and living expenses. According to the suggestions provided by the respondents, expanding scholarship and financial aid for graduate education is critical. Unfortunately, financial aid for graduate students is typically limited to student loans and scholarships. There are opportunities for federal student loan forgiveness programs in the Public Service Loan Forgiveness Program, but these are limited and expansion may be indicated. 12 Those interested in such opportunities may need to be willing to relocate to the underserved and low-income practice areas qualifying for these programs, which may significantly limit the number of students able to take advantage of them. More than one-third of the respondents in our study were unclear about the opportunities and value of obtaining a graduate degree in dental hygiene a significant barrier to their pursuit of such a degree. Unfortunately, no data exist at this time to demonstrate the value of a graduate degree in dental hygiene. One study of nursing students suggested that understanding the utility or long-term value of graduate education is an important predictor of pursuit of a graduate degree. 13 That study found that being licensed as an entry-level professional was considered an important professional achievement by senior students in baccalaureate programs although the respondents saw no additional value to a graduate education. Those researchers hypothesized this finding could be related to the life stage of the respondents since 54 percent of them had taken college courses within the past year and another 21 percent had attended college in the past one to four years. Dental hygiene graduates have some Table 2. Dental hygiene education of participants in study Number Percentage Associate of Science % Associate of Applied Science % Bachelor of Science % Certificate % Table 3. Educational background of respondents Education Variables Number Percentage Bachelor s Degree Program Bachelor of Science in Dental % Hygiene Bachelor of Applied Science % Dental Hygiene Bachelor of Science Another % Discipline Bachelor of Arts Another Discipline 4 2.5% Missing Data % similarities to the participants in that study, so those findings may suggest that more emphasis should be placed on defining and communicating the value of graduate education to those in undergraduate dental hygiene programs. Respondents to our survey made some suggestions along these lines: for example, Perhaps graduate programs should begin to provide information to undergraduate students as soon as they enroll? and I think undergraduate dental hygiene programs can prepare by providing more information about graduate programs, the available areas of study, and job potential. This would give students direction and the ability to better prepare for grad school ahead of time. Disciplines like public health require a graduate degree because individuals with a graduate education enter the field with a higher level of expertise and maturity than those with only an undergraduate education. Likewise, in nursing, Plunkett et al. suggested that graduate education fosters independent thought, critical thinking, and the ability to synthesize and critique the large amounts of information (p. 1) needed to care for an increasingly medically complex population. 13 In dental hygiene, graduate education is also needed to enhance practitioners ability to work with other health professionals who have advanced their entry-level programs to the master s and doctoral level, such as those for physician assistants and nurse practitioners. August 2011 Journal of Dental Education 1033

5 Table 4. Barriers to dental hygiene graduate education identified by study participants, by number of responses Answer Options #1 #2 #3 #4 #5 Reason Reason Reason Reason Reason Learned all I want to at this point in time Changed mind about pursuing graduate education Health-related problems (family or personal) Wanted a break from college studies Wanted to move or was transferred to a new location Marital situation changed my educational plans Uncertain about the value of a graduate education Family responsibilities were/are too great * Experienced emotional difficulties Felt racial/ethnic tension Influenced by parents or relatives Influenced by current employer or other colleagues Fear of graduate education courses being too difficult Fear of graduate education courses not being challenging Inadequate study habits Too many classes required for graduate education Unsure about quality of instructors in graduate education program Desired graduate education program was not offered Encountered unexpected expenses Applied for financial aid but did not receive it Financial aid received was inadequate to cover expenses Wanted to get work experience prior to acquiring graduate education Accepted full-time employment Accepted part-time employment Fear conflicts between demands of employment and graduate education Cost of graduate education program. 15* Loss of income while in graduate education program Amount of time required to complete graduate education program Waiting list to enter graduate education program Flexibility in completing graduate education program Entrance requirements Computer literacy requirements Preference for classroom instruction, but no graduate programs are within traveling distance to me. Finding time for graduate education program while working * 4 Fear of not learning practical skills to apply to employment Questions about the prospective job opportunities gained from graduate education Potential impact of school on personal life Health problems Lack of academic preparation for graduate education Lack of instructor support and encouragement to pursue graduate education Graduate Record Examination (GRE), Miller Analogy Test (MAT), etc. requirements Concerns about paying back student loans Concerns about personal funds to pay for graduate education program * 5 6 Afraid of losing benefits from full-time work Afraid of graduate education degree affecting future employment in clinical practice. Afraid of graduate education degree affecting future employment in general Graduate education program interested in is not offered online On-site visit requirements of graduate education program delivered online Don t see value of acquiring graduate education degree Fear of thesis research * Note: Numbers bolded and with an asterisk refer to the highest number of responses to an item in each column for #1 Reason and so on Journal of Dental Education Volume 75, Number 8

6 In addition, higher education institutions including community colleges generally prefer or even require the minimum of a master s degree for new faculty members in dental hygiene education programs. Some institutions do so to meet regional accreditation standards such as that of the Southern Association of Colleges and Schools (SACS), which reported that at least 25 percent of the discipline course hours in each major at the baccalaureate level are taught by faculty members holding the terminal degree usually the earned doctorate in the discipline or the equivalent of the terminal degree (p. 28). 14 Since the current terminal degree in dental hygiene is a master s, programs must seek permission from the SACS for making an exception to this practice when hiring new faculty. The SACS standards state that graduate education must include knowledge of the literature of the discipline (p. 28), which underlines the need for dental hygiene faculty members with graduate degrees. These types of accreditation standards thus point to the necessity of expanding access to graduate dental hygiene programs. In addition, the number of entry-level dental hygiene education programs continues to grow, adding to current and anticipated faculty shortages. The graying of the faculty and wave of ongoing retirements are leading to a shortage of educators in many health professions. 13,15 In the most recent survey of dental hygiene program directors, the average age of faculty members was found to be fifty-one years, with 47 percent being over fifty years of age. 16 Some of the respondents to our survey indicated they would want a substantial pay increase as an incentive to pursue graduate education. This may come from the fact that entry-level faculty salaries are less than those in private practice. In , the National Center for Education Statistics found the average faculty salary was $73,600 (public and private colleges/ universities), with institutional averages ranging from $61,400 at public two-year colleges to $62,400 at public four-year colleges. 17 Many dental hygiene faculty members have nine- or ten-month contracts, so their annual salaries would be below these averages. These salaries are also dependent upon the educational level attained, so those with a bachelor s degree will be at a lower professional level, often starting with no rank or as an instructor. Considering this situation, the dental hygiene profession needs to help practitioners gain a better understanding of the value of a faculty position as one of the incentives to pursuing a graduate degree. In addition to salary, those entering academia need to look at other benefits in order to evaluate total compensation. Faculty benefits typically include medical, dental, and shortand long-term disability insurance; vacation and sick pay; and retirement contribution. These benefits are an average 22 percent of the salary (average of approximately $18,000) and provide security often not available in private practice settings. 17 Opportunities for personal and professional growth, advancement to leadership positions, and professional autonomy are also benefits for those in educational settings. Another barrier identified in our study involved the challenge of managing family responsibilities while pursuing graduate education, and respondents suggestions to increase access to online education are related to helping them overcome that barrier. Half of our respondents were under the age of thirty-five, perhaps suggesting the target market for dental hygiene graduate education may be either those without children or older practitioners whose children are more independent so they have not only time and resources for graduate education but also the ability to relocate if necessary for job opportunities. The final barrier identified in our survey was anxiety about the thesis research required for a graduate degree. This finding is consistent with Plunkett et al. s study, which found low levels of self-efficacy or confidence in ability to engage in research among baccalaureate nursing students. 13 Those authors suggested their finding was a result of inadequate attention to the research process or a mismatch between student readiness and placement of research content in the curriculum. Research is critical to add to the body of knowledge for the dental hygiene profession. The ADHA report on advancing the profession urged that dental hygiene faculty and students need to be socialized to the importance and benefits of research (p. 11) and stated that graduate research is necessary to expand on knowledge in the discipline. 1 The research process prepares students for career opportunities in both academic and corporate settings. Completing a thesis is also excellent preparation for the more extensive doctoral-level research the ADHA says is needed to create a research infrastructure (p. 12) to expand the dental hygiene body of knowledge. 1 A respondent with a master s degree in our study commented on the significant personal growth she experienced during the thesis process: You will be amazed at how much transformation you will have gone through when your thesis is completed. The nursing literature supports the idea of engaging undergraduate students in research. Ad- August 2011 Journal of Dental Education 1035

7 derly-kelly advocated promoting an appreciation for research among nursing students, 18 and Plunkett et al. urged that these students gain hands-on experience with research by working with faculty members and other undergraduate and graduate students. 13 The benefits in dental hygiene would seem to be comparable, but the challenge is finding a way to integrate research into the large number of associate-level programs that currently do not include it in their curricula. Since some regional accrediting bodies and institutions limit the number of credits allowed for an associate degree program, educators may have to be creative to identify ways to incorporate research into existing coursework, such as through development of evidence-based poster presentations or community projects. The more likely place to introduce research is in dental hygiene bachelor s completion programs, which may necessitate standardization to ensure a research component is included to help prepare students to pursue graduate education. There are several limitations of our study, including the relatively small sample size, challenges associated with contacting graduates of baccalaureate and completion programs, and timing since many dental hygiene program directors are unavailable during the summer months. Despite these limitations, the survey provides preliminary information about dental hygienists perceived barriers to graduate education along with insight into areas graduate programs may address to overcome some of the barriers identified. Conclusion To elucidate the barriers dental hygienists perceive to pursuing graduate education, additional research with a larger sample of baccalaureate dental hygienists and using additional methods to contact subjects is needed. It would also be useful to conduct future surveys during a time of year more likely to encourage a larger response. As demonstrated in this preliminary study, the dental hygiene profession must focus on several factors to encourage dental hygienists to acquire a master s degree. Work with policymakers is needed to continue expanding the profession and access to care in order to create advanced oral health care positions, as well as to expand opportunities for loan forgiveness since the cost of graduate education is a major barrier. Models to increase students exposure to and participation in research in undergraduate dental hygiene curricula are also needed to ease any general fear of research and especially anxiety about conducting thesis research. This is a critical need in itself in order to continue expanding the science and evidence-based knowledge of the profession. Longitudinal research with dental hygiene students to identify the facilitators and characteristics of those who pursue graduate education as compared to those who do not would also aid undergraduate and graduate programs in encouraging dental hygienists to further their education. Research on the barriers dental hygienists face in pursuing a graduate education must continue in order to keep the profession moving forward. REFERENCES 1. American Dental Hygienists Association. Dental hygiene: focus on advancing the profession. Chicago: American Dental Hygienists Association, June American Dental Hygienists Assocation, Division of Education. Dental hygiene education: curricula, programs, enrollment, and graduate information. At: downloads/edu/dh_ed_fact_sheet.pdf. Accessed: July 2, American Dental Hygienists Association. The history of introducing a new provider in Minnesota: a chronicle of legislative efforts, At: downloads/mn_mid-level_history_and_timeline.pdf. Accessed: April 7, Lopez N, Blue CM. Socialization of the new dental therapists on entering the profession. J Dent Educ 2011;75(5): Blue CM, Lopez N. Towards building the oral health care workforce: who are the new dental therapists? J Dent Educ 2011;75(1): Alexander G, Petersen D, Pass M, Slay M, Chadwick C. Graduate and continuing education needs in maternal and child health: report of a national needs assessment, Birmingham: Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, Mediavilla C, Hansen D. California Library Association recruiting survey results, February At: org/resources/reports/r_recruitingresults.php. Accessed: May 30, Keller S, Collins V, Jones W. Nursing education barriers identification survey, Mississippi Office of Nursing Workforce. At: Nursing%20Education%20Barriers%20Identif ication%20survey.pdf. Accessed: May 30, Keating S, Thompson J, Lee G. Perceived barriers to the sustainability and progression of nurse practitioners. Int Emergency Nurs 2010;18(3): Sran M, Murphy S. Postgraduate physiotherapy training: interest and perceived barriers to participation in a clinical master s degree programme. Physiother Canada 2009;61(4): Journal of Dental Education Volume 75, Number 8

8 11. ACT, Inc. Withdrawing and non-returning student survey. At: Accessed: July 11, U.S. Department of Education. Public service loan forgiveness (PSLF). At: WebApp/students/english/PSF.jsp. Accessed: August 17, Plunkett RD, Iwasiw CL, Kerr M. The intention to pursue graduate studies in nursing: a look at BScN student selfefficacy and value influences. Int J Nurs Educ Scholarship 2010;7(1):article Commission on Colleges, Southern Association of Colleges and Schools. The principles of accreditation: foundations for quality enhancement, At: org/pdf/2010principlesofacreditation.pdf. Accessed: August 29, Nunn PJ, Gadbury-Amyot CC, Battrell A, Bruce SI, Hanlon LL, Kaiser C, Purifoy-Seldon B. The current status of allied dental faculty: a survey report. J Dent Educ 2004;68(3): American Dental Hygienists Association. Dental hygiene education program directors survey: executive summary. Chicago: American Dental Hygienists Association, Aud S, Hussar W, Planty M, Snyder T, Bianco K, Fox M, et al. The condition of education, NCES Washington, DC: National Center for Education Statistics, Institute of Education Sciences, U.S. Department of Education, At: asp?pubid= Accessed: August 29, Adderly-Kelly B. Promoting the scholarship of research for faculty and students. Assoc Black Nurs Faculty J 2003;14(2):41 4. August 2011 Journal of Dental Education 1037