Self-efficacy and oral hygiene beliefs about toothbrushing in dental patients: a model-guided study

Social cognitive predictors of regular dental visits and mouth self-examination behaviors among the elderly population: An application of the health action process approach model

OBJECTIVE

The present study aimed to identify the social cognitive predictors of regular dental visits and mouth self-examination behaviors among the elderly population, based on the Health Action Process Approach (HAPA) model.

BACKGROUND

Regular dental visits and mouth self-examination can prevent oral and dental problems among the elders. Little information is available regarding the social cognitive predictive factors of these two behaviors.

MATERIALS AND METHODS

A cross-sectional study was conducted in 24 municipality centers in Tehran, Iran in 2021. The centers were selected randomly using a multi-stage cluster sampling method and 301 elderly attendants aged 60≥years participated in the study. Data collection was done using a researcher-made questionnaire including demographic characteristics and the HAPA model constructs for two target behaviors. Data were analyzed using the Smart-PLS version 3.3.9 via correlation and PLS-SEM analysis.

RESULTS

The mean age of the participants was 65.3±5.33 years and 79.7% were female. The SEM analysis showed that Action Self-Efficacy [b (SD) = 0.595 (0.065), P< 0.001] and Risk Perception [b (SD) = 0.218 (0.070), P< 0.002] were predictors of Intention for mouth self-examination but only Action Self-Efficacy [b (SD) = 0.651 (0.043), P< 0.001] was predictor of Intention for regular dental visits. Recovery Self-Efficacy and Planning directly contributed to the prediction of Mouth Self-Examination. The relationship between Maintenance Self-Efficacy and both behaviors is mediated by Planning. Also, the mediating role of Planning between Intention and target behaviors was confirmed.

CONCLUSION

Action self-efficacy predicted the intention for regular dental visits and mouth self-examination behaviors. The relationship between intention and both behaviors was mediated by Planning. Emphasis on improving Action Self-Efficacy and Intention formation will enhance the effectiveness of interventions aiming at promoting the oral health of the elderly population.

Racial discrimination, self-efficacy, and oral health behaviours in adolescents

To examine the mediation effect of discrimination on the association of self-efficacy and oral health behaviours among adolescents. A cross sectional study of adolescents aged 12 to 18 years who were recruited from the University outpatient dental clinic were asked to complete a questionnaire consisting of: demographics (12 items), oral health behaviours (7 items), general self-efficacy (10 items) and self-efficacy for self-care (SESS, 15 items). Perceived discrimination was assessed if the adolescent had ever been treated unfairly based on their race. Perceived discrimination was assessed if the adolescent had ever been treated unfairly based on their race. Using pathway analyses, the relationship between oral health behaviours, self-efficacy, and discrimination was explored. Mediation and hierarchal logistic regression analyses were conducted. Of 252 participants, mean (SD) age was 14 (1.8) years old. 60% were female, 81% were born in Canada, 56% identified themselves as White, and 20% perceived discrimination. Mean score of all task-specific self-efficacies were significantly different within respective oral health behaviour categories (P-value <0.001). Of demographics, age and ethnicity (White) were significantly associated with discrimination (OR = 1.25: 95% CI; 1.06-1.48 and OR = 0.29: 95% CI; 0.15-0.55, respectively). Perceived discrimination was positively associated with higher sugar consumption and mediate the association between diet self-efficacy and adolescent's dietary behaviour. Significant mediation effect of perceived discrimination on the association of diet specific self-efficacy and diet oral health behaviour was observed. Oral health behaviours were self-reported which may have influenced the results.

Self-efficacy and oral health outcomes in a regional Australian Aboriginal population

BACKGROUND

Perceived self-efficacy has been associated with psychological well-being, health behaviours and health outcomes. Little is known about the influence of self-efficacy on oral health outcomes for Aboriginal adults in Australia, a population experiencing high levels of oral health conditions. This study examines associations between oral health-related self-efficacy and oral health outcomes in a regional Aboriginal Australian population and investigates whether the associations persist after adjusting for sociodemographic characteristics and other general and oral health-related psychosocial factors.

METHODS

Cross-sectional data were obtained from the baseline questionnaire of the Indigenous Oral Heath Literacy Project, South Australia. Oral health-related self-efficacy was measured using a six item scale, with total sum scores dichotomised into high/low self-efficacy. Oral health outcomes included self-rated oral health and oral health impacts, measured using the Oral Health Impact Profile (OHIP-14). Generalized linear models with a log-Poisson link function were used to estimate Prevalence Ratios (PR) of poor self-rated oral health according to levels of oral health-related self-efficacy. Multivariable linear regressions were used to estimate the association between oral health-related self-efficacy and OHIP-14 scores. Blocks of confounders were subsequently added into the models, with the final model including all factors.

RESULTS

Complete data were available for 252 participants (63%) aged 18 to 82 years (mean age of 37.6 years). Oral health-related self-efficacy was associated with poor self-rated oral health, with a 43% (PR = 1.43 (95% CI 1.09, 1.88)) greater prevalence of poor self-rated oral health among those with low self-efficacy. Oral health-related self-efficacy was associated with OHIP-14 severity scores, with a score over six points higher for those with low self-efficacy (B = 6.27 95% CI 2.71, 9.83). Although addition of perceived stress into the models attenuated the relationship, associations remained in the final models.

CONCLUSION

Lower levels of oral health-related self-efficacy were associated with a higher prevalence of poor self-rated oral health and greater impacts of oral health among Aboriginal adults in regional South Australia. These associations persisted after controlling for sociodemographic and psychosocial confounders, suggesting that increasing self-efficacy may provide an opportunity for improving oral health outcomes for Aboriginal adults.

Oral community health worker-led interventions in households with average levels of psychosocial factors

Introduction

Household-level psychosocial stress levels have been linked to child tooth brushing behaviors. Community health worker (CHW) interventions that target psychosocial factors in high-risk communities have been associated with changes in health behaviors.

Aim

Observe changes in psychosocial factors over time and an association between psychosocial factors and CHW intervention dose amongst urban Chicago families.

Patients and methods

Participants (N = 420 families) were recruited from 10 community clinics and 10 Women, Infants, or Children (WIC) centers in Cook County, Illinois to participate in a clinical trial. Research staff collected participant-reported psychosocial factors (family functioning and caregiver reports of depression, anxiety, support, and social functioning) and characteristics of CHW-led oral health intervention visits (number, content, child engagement) at 0, 6, and 12 months. CHWs recorded field observations after home visits on household environment, social circumstances, stressors, and supports.

Results

Participants across the cohort reported levels of psychosocial factors consistent with average levels for the general population for nearly all measures. Psychosocial factors did not vary over time. Social functioning was the only measure reported at low levels [32.0 (6.9); 32.1 (6.7); 32.7 (6.9); mean = 50 (standard deviation)] at 0, 6, and 12 months. We did not observe a meaningful difference in social functioning scores over time by exposure to CHW-led intervention visits (control arm, 0, 1, 2, 3, and 4 visits). Field observations made by CHWs described a range of psychosocial stress related to poverty, language barriers, and immigration status.

Conclusion

The unexpectedly average and unchanging psychosocial factors over time, in the context of field observations of stress related to poverty, lack of support, immigration status, and language barriers, suggests that our study did not adequately capture the social determinants of health related to oral health behaviors or that measurement biases precluded accurate assessment. Future studies will assess psychosocial factors using a variety of instruments in an attempt to better measure psychosocial factors including social support, depression, anxiety, functioning, trauma and resilience within our urban population. We will also look at neighborhood-level factors of community distress and resilience to better apply the social ecologic model to child oral health behaviors.

Associations between Perceived Self-Efficacy and Oral Health Behaviours in Adolescents

OBJECTIVES

Self-efficacy is a strong health predictor as it affects patients' certainty about their ability to perform recommended behaviours to improve their health. The aim of this study was to examine the associations between perceived self-efficacy and oral health behaviours among adolescents.

METHODS

A convenience sample of adolescents aged 12 to 18 years old were recruited from University of Alberta dental clinic. Demographics, oral health behaviours, self-rated oral health, and task-specific and general self-efficacy were assessed using a questionnaire with three sections. For the comparisons of outcomes across different categories, Student t-test, multivariate regression, and chi-squared tests were used.

RESULTS

Total of 252 adolescents with average (SD) age of 14 (1.7) years participated in the study; 60% were girls; 81% were born in Canada; 56% were White; and 61% had dental coverage. Demographic characteristics had no significant correlation with general self-efficacy. However, correlation coefficients indicated that younger adolescents had higher dietary self-efficacy (negative correlation), girls had higher toothbrushing and dental visit self-efficacy, and those with dental coverage had higher dental visit self-efficacy. A significant association was found between toothbrushing, dietary habits, and dental visits self-efficacy (subscales of task-specific self-efficacy) and their respective outcomes (frequency of toothbrushing, sugar-intake, and regular dentist visits). General self-efficacy was significantly associated with frequency of toothbrushing and participant's self-rated oral health.

CONCLUSION

Higher task-specific and general self-efficacy correlated with better oral health behaviours among adolescents. Therefore, behavioural interventions should be designed to enhance self-efficacy among adolescents in order to improve their oral health outcomes.

Scale of self-efficacy in oral hygiene (OHSE): analysis of psychometric properties in Spain

AIM

Oral self-efficacy has been shown to be an important variable in predicting successful treatment, preventing health risks and encouraging health-promoting behaviour. In the context of oral health, it is of paramount importance to facilitate the use of the Oral Hygiene Self-Efficacy Scale (OHSE) in clinical practice. The aim of this study was to analyze the psychometric properties of the OHSE scale in a sample of Spanish adults and offer standards for interpreting the scale.

METHOD

A sample of 360 people aged from 18 to 75 years was assessed using the OHSE scale. The scale was culturally adapted and translated, reliability tests, construct validity, comparison of means by sex and age group were carried out, and scales for evaluating the responses were prepared.

RESULTS

After eliminating six items, the reliability and validity analyses showed adequate psychometric properties. There were no differences between sex or age group.

CONCLUSION

The OHSE scale for a Spanish adult population has sufficient empirical support to be considered a valid and useful instrument with solid psychometric properties and it offers an opportunity for oral health education intervention programs aimed at the adult population.

Effectiveness of web application as educational media in increasing the caries risk knowledge and decreasing the caries risk score among dental students in Indonesia

Background

This study evaluating the effect of web application media in increasing the caries risk knowledge and decreasing the caries risk scores among dental students.

Methods

A quasi-experimental design along with a purposive sampling technique was used in this study. A total of 361 undergraduate pre-clinical dental students from 15 universities in Indonesia were divided into two groups: intervention (n = 282) and control (n = 79). The students in the intervention group received a web application media with educational materials to independently check their caries risk, whereas those in the control group received the application without any educational materials. The students were instructed to use the web application at least once a week for 21 days and complete the pretest and posttest questionnaires and web application evaluation questionnaires. In addition, they were required to independently examine their initial and final caries risk.

Results

A significant increase in the level of knowledge was observed in the intervention group, but not in the control group, after the use of the web application. Each group showed a decrease in the caries risk score, but the difference was not statistically significant before and after the use of a web application in both groups.

Conclusion

These findings indicate that health promotion and education about caries risk through web application media can improve the knowledge and reduce the caries risk in dental dentistry students.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01995-1.

Oral Hygiene Practice among 18-year-old Norwegian Adolescents Using Health Belief Model: A Cross-Sectional Study

Objectives  The aim was to compare oral hygiene practice (brushing/flossing) among 18 years old from two regions, Hordaland County, Norway, and possible perceptional correlates using the Health Belief Model.

Materials and Methods  The participants from six municipalities from the south district with high prevalence of dental caries to six municipalities from the rest of Hordaland county, with low prevalence of dental caries (control), using a web-based questionnaire. Statistical analyses: the Mann–Whitney U test was used and the t -test for independent samples. Bivariate and logistic regression analyses to examine associations.

Results  A total of 416 people participated. The south district’s participants had lesser percentage brushing twice a day and flossing at least once a day, they significantly visited lesser the dental service, perceived more susceptibility to dental caries, and lower benefits of brushing/flossing compared with the controls. Girls (odds ratio [OR]: 0.34) who perceived higher severity of dental caries (OR: 1.86), higher self-identity (OR: 2.14), and lesser barriers to brushing (OR: 0.14) had higher odds to brushing twice a day compared with their counterparts. Girls (OR: 0.34) who perceived higher severity of dental caries (OR: 2.34), higher benefits (OR = 2.8), and lesser barriers to flossing (OR = 0.23) had higher odds to flossing at least once a day compared with their counterparts.

Conclusion  South district’s participants significantly had some of risk factors to the recommended brushing/flossing practice compared with the control and these might help in explaining the difference in oral hygiene practice.

The efficacy of peer-led oral health programs based on Social Cognitive Theory and Health Belief Model among Hong Kong adolescents: a cluster-randomized controlled trial

Oral diseases are preventable through the building of good oral health behaviors. Theory-based behavior change was key to the efficacy of oral health promotion since conventional promotion strategies achieved only short-lived and limited improvements. The objective of the study was to investigate the efficacy of a peer-led oral health intervention based on the health belief model (HBM) and the social cognitive theory (SCT) on oral self-care behaviors among Hong Kong adolescents. One thousand one hundred and eighty-four adolescents in 12 schools participated and were randomly assigned to either intervention or control group, utilizing a cluster-randomized controlled trial design. Brushing/flossing frequency, HBM/SCT constructs, oral health knowledge, and dental anxiety were measured at baseline and 6-month follow-up. Changes in behaviors were assessed using mixed-effects model and the mediators of behavioral change were identified with parallel multiple mediation analysis. At 6 months, the intervention group showed a significant increase in the frequency of brushing and flossing compared with the control group. Self-efficacy was identified as mediator between treatment condition and behavioral changes of brushing and flossing. Combining theories of HBM and SCT is a promising avenue for efficacy in oral health behaviors. The effects were mediated through cognitive variables, which provided guidance for both theory and health intervention development.

Factors Associated with Health Literacy, Self-Efficacy, Social Support, and Oral Health Care Behaviors Among Elderly in Northern Border Community Thailand

Background

Oral health problems among elderly people are an important public health issues worldwide. Oral healthcare is essential to the health and well-being of elders and is one of the key indicators determining their quality of life. This research aimed to study oral health literacy, self-efficacy, social support, and demographic characteristic factors associated with the oral health care behaviors of elderly people living in the rural areas of northern Thailand.

Methods

This research was a cross-sectional study that recruited 406 elderly participants using convenience and snowball samplings. Participants’ names were obtained from the registration list of the Java Health Center Information System (JHCIS) program, where they received a health service between 2018 and 2020. Data were obtained through face-to-face interviews with participants, while they were waiting to receive a health service or through a phone interview. Linear regression was analyzed to determine the factors associated with oral healthcare behaviors.

Results

The majority of participants (85%) had inadequate functional health literacy, 52% had moderate self-efficacy toward oral health behaviors, 91.9% had moderate social support, and 53% admitted to moderate oral health behaviors. The results from the model show that self-efficacy, social support, and oral health literacy are positively associated with oral health care behaviors among the elderly (p-value < 0.05). The multiple regression model can account for 47.2% of the variance in oral health care behaviors.

Conclusion

Improving oral health care behaviors among elderly people should be considered by health care providers and those who provide social support. Self-esteem, communication skills among service providers and service receivers, and self-management of oral healthcare should receive special attention. Moreover, social support and relevant agencies can help promote oral healthcare by collaborating with other healthcare providers for better oral health outcomes among elderly people.

Family-Centered Social Cognitive Factors Preventing Primary Tooth Caries in Children Based on Intervention Mapping Approach

Background

Given the increasing prevalence of primary tooth caries in Iran and the importance of providing evidence- and theory-based family-centered prevention programs, the present study is aimed at determining the family-centered social cognitive factors preventing deciduous tooth caries among children using the intervention mapping protocol.

Methods

This cross-sectional study was performed on 240 Iranian mothers in Ilam who were randomly selected to participate in the study. The data were collected using a self-designed questionnaire including items on demographic information and social cognitive constructs (knowledge, attitude, perceived severity, perceived benefits, perceived barriers, practice guidance, perceived self-efficacy, behavior intention, subjective norms, and social norms). The questionnaire was completed by mothers, and the data were analyzed by performing one-way analysis of variance and linear regression.

Results

The results obtained from linear regression analysis showed that perceived self-efficacy (B = 0.295, p < 0.001), perceived barriers (B = 0.084, p < 0.028), practice guidance (B = 0.774, p < 0.001), and social norms (B = 0.137, p < 0.020) accounted for 71% of the behavioral intention variance and were the most important predictors for preventing primary tooth caries among children.

Conclusion

The findings suggest that perceived self-efficacy, perceived barriers, practice guidance, and social norms are essential for developing family-centered programs to prevent primary tooth caries in children.

Evaluating Cognitive/Emotional and Behavioral Mediators of Oral Health Outcomes in Vulnerable Older Adults

Inconsistent outcomes of oral hygiene interventions require testable theories combining cognitive and behavioral domains to guide intervention and improve results. This article evaluates the integrated model as a cognitive-behavioral approach to improve oral health clinical outcomes in ethnically diverse low-income older adults. Baseline data from a clinical trial utilizing the integrative model (IM) model evaluated predictors of gingival index (GI) and plaque score (PS). Individual logistic regression was performed for all predictors in relation to GI and PS. Multiple logistic regression was performed with significant predictors of GI and PS only. Greater locus of control and more brushing predicted lower GI; greater locus of control predicted lower PS. Both cognitive and behavioral domains impact GI, requiring more prolonged effort for improvement while locus of control, a cognitive variable, predicts PS, immediately improved by daily brushing/flossing. A streamlined IM including locus of control and tooth brushing should improve oral hygiene of low-income older adults.

Modelling health belief predictors of oral health and dental anxiety among adolescents based on the Health Belief Model: a cross-sectional study

Background

A vicious cycle exists between dental anxiety, oral health behaviors and oral health status. Based on previous research, psychological factors of the Health Belief Model (HBM) are associated with oral health behaviors and oral health, and are likely involved in this cycle. However, little is known about the relationship between HBM factors and dental anxiety of adolescents. The purpose of this cross-sectional study was to investigate the relationship between health belief factors, oral health and dental anxiety based on the constructs of the HBM.

Methods

1207 Grade 2 students from 12 secondary schools in Hong Kong were randomly selected and measured for the decayed, missing and filled permanent teeth (DMFT) index. Data for oral health behaviors, HBM constructs and dental anxiety were collected using questionnaires. The hierarchical entry of explanatory variables into logistic regression models estimating prevalence odds ratios (POR) were analyzed and 95% confidence intervals (95% CI) for DMFT and dental anxiety were generated. Path analysis was used to evaluate the appropriateness of the HBM as predictors for oral health behaviors, DMFT and dental anxiety.

Results

Based on the full model analysis, individuals with higher perceived susceptibility of oral diseases (POR: 1.33, 95% CI: 1.14–1.56) or girls or whose mother received higher education level were likelier to have a DMFT≥1, while those with higher perceived severity (POR: 1.31, 95%CI: 1.09–1.57), flossing weekly, DMFT≥1 or higher general anxiety level statistically increases the possibility of dental anxiety. The results from path analysis indicated that stronger perceived susceptibility, greater severity of oral diseases, less performing of oral health behaviors and a higher score of DMFT were directly related to increased dental anxiety level. Other HBM variables, such as perceived susceptibility, self-efficacy beliefs, cues to action and perceived barriers, might influence dental anxiety through oral health behaviors and caries status.

Conclusions

Clarifying the propositional structures of the HBM may help the future design of theory-based interventions in reducing dental anxiety and preventing dental caries.

Supplementary Information

Supplementary information accompanies this paper at 10.1186/s12889-020-09784-1.

A randomised controlled trial of a smartphone application for improving oral hygiene

Aim The study aimed to test the effectiveness and acceptability of a smartphone application used in conjunction with a movement sensor toothbrushing attachment for promoting plaque control. Method One hundred and eight dental practice patients were recruited to the study from two general dental practices. Participants were randomised to test and control groups, and both groups offered oral hygiene instruction according to a single protocol. Test participants were given the smartphone device and toothbrush attachment. Control patients were not. After two and four weeks, full mouth plaque scores of the mouths of both test and control participants were measured. A comprehensive questionnaire administered to the test group assessed participants' views about the acceptability of the smartphone device and application. Results Full mouth plaque scores declined from 40.1 to 11.7, a reduction of 70% in the test group compared to a reduction from 29.1 to 20.5 (30%) in the control group. The device was found to be very well accepted. Participants were conscious of improving their brushing and improving their knowledge of how to brush well. They also reported enjoyment and fun being derived from use of the device and found it simple to use. Conclusion Providing immediate day-to-day feedback to dental patients about their brushing results in dramatic improvements in oral hygiene and highly significant reductions in plaque levels, in at least the short-term; beyond that seen in previous toothbrushing interventions with adult patients.

Relational Model between Parental Dental Belief and Formation of Dental Fear among Preschool Children in Indonesia

Objective  Parents’ behavior and belief can strongly impact preschool children. Parents play an important role in the formation of dental fear. The aim of the research is to analyze parental dental belief model as a source of dental fear among preschool children.

Materials and Methods  The research was undertaken at 15 kindergartens in Bandung City, Indonesia, which were chosen by means of multistage cluster random sampling. The participants of the research were parents and children aged 3 to 6. The research involved analysis of quantitative data to assess the relational model between parental dental belief and the formation of dental fear among children. While parental dental belief was measured using the Dental Belief Scale, children’s dental fear was measured using the Indonesian transadaptation of the Children’s Fear Survey Schedule-Dental Subscale based on parents’ report. The results were analyzed statistically by using structural equation modeling which is a combination of regression and factor analysis.

Results  The results indicate that the direct effect structural model of parental dental belief significantly fit the formation of dental fear among children in Bandung ( t -value = 2.41).

Conclusion  The research concludes that parents’ perception and behavior—the latter contributing more—correlate with the formation of dental fear among preschool children.

Psychosocial dental impact in adult orthodontic patients: what about health competence?

Background

Several studies have assessed the psychological benefits of orthodontic treatment; however, the impact of competence on psychological benefits remains unknown.

Aims: To analyze the change of the perception of psychosocial dental impact in a sample of adults undergoing orthodontic treatment (mild/moderate dental malocclusions) and to assess the possible moderating effect of health competence level.

Methods

A longitudinal prospective design was used. Three time points were included: baseline (T0), 6 months after starting orthodontic treatment (T1) and once treatment had finished (T2). The pretreatment sample consisted of 78 patients recruited from the Rey Juan Carlos University Dental Clinic, all of whom had moderate malocclusions and were going to undergo orthodontic treatment for approximately 18 months with fixed metal multibrackets. All participants were instructed to complete the Spanish version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and the aesthetic component of the Index of Orthodontic Treatment Need (IOTN-AC) on the three points of the research. Statistical analysis involved the General Linear Model (GLM) repeated-measures ANOVA to test if the outcome measures of psychosocial dental impact significantly changed over time during orthodontic treatment (baseline, at 6-month evaluation and posttreatment). To assess the effect of the previous health competence levels (high/low) in the change from baseline to the 6-month assessment, for each PIDAQ dimension, a 2*2 (time*group) repeated measures ANOVA was performed.

Results

A significant increase was observed in dental self-confidence values (T0-T1 and T0-T2). Similar results were observed for the psychological impact variables and for the IOTN-AC scores, which showed significant decreases between T0 and T1 and between T0 and T2. Finally, significantly decreases were observed between T0 and T2 in aesthetic concern. Interaction effects were found regarding the health competence variable from T0-T1 for the psychological impact, social impact and aesthetic concern and the IOTN-AC index, with significant development results regarding the high competence group.

Conclusions

The first 6 months of orthodontic treatment seemed to be key to the development of psychosocial dental impact perception, during which the role of health competence was of great importance to developing a positive change. It is necessary to follow a biopsychosocial approach towards orthodontic treatment.

Oral health behavior of children and guardians' beliefs about children's dental caries in Vientiane, Lao People's Democratic Republic (Lao PDR)

Dental caries is considered a major health problem among schoolchildren in Lao People’s Democratic Republic (Lao PDR). According to Health Belief Model (HBM)-based research, children’s oral health behavior can be determined by their guardians’ beliefs. This study aimed to describe children’s oral health behavior and its association with childhood dental caries, as well as to assess associations between children’s tooth-brushing behavior and guardians’ beliefs in an urban area of Lao PDR, using HBM. Data were collected from ten primary schools in the Sisattanak district, the Vientiane capital, between 2013 and 2014. Ten dentists with the help of dental hygienists and schoolteachers conducted dental health check-ups at the schools that diagnosed dental caries based on visual inspection. They also conducted a questionnaire-based survey with the schoolchildren’s guardians to collect data including socio-economic and demographic information, their children’s oral health behavior, and guardians’ beliefs derived from HBM, including perceived susceptibility to and perceived severity of child dental caries, perceived benefit of and perceived barrier to child’s tooth brushing, and self-efficacy in making their children brush their teeth twice daily. A mixed-effects logistic regression model assessed the association between dental caries and children’s oral health behavior and between children’s tooth-brushing behavior and guardians’ beliefs. Data from 1161 of 1304 (89.0%) children registered at the schools were used. The prevalence of dental caries was 82%. Children who brushed their teeth ≥ twice/day were significantly less likely to have dental caries than those brushing once or seldom (OR: 0.64, 95% CI: 0.45 to 0.91). The number of children who brushed twice daily also significantly increased with the increased level of guardians’ self-efficacy (OR: 2.14, 95% CI: 1.91 to 2.41). In conclusion, childhood dental caries was associated with daily tooth brushing. Children’s tooth-brushing behavior was associated with guardians’ self-efficacy in making their children brush twice daily.

Validity of Measures Assessing Oral Health Beliefs of American Indian Parents

OBJECTIVES

This aimed to validate measures of constructs included in an extended Health Belief Model (EHBM) addressing oral health beliefs among American Indian (AI) parents.

METHODS

Questionnaire data were collected as part of a randomized controlled trial (n = 1016) aimed at reducing childhood caries. Participants were AI parents with a preschool-age child enrolled in the Navajo Nation Head Start program. Questionnaire items addressed five EHBM constructs: perceived susceptibility, severity, barriers, benefits, and parental self-efficacy. Subscales representing each construct underwent reliability and validity testing. Internal consistency reliability of each subscale was evaluated using Cronbach's alpha. Convergent validity was assessed using linear regression to evaluate the association of each EHBM subscale with oral health-related measures.

RESULTS

Internal consistency reliability was high for self-efficacy (α = 0.83) and perceived benefits (α = 0.83) compared to remaining EHBM subscales (α < 0.50). Parents with more education (p < 0.0001) and income (p = 0.0002) perceived dental caries as more severe younger parents (ps = 0.02) and those with more education (ps < 0.0001) perceived greater benefits and fewer barriers to following recommended oral health behavior. Female parents (p < 0.0001) and those with more education (p = 0.02) had higher levels of self-efficacy. Parental knowledge was associated with all EHBM measures (ps < 0.0001) excluding perceived susceptibility (p > 0.05). Parents with increased self-efficacy had greater behavioral adherence (p < 0.0001), whereas lower behavioral adherence was associated with parents who reported higher perceived barriers (p < 0.0001). Better pediatric oral health outcomes were associated with higher levels of self-efficacy (p < 0.0001) and lower levels of perceived severity (p = 0.02) and barriers (p = 0.05).

CONCLUSIONS

Results support the value of questionnaire items addressing the EHBM subscales, which functioned in a manner consistent with the EHBM theoretical framework in AI participants.

Oral and dental health care during pregnancy: Evaluating a theory-driven intervention

OBJECTIVE

The present research aimed to investigate the effect of an educational intervention based on the health belief model in pregnant women visiting the healthcare centers in the west of Tehran in 2016.

MATERIALS AND METHODS

The present experimental research was conducted on 135 pregnant women visiting the healthcare centers in the west of Tehran. The subjects were selected through a randomized multistratified sampling and were divided into an experimental and a control group. The collected data were then statistically analyzed in SPSS ver.16. To do so, descriptive statistics and inferential statistics were used including the independent-samples t-test, repeated-measures one-way ANOVA and paired-sample t-test.

RESULTS

The present findings revealed a statistically significant difference between the experimental and control groups in terms of immediate post-test results including perceived sensitivity, severity, benefits, barriers, and self-efficacy along with awareness and performance constructs (p ˂ 0.001). Moreover, two months after the intervention, except for the perceived sensitivity construct (p = 0.088), the two groups diverged significantly in terms of the other constructs (p ˂ 0.001).

CONCLUSIONS

The educational intervention driven by the health belief theory showed to be effective on pregnant women and can help to promote preventive behaviors of tooth decay.

Promoting Self-Regulation in Health Among Vulnerable Brazilian Children: Protocol Study

The Health and Education Ministries of Brazil launched the Health in School Program (Programa Saúde na Escola - PSE) in 2007. The purpose of the PSE is two-fold: articulate the actions of the education and health systems to identify risk factors and prevent them; and promote health education in the public elementary school system. In the health field, the self-regulation (SR) construct can contribute to the understanding of life habits which can affect the improvement of individuals' health. This research aims to present a program that promotes SR in health (SRH). This program (PSRH) includes topics on healthy eating and oral health from the PSE; it is grounded on the social cognitive framework and uses story tools to train 5th grade Brazilian students in SRH. The study consists of two phases. In Phase 1, teachers and health professionals participated in a training program on SRH, and in Phase 2, they will be expected to conduct an intervention in class to promote SRH. The participants were randomly assigned into three groups: the Condition I group followed the PSE program, the Condition II group followed the PSRH (i.e., PSE plus the SRH program), and the control group (CG) did not enroll in either of the health promotion programs. For the baseline of the study, the following measures and instruments were applied: Body Mass Index (BMI), Simplified Oral Hygiene Index (OHI-S), Previous Day Food Questionnaire (PFDQ), and Declarative Knowledge for Health Instrument. Data indicated that the majority are eutrophic children, but preliminary outcomes showed high percentages of children that are overweight, obese and severely obese. Moreover, participants in all groups reported high consumption of ultraprocessed foods (e.g., soft drinks, artificial juices, and candies). Oral health data from the CI and CII groups showed a prevalence of regular oral hygiene, while the CG presented good oral hygiene. The implementation of both PSE and PSRH are expected to help reduce health problems in school, as well as the public expenditures with children's health (e.g., Obesity and oral diseases).

Parental supervision for their children's toothbrushing: Mediating effects of planning, self-efficacy, and action control

OBJECTIVES

With 60-90% of children worldwide reportedly experiencing dental caries, poor oral health in the younger years is a major public health issue. As parents are important to children's oral hygiene practices, we examined the key self-regulatory behaviours of parents for supervising their children's toothbrushing using the health action process approach.

DESIGN AND METHOD

Participants (N = 281, 197 mothers) comprised Australian parents of 2- to 5-year-olds. A longitudinal design was used to investigate the sequential mediation chain for the effect of intention (Time 1) on parental supervision for their youngest child's toothbrushing (Time 3), via self-efficacy and planning (Time 2), and action control (Time 3).

RESULTS

A latent-variable structural equation model, controlling for baseline behaviour and habit, revealed significant indirect effects from intention via self-efficacy and action control and intention via planning and action control, on parental supervision behaviour. The model was a good fit to the data, explaining 74% of the variance in parents' supervising behaviour for their children's toothbrushing.

CONCLUSION

While national recommendations are provided to guide parents in promoting good oral hygiene practices with their children, current results show the importance of going beyond simple knowledge transmission to support parents' intentions to supervise their children's toothbrushing actually materialize. Current findings make a significant contribution to the cumulative empirical evidence regarding self-regulatory components in health behaviour change and can inform intervention development to increase parents' participation in childhood oral hygiene practices, thus helping to curb rising oral health conditions and diseases. Statement of contribution What is already known on this subject? Self-regulatory skills are important to translate intentions into behaviour. Self-efficacy, planning, and action control are key self-regulatory skills for behaviour change. What does this study add? Self-regulatory skills are needed for parents to supervise their children's toothbrushings. Self-efficacy, planning, and action control are important self-regulatory skills in this context. Future interventions should map these self-regulatory predictors onto behaviour change techniques.

Oral health knowledge and psychological determinants of oral health behavior of nursing students

This survey examined the oral health knowledge and psychological determinants of oral health behavior of 1019 undergraduate and postgraduate nursing students. Overall, most of the students perceived their oral health to be average, and their flossing and dental visiting frequencies were inadequate. Moreover, the students' oral health knowledge was suboptimal, regardless of the type of study, and it was not significantly associated with oral health behavior. Binary logistic regression showed that toothbrushing self-efficacy and the type of study were both significantly associated with toothbrushing behavior. Furthermore, flossing self-efficacy and dental visiting self-efficacy were both significantly associated with flossing and dental visiting behaviors, respectively.

Combining self-management cues with incentives to promote interdental cleaning among Indian periodontal disease outpatients

Background

Periodontal disease is a significant public health issue worldwide. Motivational techniques in combination with financial incentives are shown to lead to effective behavior change. The current study sought to examine whether a brief oral health promotion program (self-management cues that were based on self-efficacy and self-regulatory skills) in combination with an incentive (free dental treatment) would make a difference in the adoption of regular dental flossing in a population of Indian periodontal disease outpatients.

Methods

One hundred and twelve participants (n = 55 oral health promotion intervention group; n = 57 control group) were assigned to the intervention (self-management cues + incentive) or control groups, and follow-up assessments were performed three weeks later. Flossing frequency, behavioral intentions, and perceived self-efficacy served as dependent variables. Data were analyzed with mixed models, ANCOVAs, and path analyses.

Results

The intervention yielded effects on flossing frequency (p < 0.01) and flossing intentions (p < 0.01) at follow-up. Women developed stronger intentions than men. Moreover, by path analysis a sequential mediation chain was found that demonstrated an indirect effect of the intervention on flossing via self-efficacy and intentions: the intervention predicted changes in self-efficacy which, in turn, were associated with changes in intentions, predicting flossing frequency at follow up, while controlling for baseline behavior, gender, and age.

Conclusions

Combining incentives with minimal self-management cues has been found effective in improving interdental cleaning intentions and habits in periodontal disease patients, and the facilitating role of dental self-efficacy has been demonstrated.

Self-efficacy, planning and action control in an oral self-care intervention

To evaluate a theory-guided intervention on oral self-care and examine the possible mechanisms among self-regulatory factors, two brief intervention arms were compared, an information-based education treatment and a self-regulation treatment focusing on planning and action control. Young adults (N = 284; aged 18-29 years) were assessed at baseline and 1 month later. The self-regulation intervention improved levels of oral self-care, dental planning and action control. Moreover, a moderated mediation model with planning as the mediator between experimental conditions and dental outcome, and self-efficacy as well as action control as moderators elucidated the mechanism of change. More self-efficacious participants in the self-regulation condition benefitted in terms of more planning, and those who monitored their actions yielded higher levels of oral hygiene. Dental self-efficacy, dental planning and action control are involved in the improvement of oral self-care. Their joint consideration may contribute to a better understanding of health behavior change.

Scaling-stimulated salivary antioxidant changes and oral-health behavior in an evaluation of periodontal treatment outcomes

AIM

Our goal was to investigate associations among scaling-stimulated changes in salivary antioxidants, oral-health-related behaviors and attitudes, and periodontal treatment outcomes.

MATERIALS AND METHODS

Thirty periodontitis patients with at least 6 pockets with pocket depths of >5 mm and more than 16 functional teeth were enrolled in the study. Patients were divided into three groups: an abandoned group (AB group), a nonprogress outcome group (NP group), and an effective treatment group (ET group). Nonstimulated saliva was collected before and after scaling were received to determine superoxide dismutase (SOD) and the total antioxidant capacity (TAOC).

RESULTS

Salivary SOD following scaling significantly increased from 83.09 to 194.30 U/g protein in patients who had irregular dental visit patterns (<1 visit per year). After scaling, the TAOC was significantly higher in patients who had regular dental visits than in patients who had irregular dental visits (3.52 versus 0.70 mmole/g protein, P < 0.01). The scaling-stimulated increase in SOD was related to a higher severity of periodontitis in the NP group, while the scaling-stimulated increase in the TAOC was inversely related to the severity of periodontitis in the AB group.

CONCLUSIONS

These results demonstrate the importance of scaling-stimulated salivary antioxidants as prognostic biomarkers of periodontal treatment.

A brief intervention changing oral self-care, self-efficacy, and self-monitoring

BACKGROUND AND AIM

The roles of self-efficacy and self-monitoring as proximal predictors of dental flossing frequency are studied in the context of an oral health intervention.

MATERIALS AND METHODS

A study among 287 university students, aged 19 to 26 years, compared an intervention group that received a brief self-regulatory treatment, with a passive and an active control group. Dental flossing, self-efficacy, and self-monitoring were assessed at baseline and 3 weeks later.

RESULTS

The intervention led to an increase in dental flossing regardless of experimental condition. However, treatment-specific gains were documented for self-efficacy and self-monitoring. Moreover, changes in the latter two served as mediators in a path model, linking the intervention with subsequent dental flossing and yielding significant indirect effects.

CONCLUSIONS

Self-efficacy and self-monitoring play a mediating role in facilitating dental flossing. Interventions that aim at an improvement in oral self-care should consider using these constructs. Statement of contribution What is already known on this subject? The adoption and maintenance of oral self-care can be facilitated by a number of social-cognitive variables. Interventions that include planning, action control, or self-efficacy components have been shown to improve dental flossing. In one recent study on flossing in adolescent girls, planning intervention effects were mediated by self-efficacy. What does this study add? Self-monitoring is associated with better oral self-care. A 10-min intervention improves self-efficacy and self-monitoring. Self-efficacy and self-monitoring operate as mediators between treatment and flossing.

Brushing behavior among young adolescents: does perceived severity matter

BACKGROUND

Oral health is a basis for general health and well-being and affects physical and psychological aspects of the human life. The aim of this study was to determine the power of the health belief model in general and the role of perceived severity and its components in particular in predicting tooth brushing behavior among young adolescents.

METHODS

This was a cross sectional study of a sample of female students grade four in Rasht (a metropolitan in north Iran) in 2012. A systematic random sampling method was applied to recruit students. They were asked to respond to a designed questionnaire containing items on brushing behavior based on the health belief model. In this study for the first time perceived severity and perceived barriers were divided into two parts, perceived subjective and objective severity and perceived physical and psychological barriers and were treated as independent variables. Logistic regression analysis was performed in order to identify the variables that predict the desirable behavior (brushing twice a day or more).

RESULTS

In all 265 female students were entered into the study. Of these, only 17.4% reported that they were brushing at least twice a day (desirable behavior). The results obtained from the logistic regression analysis indicated that perceived objective severity (OR = 0.37, 95% CI = 0.21- 0.66, P = 0.001) and feeling less perceived psychological barriers (OR = 2.60, 95% CI = 1.50- 4.52, P = 0.001) were the significant predicting factors for brushing twice a day.

CONCLUSION

The findings suggest that perceived objective severity and perceived psychological barriers play important role in adapting a desirable health behavior among young adolescents.

The impact of frailty on oral care behavior of older people: a qualitative study

BACKGROUND

Frailty has been demonstrated to negatively influence dental service-use and oral self-care behavior of older people. The aim of this study was to explore how the type and level of frailty affect the dental service-use and oral self-care behavior of frail older people.

METHODS

We conducted a qualitative study through 51 open interviews with elders of varying frailty in the East-Netherlands, and used a thematic analysis to code transcripts, discussions and reviews of the attributes and meaning of the themes to the point of consensus among the researchers.

RESULTS

Three major themes and five sub-themes emerged from our analyses. The major themes indicate that frail elders: A) favor long-established oral hygiene routines to sustain a sense of self-worth; B) discontinue oral hygiene routines when burdened by severe health complaints, in particular chronic pain, low morale and low energy; and C) experience psychological and social barriers to oral health care when institutionalized. The subthemes associated with the discontinuation of oral care suggest that the elders accept more oral pain or discomfort because they: B1) lack belief in the results of dental visits and tooth cleaning; B2) trivialize oral health and oral care in the general context of their impaired health and old age; and B3) consciously use their sparse energy for priorities other than oral healthcare. Institutionalized elderly often discontinue oral care because of C1) disorientation and C2) inconveniencing social supports.

CONCLUSION

The level and type of frailty influences people's perspectives on oral health and related behaviors. Frail elders associate oral hygiene with self-worth, but readily abandon visits to a dentist unless they feel that a dentist can relieve specific problems. When interpreted according to the Motivational Theory of Life Span Development, discontinuation of oral care by frail elderly could be viewed as a manifestation of adaptive development. Simple measures aimed at recognizing indicators for poor oral care behavior, and providing appropriate information and support, are discussed.

Effect of a school-based oral health-education program on Iranian children: results from a group randomized trial

Parents and school staff play important roles in promoting children's oral health. Our study goals were to investigate whether an intervention targeting parents and school staff can improve the oral-health behavior and oral-health status of schoolchildren. Three-hundred and ninety-two schoolchildren in six schools in Tehran participated in a group randomized trial from September 2010 to March 2011. Schools were randomly allocated into three groups: comprehensive, student, and control. Intervention in the comprehensive group consisted of strategies to encourage children, their parents, and school staff to increase the frequency of toothbrushing and flossing. In the student group, the intervention targeted only children. The control group received no intervention. The primary outcome was change in oral-health behaviors (brushing and flossing), while the secondary outcomes were changes in oral hygiene and Community Periodontal indices and in Health Belief Model components. Multilevel modeling was employed for data analyses. Students who were in the comprehensive intervention group brushed and flossed significantly more frequently compared with those in the student intervention group. Although students' gingival health improved significantly in the comprehensive intervention group, such significant improvement was not seen in the student group. In conclusion, promising results are seen when the oral-health education targets both school and home settings.