Development of a Self-Efficacy Scale for Self-care (SESS) among Periodontal Disease Patients-Reliability and Validity Examination-

A cross-sectional study based on the Comprehensive Model of Information seeking: which factors influence health information-seeking behavior in patients with periodontitis

BACKGROUND

To investigate the current status of health information-seeking behavior (HISB) of periodontitis patients, and to identity its main influencing factors using the Comprehensive Model of Information Seeking (CMIS).

METHODS

In total, 274 periodontitis patients were recruited from a specialized dental hospital in Hangzhou by purposive sampling method for a cross-sectional study. Demographics, direct experience, salience, beliefs, characteristics and utility were 6 variables of CMIS. Data were collected from the patients by using the general information questionnaire, the Health Information Seeking Behavior Scale, the Self-Efficacy Scale for Self-care (SESS) for measuring belief, the Short Form of Health Literacy Dental Scale (HeLD⁃14) for measuring direct experience, and the Brief Illness Perception Questionnaire (BIPQ) for measuring salience. Univariate analysis and regression analysis were utilized to determine the factors influencing the HISB.

RESULTS

The HISB score of periodontitis patients in this study was 3.68 ± 0.40. The low level of HISB was negatively associated with multiple factors, including age of 40 ~ 59 (odds ratio [OR] 0.041, 95% confidence interval [CI] 0.006-0.299), age of 18 ~ 39 (OR 0.053, 95%CI 0.008-0.364), low level of understandability of information (characteristic) [OR 0.317, 95%CI 0.119-0.840] and low level of satisfaction of information (utility) [OR 0.027, 95%CI 0.008-0.089]. However, low level of HISB was positively correlated with medium self-efficacy level [OR 3.112, 95% CI 1.463-6.747] and low self-efficacy level [OR 8.061, 95% CI 1.981-32.807].

CONCLUSIONS

According to the CMIS model, we identified several factors influencing health-seeking behaviors (HISB). Lower levels of HISB are closely associated with older age and lower level of understandability and satisfaction of information. Conversely, higher self-efficacy may encourage patients to seek health information more actively. Therefore, it is essential to focus on elderly patients and assess their information expectations and needs in a timely manner, while also working to enhance their self-efficacy to promote more effective access to health information.

Translation and validation into Spanish of the oral health self-efficacy scale in Chilean older adults

BACKGROUND

Population ageing poses a challenge to improving the well-being of older adults, particularly in terms of oral health. Promoting self-efficacy in oral health behaviours is crucial for maintaining this population's health and quality of life. The Oral Health Self-Efficacy Scale (OHSES) has been widely used to assess dental self-efficacy and is considered comprehensive and reliable. However, there is a need to validate OHSES for Spanish-speaking older adults. This study aimed to assess the reliability and validity of the translated questionnaire for use in the older Chilean population.

METHODS

A sample of 188 older adults, aged 60 years and above residing independently in the community, were recruited by accessing databases from the National Senior Citizen Service and various community organisations within the region of La Araucanía. The participants underwent comprehensive oral examinations and oral health interviews, focusing on variables such as OHSES, Oral health-related quality of life (OHIP-14Sp), assessment of remaining teeth, knowledge and attitudes toward oral health, and sociodemographic characteristics. The validity of the translated questionnaire was assessed through translation and cross-cultural adaptation, cognitive debriefing, and face and content validation. The psychometric properties of the questionnaire were evaluated through measures of internal consistency (Cronbach's alpha), content validity (Content validity index), construct validity (factor analysis and Pearson correlation analysis), and test-retest reliability (intraclass correlation).

RESULTS

The Spanish version of OHSES demonstrated adequate face and content validity. The confirmatory factor analysis confirmed a two-factor scale with 7 items for a better fit. The scale demonstrated high internal consistency (Cronbach's alpha = 0.821) and acceptable test-retest reliability (ICC = 0.411). Correlations were found between the OHSES score, the number of remaining teeth, knowledge and attitudes towards oral health, and the OHIP-14Sp (p < 0.01).

CONCLUSIONS

This study confirms the validity of the Spanish version of the Oral Health Self-Efficacy Scale for older adults in Chile. The scale is expected to be helpful in assessing self-efficacy in dental interventions and collecting data for international comparisons. This research opens new dimensions in patient-reported assessment of oral health.

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.

The role of knowledge and self-efficacy on dental consultation behavior of patients with type 2 diabetes

AIM

This study aimed to examine the association of knowledge and self-efficacy as variables for behavior related to dental consultations among patients with type 2 diabetes, depending on the diagnosis of periodontal disease at a general hospital in Japan.

METHODS

A cross-sectional survey was conducted with 198 patients with type 2 diabetes (mean age: 66.1 ± 10.1 years, men: 56.6%, mean glycated hemoglobin: 7.3 ± 1.0%). The self-efficacy of patients with periodontal disease was assessed using the Self-Efficacy Scale for Self-Care. Knowledge was measured using five dichotomous items based on reference to clinical guidelines. Dental consultation behavior was assessed from regular dental checkup behavior.

RESULTS

In total, 31.8% of participants attended their regular dental checkup in the last year. Logistic regression analysis revealed that dental consultation behavior was positively associated with self-efficacy among patients diagnosed with periodontal disease (odds ratio [OR] = 1.26, 95% confidence interval [CI]: 1.10-1.45), and positively associated with the knowledge among patients not diagnosed with periodontal disease (OR = 1.54, 95%, CI: 1.09 - 2.16).

CONCLUSION

Patients without periodontal disease need to learn about accurate knowledge regarding periodontal disease as a complication of diabetes and its prevention via dental checkups. Supportive consultation to improve self-efficacy with respect to dental consultations should be offered to patients with periodontal disease. Medical professionals will be able to support each patient with type 2 diabetes by changing the educational approach for promoting regular dental checkups at the time of diabetes consultations.

The relationship between oral hygiene-related self-efficacy, general self-efficacy and daily plaque control

OBJECTIVES

To assess validity and reliability of Turkish oral hygiene-related self-efficacy (OHSE) scale, and the scores of general self-efficacy (GSE) and OHSE in the patients with gingivitis and chronic periodontitis (CP). Additionally, the effect of motivation and oral hygiene instructions on the OHSE scores and plaque index (PI) was also aimed.

MATERIALS AND METHODS

GSE and OHSE scores were obtained from 210 patients with gingivitis and CP (Group A). After determination of "cut-off" values on OHSE scores, patients with OHSE scores <30 (OHSE-low) and ≥50 (OHSE-high) were included in Group B (gingivitis, N = 25; CP, N = 27). PI values were determined, and motivation and oral hygiene instructions were performed in Group B at baseline. PI measurements and OHSE questionnaire were repeated at 1 and 3 months.

RESULTS

The intraclass reliability coefficient and Cronbach's alpha for Turkish translation of OHSE scale were 0.920 and 0.911. OHSE scores significantly correlated with GSE scores and smokers had lower OHSE scores than those of non-smokers in patients (n = 210). In both gingivitis and CP groups, OHSE scores increased and PI values decreased at 3 months. PI values were lower in gingivitis and CP groups with OHSE-high scores compared to patients with OHSE-low scores at 3 months.

CONCLUSIONS

Within the limitations of this study, it seems that Turkish version of OHSE questionnaire is reliable and valid. Patients with OHSE-low scores in both gingivitis and CP groups were less successful in performing daily plaque control, compared to patients with OHSE-high scores.

Prediction of loss to follow-up in long-term supportive periodontal therapy in patients with chronic periodontitis

AIM

This study examined the predictors of loss to follow-up in long-term supportive periodontal therapy in patients with chronic periodontitis.

METHODS

A total of 280 patients with moderate to severe chronic periodontitis in a tertiary care hospital in China were investigated and followed over the course of study. Questionnaires on clinical and demographic characteristics, self-efficacy for oral self-care and dental fear at baseline were completed. Participants were followed to determine whether they could adhere to long-term supportive periodontal therapy. Binary logistic regression analysis was used to examine the association between clinical and demographic characteristics, self-efficacy for oral self-care, dental fear and loss to follow-up in long-term supportive periodontal therapy.

RESULTS

The loss to follow-up in long-term supportive periodontal therapy was significantly associated with age [adjusted OR = 1.042, 95% confidence interval (CI): 1.012-1.074, p = 0.006], severe periodontitis [adjusted OR = 4.892, 95%CI: 2.280-10.499, p<0.001], periodontal surgery [adjusted OR = 11.334, 95% CI: 2.235-57.472, p = 0.003], and middle and low-scoring of self-efficacy scale for self-care groups. The adjusted ORs of loss to follow-up for the middle- (54-59) and low-scoring groups (15-53) were 71.899 (95%CI: 23.926-216.062, p<0.001) and 4.800 (95% CI: 2.263-10.182, p<0.001), respectively, compared with the high-scoring SESS group (60-75).

CONCLUSION

Age, severity of periodontitis, periodontal surgery and the level of self-efficacy for self-care may be effective predictors of loss to follow-up in long-term supportive periodontal therapy in patients with chronic periodontitis.

A periodontal disease care program for patients with type 2 diabetes: A randomized controlled trial

Background

Diabetes and periodontitis are interrelated, and patient education and guidance are important. Therefore, we conducted a periodontitis care program for patients with type 2 diabetes to provide education about diabetes and periodontitis and to promote self‐care skills, and we evaluated the effectiveness of this program.

Methods

This was a randomized controlled trial. Thirty‐eight and 39 adult patients diagnosed with type 2 diabetes were allocated to the intervention and control groups, respectively. The program comprised content that promoted optimal behavior for the improvement of diabetes and periodontitis. Periodontitis status, diabetes status, tumor necrosis factor‐α levels, self‐efficacy in relation to periodontitis, and teeth‐brushing behaviors were evaluated before and after the intervention program.

Results

After the intervention program, the intervention group demonstrated significant improvements in bleeding on probing, which was used to evaluate periodontitis status (F=7.919; P<.01), and in clinic visit (F=11.765; P<.01), brushing teeth (F=21.606; P<.01), and meal (F=10.884; P<.01) scores on the Self‐Efficacy Scale for Self‐care among Periodontal Disease Patients; patients in the intervention group also exhibited improvements in dental health‐related behaviors (F=7.141; P<.01).

Conclusions

These results suggest that the intervention program was effective at improving periodontitis, self‐efficacy in relation to periodontitis, and dental health‐related behaviors in patients with type 2 diabetes.

Development of the outcome expectancy scale for self-care among periodontal disease patients

RATIONALE

The theory of self-efficacy states that specific efficacy expectations affect behaviour. Two types of efficacy expectations are described within the theory. Self-efficacy expectations are the beliefs in the capacity to perform a specific behaviour. Outcome expectations are the beliefs that carrying out a specific behaviour will lead to a desired outcome.

OBJECTIVE

To develop and examine the reliability and validity of an outcome expectancy scale for self-care (OESS) among periodontal disease patients.

METHODS

A 34-item scale was tested on 101 patients at a dental clinic. Accuracy was improved by item analysis, and internal consistency and test-retest stability were investigated. Concurrent validity was tested by examining associations of the OESS score with the self-efficacy scale for self-care (SESS) score and plaque index score. Construct validity was examined by comparing OESS scores between periodontal patients at initial visit (group 1) and those continuing maintenance care (group 2).

RESULTS

Item analysis identified 13 items for the OESS. Factor analysis extracted three factors: social-, oral- and self-evaluative outcome expectancy. Cronbach's alpha coefficient for the OESS was 0.90. A significant association was observed between test and retest scores, and between the OESS and SESS and plaque index scores. Further, group 2 had a significantly higher mean OESS score than group 1.

CONCLUSION

We developed a 13-item OESS with high reliability and validity which may be used to assess outcome expectancy for self-care. A patient's psychological condition with regard to behaviour and affective status can be accurately evaluated using the OESS with SESS.

Systematic cognitive behavioral approach for oral hygiene instruction: a short-term study

OBJECTIVE

Determine whether a six-step behavioral cognitive method is more effective than traditional oral hygiene instruction.

METHODS

Thirty-eight patients with chronic periodontitis were randomly assigned to two groups. The control group was given traditional oral hygiene instruction for 20 min. The intervention group received counseling by Farquhar's six-step method for 10 min after traditional oral hygiene instruction. In both groups, oral hygiene instruction was given once a week, and performed three times in total for 3 weeks. Clinical characteristics, deposition of dental plaque, frequency and duration of brushing, frequency of interdental cleaning and scores based on scale of "self-efficacy for brushing of the teeth" were compared in both groups.

RESULTS

There were no differences between the two groups in clinical, demographic, behavioral and self-efficacy characteristics at the baseline examination. However after the third visit, the intervention group had a significantly higher self-efficacy, lower plaque index, longer brushing duration and higher frequency of inter-dental cleaning than those of the control group. Multiple regression analysis showed significant association of toothbrushing duration with self-efficacy for brushing of the teeth (p<0.001).

CONCLUSION

The six-step method might be more effective for enhancing self-efficacy and behavioral change of oral hygiene than traditional oral hygiene instruction alone.

PRACTICE IMPLICATIONS

Dentists and dental hygienists can use the six-step method for effective oral hygiene instruction.