Modeling the theory of planned behavior for intention to improve oral health behaviors: the impact of attitudes, knowledge, and current behavior

Survey on the attitudes and perceptions of Swiss dental practitioners and dental students toward treating patients with disabilities and sensory impairments

AIMS

This study evaluated the attitudes and perceptions of private dental practitioners (PPs) and students on treating patients with disabilities and sensory impairments.

METHODS AND RESULTS

A multifaceted questionnaire was used to assess the participants' attitudes on providing care to persons with disabilities and sensory impairments [visual (VI) and hearing (HI)]. The survey evaluated different aspects of the participants' attitudes that included integrity, altruism, perceived barriers, and theory of planned behavior (TPB). One hundred twenty participants [students: n = 73, practitioners (PP): n = 47), with a mean-age of 27.7 ± 5.3 years, completed the survey (response rate: 100%). Fourth-year students scored better than the PP in integrity (p = .019). For altruism, the students scored better than PPs (vs. fourth-year: p = .009, vs. fifth-year: p = .031). There were no differences between the participant groups for the overall assessments of the TPB (p = .213), VI (p = .863), and HI (p = .261).

CONCLUSION

Dental practitioners and students revealed a positive attitude, with few barriers, towards treating individuals with disabilities/sensory impairments and considered the training in the field of special care dentistry as a necessary part of the dental education. Furthermore, a demand for an increase in the hands-on practical experience in treating individuals with disabilities/sensory impairments during the undergraduate study curriculum was identified.

Autonomy and factors affecting dental health care seeking behaviour in women: An application of theory of planned behaviour

Background

Understanding oral health care seeking behaviour and it's determinants is essential in improving oral health. The health care utilization in women was found to be influenced by their autonomy. A socio-cognitive model that can explain variance in dental attendance behaviour in women including autonomy has yet to be validated. The Theory of Planned Behaviour (TPB), which takes into account women's autonomy, attitude, subjective norms, and perceived behavioural control, is empirically tested in this study with regard to self-reported dental visiting intentions and dental health seeking behaviour.

Method

Cross sectional study using self-administered questionnaires was conducted to assess socio-demographic factors, autonomy, dental visiting behaviors as well as constructs of TPB model in 400 women aged 18 years or older in Bangalore city selected via stratified cluster sampling method. Two-stage structural equation modelling (SEM) was used to test the hypothesized TPB model.

Results

The proposed correlated 5-factor measurement model was confirmed through confirmatory factor analysis (CFA). In SEM subjective norm (β = 0.17), perceived behavioural control (β = -0.27) and autonomy (β = 0.49) significantly predicted dental visiting intentions in women. Intention (β = 0.56) and autonomy (β = 0.25) explained dental visiting behaviour. It also revealed indirect effect of autonomy and perceived behaviour control on dental visiting behaviour through intentions. The hypothesized model predicted 27.6 % and 23.8% of the variance in intention and dental visiting behaviour respectively.

Conclusion

The hypothesized model was successful in predicting intention and dental visiting behaviour in women. This could explain the multidimensional nature of dental care utilization in women which in turn might be helpful in improving access to dental care among them in future.

Effects of social support on oral health behavior: Serial multiple-mediator model

OBJECTIVE

This study investigates the serial multiple mediation of job stress and perceived behavioral control (PBC) in the relationship between social support and oral health behavior (OHB).

MATERIALS AND METHODS

This cross-sectional study was conducted in Minhang District, Shanghai, China, between July and November 2021. 559 Employees from 10 community health centers were recruited. A five-part survey was used to collect data on demographic characteristics, social support, job stress, PBC and OHB. Descriptive statistics, independent-sample t-test, Pearson's correlation analysis, ordinary least-squares regression and the bootstrap method were used to analyze data.

RESULTS

Social support was found to impact OHB through three significant mediation pathways: the pathway through job stress (point estimate = 0.033; 95%BC CI [0.004, 0.089]), the pathway through PBC (point estimate = 0.283; 95%BC CI [0.174, 0.416]), and the serial multiple mediating pathway through first job stress and then PBC (point estimate = 0.006; 95%BC CI [0.001, 0.019]).

CONCLUSION

This study indicates that job stress and PBC play a serial multiple-mediator role in the relationship between social support and OHB. To ensure the effectiveness of social support intervention on OHB, workplace managers and employees should strengthen the motivators that could promote the reduction of job stress and the improvement of PBC.

The effect of nutritional education based on the health action process approach (HAPA) on the pregnancy outcomes among malnourished pregnant mothers

OBJECTIVE

To examine the effectiveness of nutritional education based on the health action process approach (HAPA) on pregnancy outcomes among malnourished pregnant mothers utilizing nutritional support.

METHODS

In a randomized controlled trial, 234 malnourished pregnant women under nutritional support from the fourth month of pregnancy participated. Participants were randomly allocated in study groups by the balance block randomization method. Data were collected using a socio-demographic and pregnancy outcomes checklist as well as self-devised questionnaire assessing the constructs of the HAPA model before and three months after the educational intervention. The framework of the educational intervention was based on the constructs of the HAPA and included three one-hour training sessions through lectures, group discussions, 'question and answer' sessions, and the use of educational tools. Data were analyzed using analysis of covariance (ANCOVA) and SPSS software.

RESULTS

Pregnancy outcomes including optimal weight gain during pregnancy (p = 0.47), neonate's birth weight (p = 0.58), gestational age at delivery (p = 0.83), type of delivery (p = 0.48) gestational anemia (p = 0.22), diabetes (p = 0.59) and hypertension (p = 0.29) were not significantly different in the intervention and control groups. The results showed that the educational intervention produced a significant increase in the total score (24 points) in the intervention group. Improvement of scores in the intervention group compared to the control was observed in all of the model constructs except outcome expectation (0.68 decrease). The educational intervention in the present study had a large measure of effect in total (SMD: 2.69, partial eta2: 0.664).

CONCLUSION

A nutritional education intervention based on the HAPA model for malnourished pregnant women increased behavioral intention and planning for action to have better nutritional behavior. However, the intervention did not change the pregnancy outcomes significantly.

PRACTICE IMPLICATIONS

Nutritional education based on the HAPA model can be used to improve nutritional behaviors of malnourished pregnant women.

Application of the extended theory of planned behavior to predict dentist intention and behavior in providing caries preventive care for preschool children

BACKGROUND

Various studies show a gap between evidence-based recommendations and the preventive practice of dentists. This study aimed to create and assess an extended Theory of Planned Behavior (TPB) model on dentists' intentions to do caries preventive measures and related barriers experienced by dentists.

METHODS

A total of 362 general dentists from 34 Indonesian provinces were included in this study. A self-administered online questionnaire consisted of three sections: dentist characteristics and practice pattern, TPB questionnaire, and dentist perceived behavior regarding preventive care for pediatric patients. The questionnaire was distributed and the data was analyzed through structural equation modeling.

RESULTS

TPB's extended version is a fit and relevant model, explaining 55.3% of dentists' intentions to undertake preventive procedures and 17.8% of preventive practices. Perceived behavioral control was the most powerful predictor of intention (44.2%) and practice (8.8%), while parental barriers were the most significant barrier to provide preventive care (18.9%).

CONCLUSION

Extending the TPB by taking barriers from multiple stakeholders as a consideration has a higher predictive level for preventive practices. Each barrier should be addressed through oral health programs and policies, and dentists must be taught to overcome these barriers (through formal or continuing education) in order to maximize caries prevention strategies.

Investigating oral health-related quality of life in patients with ischaemic stroke in China

OBJECTIVE

The objective of the study was to explore factors associated with oral health-related quality of life (OHRQoL) in patients with ischaemic stroke in China, guided by the theory of planned behaviour (TPB) and Andersen's oral health outcome model.

BACKGROUND

Recent studies have reported that the prevalence of stroke is increasing and that stroke patients are facing many oral health related problems. This study provided insights into the role of TPB in the OHRQoL among patients with ischaemic stroke.

MATERIALS AND METHODS

Three hundred eight patients with ischaemic stroke from the Department of Neurology of a third-grade class-A hospital in Xuzhou, China, were enrolled in this cross-sectional study between June and September 2020. They completed a questionnaire that included information on socio-demographic characteristics and health behaviours, the Montreal Cognitive Assessment Scale, the Modified Rankin Scale and the Chinese version of the Oral Health Impact Profile-14 scale (OHIP-14). Structural equation modelling (SEM) was used to examine the association among the selected variables based on the TPB and Andersen's oral health outcome model.

RESULTS

Among the participants (mean age 65.6), most (57.5%) were male. Their mean OHIP-14 score was 13.3 ± 7.6. Based on the SEM path diagram, behavioural attitude, subjective norms and perceived behavioural control of oral health were positively associated with intention; intention was associated with OHRQoL. The degree of disability was negatively associated with intention. Cognitive function was positively associated with OHRQoL.

CONCLUSION

The OHRQoL of hospitalised patients with ischaemic stroke in China is fair to poor and affected by their oral health behaviours. Improved oral health behavioural attitude, subjective norms and perceived behavioural control might help them form good intentions and improve their OHRQoL.

Prevention of Disease and the Absent Body: A Phenomenological Approach to Periodontitis

A large part of the contemporary phenomenology of medicine has been devoted to accounts of health and illness, arguing that they contribute to the improvement of health care. Less focus has been paid to the issue of prevention of disease and the associated difficulty of adhering to health-promoting behaviours, which is arguably of equal importance. This article offers a phenomenological account of this disease prevention, focusing on how we-as embodied beings-engage with health-promoting behaviours. It specifically considers how we engage with oral hygiene regimens to prevent periodontitis and why we are not good at it. The article suggests that poor adherence to health-promoting behaviours can be explained with reference to the concept of the absent body, because prevention of disease is generally concerned with pre-symptomatic illness experience. The final section contains a discussion of some strategies for the improvement of disease prevention based on this viewpoint.

Effect of Educational Intervention Based on Theory of Planned Behavior (TPB) on Doing Breast Self-examination in a Sample of Iranian Women

Background

Breast self-examination (BSE) is an important part of health care for all women in every stage of life. This study aimed to investigate the effect of theory of planned behavior (TPB) on doing BSE in a sample of Iranian women.

Methods

A cross-sectional study was carried out to examine the factors affecting the BSE in 400 women. Then, a quasi-experimental study was conducted on 200 subjects (100 in experimental group and 100 in control group). The educational intervention for the experimental group consisted of 8 training sessions. A questionnaire including demographic characteristics, knowledge, and constructs of TPB was used to measure BSE performance before and 6 months after the intervention. Constructs of attitude, subjective norms, and perceived behavioral control predicted the intention to do the BSE.

Results

The mean age of the subjects was 31.65 ± 7.59 years. The studied variables predicted 38.7% of behavioral intention (P < .001, odds ratio = 0.387). Six months after the intervention, the experimental group showed a significant increase in the knowledge, attitude, perceived behavioral control, subjective norms, intention, and BSE performance compared with the control group (P < .001).

Conclusions

This study showed that educational intervention based on the TPB was effective in promoting breast cancer screening behavior such as BSE. Therefore, it is suggested that health educators and health care planners use educational texts based on these constructs of TPB to increase their influence on individuals via screening behavior for breast cancer.

Suicide knowledge and intention to intervene: college students

Objective: The revised Willingness to Intervene against Suicide questionnaire and the Expanded Revised Facts on Suicide Quiz were employed to examine the relationship between college students' knowledge about suicide and intention to intervene. Participants: College students (n = 515) participated, a majority being women and Caucasian. Methods: Participants completed an online survey. Data were analyzed in SPSS. Results: College students have poor knowledge of suicide facts; however, this low level of accurate knowledge was not associated with intention to intervene with a suicidal person. Attitudes, subjective norms, perceived behavioral control, sex, and no previous suicide attempt were all significant predictors of intention to intervene. Conclusions: These results challenge the notion that one must be well-informed in order to intend to take action.

Healthcare graduate students' perceived control and preventive behavior for COVID-19 in Japan and the United States: A cross-sectional study

Background

Both individual and policy level perceived control are known to be positively related to preventive behavior, and both may differ among healthcare graduate students with different cultural backgrounds. This study compared the preventive health behavior and perceived control among domestic and international healthcare graduate students in Japan and the United States during the COVID-19 pandemic, and analyzed factors associated with preventive health behavior and perceived control.

Methods

The study used a self-administered online survey, conducted at two universities in Japan and one university in the United States. The survey included sociodemographic data and scales of preventive health behaviors, perceived control (policy level), and perceived health competence (individual level). Association among variables were analyzed using structural equation modeling.

Results

A total of 610 students (485 domestic and 125 international) in Japan and 231 students (220 domestic and 11 international) in the United States completed the survey. Participants' average age was 31.3 years, and 67.0% were female. Model fit of structural equation modeling was good (χ2 = 9.419, P = 0.151, comparative fit index = 0.995, RMSEA = 0.026). Japanese students had better preventive health behavior than American (β = -0.407, P < 0.001) and international students in both countries (β = -0.112, P < 0.001). However, Japanese students had significantly lower perceived control than American students (β = 0.346, P < 0.001) and international students in both countries (β = 0.188, P < 0.001). Overall higher perceived control (β = 0.175, P < 0.001) and being female (β = 0.141, P < 0.001) were significantly associated with better preventive behavior. Although higher perceived control was related to higher perceived health competence (β = 0.295, P < 0.001), perceived health competence was not associated with preventive behavior (β = 0.025, P = 0.470). Religion was not associated with perceived control or preventive behavior.

Conclusion

Nationality was identified as the main factor associated with both perceived control and preventive behavior. Policy level perceived control was more strongly associated with preventive health behavior than individual level perceived health competence. Further investigations in the contribution of specific cultural dimensions associated with perceived control and preventive behaviors are recommended.

Using the Theory of Planned Behaviour to assess nursing and allied health students' knowledge and intention to care for patients with COVID-19

AIMS AND OBJECTIVES

To assess nursing and allied health students' demographics, knowledge and intentions to care for patients with an infectious disease, COVID-19.

BACKGROUND

COVID-19 has caused a public health crisis and worldwide panic. Little is known about students' knowledge levels and intentions to care for infected patients during pandemics.

DESIGN

A quantitative, cross-sectional study.

METHOD

A cross-sectional study with a convenience sample (N = 480) of nursing and allied health students was analysed using the Mann-Whitney and Spearman's correlation tests.

RESULTS

At least 60% of the participants attained high scores for 16 of the 22 items on the knowledge scale. Knowledge was positively associated with attitude (rs  = .19, p < .01) and perceived behavioural control (rs  = .38, p < .01) and negatively associated with subjective norms (rs  = -.11, p < .05). Senior students had higher scores (p = .024) in knowledge. Intention was negatively correlated with knowledge (rs  = -.24, p < .01) and perceived behavioural control (rs  = -.16, p < .01). Male students (p = .031) and younger students had higher scores in intention (p = .040). Males had higher scores in subjective norms (p < .001), and older and senior students had higher scores in perceived behavioural control (p < .001).

CONCLUSIONS

Despite the current knowledge on COVID-19 available through multimedia-communication channels, students had negative perceived behavioural controls and intentions to care for COVID-19 patients. Formal education and training are required to enhance students' intentions to care for patients with infectious diseases. Additionally, demographics and belief variables influence students' intentions to care, and further in-depth analysis is required. Relevance to Clinical Practice This study suggests the importance of updating and contextualizing nursing and allied health curricula to meet global infectious disease guidelines and, ultimately, to support the healthcare system with efficient practitioners in future pandemics.

Modeling the theory of planned behavior to predict adults' intentions to improve oral health behaviors

Background

The present study aimed to apply the theory of planned behavior (TPB) to identify predictors of adults’ intentions to improve oral health behaviors.

Methods

This cross-sectional study was conducted with 1,328 adults living in the Jeddah city, Saudi Arabia. A 64-item questionnaire that evaluated behavioral intention, oral health knowledge (OHK) and TPB constructs (attitudes, perceived behavioral control, and subjective norms) was distributed. Descriptive statistics and structural equation modeling (SEM) were used to describe the data and examine the associations among the variables. A p-value of < 0.05 was considered significant.

Results

The analysis revealed that the TPB model explained 72% of the variance in oral health behavioral intentions (OHBI), indicating a good model fit. The TPB constructs of attitudes (β = 0.299), subjective norms (β = 0.035), and perceived behavioral control (β = 0.144) were significant predictors of OHBI, whereas OHK was not. Attitude was the strongest predictor of intentions to improve oral health behaviors.

Conclusions

The findings suggest that this model could be a helpful framework for designing oral health promotion and intervention programs. Such programs should focus on changing adults’ attitudes, positive influences from close relationships, and improving self-efficacy of OHB to improve their oral health behavior.

Predicting hand washing, mask wearing and social distancing behaviors among older adults during the covid-19 pandemic: an integrated social cognition model

BACKGROUND

Older adults are at a higher risk from COVID-19. Individual preventive behaviors including frequent hand washing, mask wearing, and social distancing play important roles in reducing the transmission of COVID-19 in the community. This study aimed to identify the determinants of three preventive behaviors of older adults during the COVID-19 pandemic by using an Integrated Social Cognition Model.

METHODS

Using a prospective study design, 516 Chinese older adults from Hubei province of China (mean age = 67.55 years, SD = 6.60, 57.9% females) completed two online questionnaire surveys. The demographics, social cognition constructs (motivational self-efficacy, risk perception, attitude, subjective norm, health knowledge, intention, volitional self-efficacy, planning, action control) and three preventive behaviors were measured during the first-wave online survey from 18 May 2020 to 7 June 2020. One month later, three preventive behaviors were measured again during the second-wave online survey. Data were analyzed by structural equation modelling.

RESULTS

Models showed attitude, motivational self-efficacy and subjective norm were consistent predictors of intention, motivational self-efficacy was a consistent predictor of volitional self-efficacy, planning and volitional self-efficacy were consistent predictors of action control, and health knowledge was a consistent predictor of behaviors across all three preventive behaviors. In addition, mediating relationships were found in the model of hand washing behavior. In particular, planning (β = .109, p = .042) and action control (β = .056, p = .047) mediated between volitional self-efficacy and hand washing respectively. Action control also mediated between planning and hand washing (β = .087, p = .044). Moreover, the inclusion of past behaviors in three models attenuated most of the structural relations.

CONCLUSIONS

The current study's findings basically supported the Integrated Social Cognition Model and identified key modifiable determinants of preventive behaviors. Based on this model, future interventions aiming to promote COVID-19 preventive behaviors among older adults are warranted.

Evaluating the Impact of Verified Government Accounts on the Knowledge, Attitudes, and Intentions of Saudi Residents During the COVID-19 Pandemic

Governments utilize various media channels to disseminate knowledge pertaining to infectious diseases such as COVID-19. When it was declared a pandemic, society began to depend on the media for critical information and countermeasures that would facilitate tackling the virus. The main objective of this research is to examine the impact of verified Saudi government accounts across various media outlets on respondents’ knowledge, attitudes, and intentions regarding COVID-19.A structured online questionnaire was distributed and 315 responses were used for analysis. The results were analyzed using SPSS. The results indicate that the residents of Saudi Arabia have adequate knowledge concerning the symptoms, precautionary measures, and modes of transmission of COVID-19. The respondents have gained this knowledge from verified Saudi government accounts across various media outlets, most prominently via social media..

The Outcomes of an Interventional Oral Health Program on Dental Students' Oral Hygiene

Dental students are an interesting population because they are expected to have a higher level of knowledge of and to exhibit better oral hygiene habits, and thus have a greater impact on the environment, families, and society as a whole. The aim of this research was to determine the state of oral hygiene in dental students before and after the interventional health education program. The research sample consisted of 119 students of dentistry in their first and fourth years of study. The first research stage was conducted before health education intervention (for the evaluation of selected oral health parameters, the Decayed, Missing and Filled index, Greene–Vermillion index, Silness–Löe plaque index, Silness–Löe gingival index, and the Community Periodontal Index of Treatment Needs index were used). The second stage was conducted as a clinical measurement of oral health changes. The conducted health education intervention, to an extent, led to changes in the state of oral hygiene among the students, and thus healthier habits. There was a statistically significant difference in the examined population between the beginning of the study and after the health education intervention program. Although a significant improvement in oral hygiene and oral health was noticed after the health education intervention program, the state of oral hygiene was still not at a satisfactory level among the dental students, contrary to our expectations.

Cross-sectional study of oral health care service, oral health beliefs and oral health care education of caregivers in nursing homes

OBJECTIVES

To assess oral care beliefs and oral hygiene procedures among nursing home personnel to identify strengths and weaknesses in managing oral care.

METHODS

A cross-sectional study in two nursing homes using an oral health care questionnaire including the Nursing Dental Coping Belief Scale.

RESULTS

A total of 109 health personnel participated. Oral care was seldomly achieved twice a day and dental supplies were not guaranteed. Registered nurses found the oral health of residents more acceptable than did allied health personnel with less oral care education, who mostly delivered daily care. Conversely, nursing staff with oral care education had lower dental coping beliefs, suggesting a lack of self-reliance in controlling oral health outcomes.

CONCLUSION

Dental supplies should be part of nursing care equipment. Educational programs could increase positive oral health beliefs and enhance the quality of care in these settings, particularly among those who are accountable for oral care.

Determinants of restaurant consumers' intention to practice COVID-19 preventive behavior: an application of the theory of planned behavior

BACKGROUND/OBJECTIVES

The purpose of this study was to examine the effects of knowledge about coronavirus disease 2019 (COVID-19), attitude, subjective norm, and perceived behavioral control on behavioral intentions to practice COVID-19 preventive behaviors using the theory of planned behavior (TPB).

SUBJECTS/METHODS

A total of 519 restaurant customers' responses was collected in this study through an online self-administered questionnaire. Descriptive statistical analysis was performed on socio-demographic factors. One-way analysis of variance and t-test were conducted to determine differences in the constructs from the TPB according to age and sex. The hypotheses were tested using structural equation modeling (SEM).

RESULTS

SEM revealed the positive effect of knowledge about COVID-19 on attitude, subjective norm, and perceived behavioral control to prevent the spread of COVID-19 in restaurants. Attitude, subjective norm, behavior intention, and knowledge positively affected COVID-19 preventive behavior intentions in restaurants.

CONCLUSIONS

The results of this study confirmed that the TPB is helpful in elucidating the determinants of consumers' intention to practice COVID-19 preventive behavior in restaurants. These findings can help policy makers and professionals provide material for further public health interventions and inform them about awareness-raising, guidelines, and health education programs.

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.

Effect of educational program based on theory of planned behavior on osteoporosis preventive behaviors: a randomized clinical trial

Background

The prevalence of chronic diseases is increasing worldwide. Implementing educational programs is an important step in prevention of chronic diseases in the community setting. This study was conducted to assess the effect of educational program based on the Theory of Planned Behavior (TPB) on the osteoporosis preventive behaviors in middle-aged individuals.

Methods

A randomized clinical trial was conducted on 64 middle-aged individuals presenting to primary care centers. A researcher-made questionnaire developed according to “a guide for compiling and analyzing the questionnaire based on TPB” was used for data collection. Random block sampling was applied to assign participants to control and intervention groups after ensuring the validity and reliability. An educational program on osteoporosis prevention was conducted in six educational sessions based on the TPB constructs for the intervention group in primary care centers. Control group received routine education about lifestyle changes including osteoporosis by primary care centers. Eight weeks after the intervention, the questionnaires were completed again and the data were analyzed using the SPSS V16 software.

Results

Independent t-test found no significant difference in the mean score of knowledge, osteoporosis preventive behavior, attitude, subjective norms, perceived behavioral control and behavioral intention between intervention and control groups before intervention (p > 0.05). After the intervention, however, a significant difference was found in the mean score of knowledge, attitude, subjective norms, perceived behavioral control and behavioral intention between the cases in intervention and control groups (P < 0.05). In addition, based on repeated measurement ANOVA, the intervention had a significant effect on knowledge, preventive behaviors, attitude, subjective norms, perceived behavioral control, and behavioral intention (P < 0.05).

Conclusions

The results of the present study showed that implementation of an educational intervention based on the Theory of Planned Behavior significantly increased the knowledge along with all constructs of TPB in osteoporosis preventive behaviors.

Trial registration

This study was registered in the Iranian Registry of Clinical Trials IRCT2017081735647N2 (11/10/2017).

Quarantine Hotels: Integration between Hospitality and Healthcare Services to Promote Health Behavior and Quality of Life

OBJECTIVES

COVID-19 has spread globally and infected millions of people, thereby restricting their movement. Quarantine hotels play an important role in protecting people from COVID-19 and contribute to a better quality of life. The objective of this study was to examine the role of quarantine hotels in providing improved quality of life through both medical and hospitality services under one roof to address the COVID-19 situation in Saudi Arabia.

METHODS

This study used a quantitative, cross-sectional research design. Data were collected from quarantine hotels in Saudi Arabia using a survey, and analyzed through Partial Least Square (PLS)-Structural Equation Modeling (SEM).

RESULTS

Medical service quality, financial savings and convenience had a positive effect on people's attitudes and intention to use quarantine hotels. Similarly, attitude, intention, and hospitality products had a positive effect on health behavior, which favorably affected quality of life.

CONCLUSIONS

Medical service quality, financial savings, and convenience, as well as hospitality provided by quarantine hotels, have a positive role in promoting health behavior and quality of life.

Mothers' role in promoting oral health in children aged 6 months to 1 year

Introduction:

It is essential for parents, and especially mothers, to become aware of the factors that affect oral health-promoting behaviors in children through behavior change theories. This study aimed to determine mothers’ role in improving children's oral health based on the health belief model (HBM).

Methods:

The population of this descriptive, analytical, cross-sectional study comprised 240 mothers in Ilam (Iran), selected via stratified random sampling. The data collection instrument was a self-report questionnaire with two sections, including seven demographic and contextual questions, four items for perceived severity, four items for perceived benefits, four items for perceived barriers, three items for cues to action, and five items for perceived self-efficacy. The data were analyzed in SPSS 21 by using descriptive and inferential statistics, including independent samples t-test, linear regression analysis, and Pearson correlation coefficient, at a significance level of 0.05.

Results:

The participants aged 20–47 with a mean of 31.8 ± 5.67 years. The linear regression analysis indicated that the constructs of perceived severity (B = 0.073, P < 0.001), perceived benefits (B = 0.013, P < 0.001), perceived barriers (B = 0.111, P < 0.01), cues to action (B = 0.517, P < 0.001), and perceived self-efficacy (B = 0.292, P < 0.001) explained 55% of the variance of behavioral intention.

Conclusion:

With respect to the effects of perceived barriers and perceived severity on predicting oral health behaviors, effective outcomes can be achieved by emphasizing these two constructs in educational programs based on the HBM.

Role of knowledge, behavior, norms, and e-guidelines in controlling the spread of COVID-19: evidence from Pakistan

The COVID-19 pandemic is straining public health systems and the global economy, triggering unprecedented measures by governments around the globe. The adoption of a preventive measure is required to control the spread. This research explores the impact of influencing factors like COVID-19 knowledge, behavioral control, moral and subject norms, preventive e-guidelines by the government, and environmental factors on the intention to prevent COVID-19 and risk aversion. A cross-sectional study was performed of 310 respondents about different COVID-19 related influencing factors in Pakistan. The partial least square-structural equation modeling was applied to estimate the path coefficient. Moral and subject norms (0.359) had a comparatively higher path coefficient. Other influencing factors/drivers were preventive e-guideline by the government (0.215) followed by COVID-19 knowledge (0.197), and behavioral control (0.121). The intention to prevent COVID-19 showed a positive and significant impact (0.705) on risk aversion. The indirect analysis also confirmed that the positive influence of moral and subject norms, COVID-19 knowledge, preventive e-guideline by the government, and behavioral control on risk aversion. However, the path coefficient of environmental factors was negative but insignificant, which implies than environmental factors do not influence the intention to prevent COVID-19. It is suggested to provide clear guidelines using print, social, electronic media. It is also suggested to provide e-guidelines in local languages. The COVID-19 knowledge about its transmission, symptoms, and precautions is also useful. It is suggested to include the causes, symptoms, and precaution of viral diseases in the educational syllabus. The government should ensure the availability of preventive medical items like surgical masks and sanitizers to meet the demand of the public.

Assessing Medical Students' Confidence towards Provision of Palliative Care: A Cross-Sectional Study

Under a surging demand for palliative care, medical students generally still show a lack of confidence in the provision in abroad studies. This cross-sectional study aims to investigate the confidence and its association with knowledge, attitude and exposure on providing palliative care among medical undergraduates with a self-administered questionnaire to improve the international phenomenon. Full-time local medical undergraduates were recruited to obtain information regarding the demographics, confidence, knowledge, attitude and exposure on palliative care; the information was collected from July 2020 to October 2020. Questions on confidence (10-items), knowledge (20-items), attitude (10-items) and exposure were referenced from validated indexes and designed from literature review. Confidence level was categorized into “Confident” and “Non-confident” as suggested by studies to facilitate data analysis and comparison. Of the 303 participants, 59.4% were “Non-confident” (95% C.I.: 53.8% to 65.0%) in providing palliative care on average. Among medical students, knowledge (p = 0.010) and attitude (p = 0.003) are significantly positively associated with the confidence to provide palliative care, while exposure to death of family/friends (p = 0.024) is negatively associated. This study begins an investigation on the research area in Hong Kong primarily. The confidence of local medical students should be enhanced to provide palliative care in their future. It thus highlights the importance of the medical curriculum and provides insights to remove barriers responsively to improve the overall confidence and the quality of palliative care.

The Impact of Health Literacy on Knowledge and Attitudes towards Preventive Strategies against COVID-19: A Cross-Sectional Study

The coronavirus disease 2019 (COVID-19) pandemic introduced a set of mitigation measures based on personal behavior and attitudes. In the absence of vaccination or specific treatment, it became essential to comply with these measures to reduce infection transmission. Health literacy is the basis for changing behaviors.

AIM

To characterize the impact of literacy on knowledge and attitudes towards preventive strategies against COVID-19.

METHODS

This cross-sectional study involved an online questionnaire applied to students of the University of Porto, Portugal, containing questions about knowledge and attitudes towards COVID-19 based on European guidelines. Health literacy was assessed through the Newest Vital Sign questionnaire. Logistic regression estimated the relationship between health literacy and both knowledge and attitudes.

RESULTS

We included 871 participants (76.3% female), with a median age of 22 years old. We found adequate literacy in 92% of our sample, irrespective of gender and age. In the global analysis, 78.6% of the participants had adequate knowledge, and 90.4% had adequate attitudes. We found that better literacy was significantly associated with attitudes towards COVID-19, but not with better knowledge. In a model adjusted for gender, age, and previous education in the health field, female gender and previous education in the health field were associated with better knowledge and attitudes.

CONCLUSION

Better health literacy is associated with better attitudes towards preventive strategies against COVID-19. We should invest in ways to improve health literacy, so we can improve people's attitudes and consequently reduce coronavirus' transmission.

Examining the intention to stay home due to COVID-19: a pandemic's second wave outlook

Purpose

At present, almost the whole globe is facing a severe threat of coronavirus disease 2019 (COVID-19). The present study examines the intention to stay home due to COVID-19 during a second wave of the pandemic.

Design/methodology/approach

The study employed a deductive approach based on cross-sectional data. An online survey is conducted from citizens of Pakistan. A convenience sampling is applied to target the respondents. In total, 238 useable responses proceed for final analysis. The structural equation model (SEM) is used to infer the results.

Findings

The findings of the study highlight a positive and significant effect of fear of COVID-19, attitudes to stay at home behaviour (AtSHB), knowledge about COVID-19 (Ka19) and health consciousness (HC) on the intention to stay at home (ItSAH).

Practical implications

The study would provide the guidelines to policymakers and planners to develop the policies which may establish the individual's ItSAH. This strategy would restrict the spread of COVID-19. The government should also formulate the plannings to reduce the fear about COVID-19 and health concerns to combat the pandemic. The government should launch awareness programs regarding the spread and cure of COVID-19.

Originality/value

This study is the first study which highlights the factors such as fear, HC, attitudes and knowledge towards ItSAH. The study may be unique in the COVID-19 perspective, particularly in the Pakistani context.

Pharmacy students' attitude towards providing pharmaceutical care to patients with anxiety and their knowledge of psychotropic medicines in Jordan

OBJECTIVES

To describe pharmacy students' attitude towards providing pharmaceutical care (PC) to patients with anxiety and their knowledge of psychotropic medicines (PM).

METHODS

A cross-sectional emailed survey was sent to all 200 pharmacy students (fourth and fifth year) in one Jordanian university. Statistical analysis included descriptive statistics and chi-square test.

KEY FINDINGS

A total of 134 responses were received (response rate 67%). About two-thirds of students (87, 64.9%) would like to give enough time to patients with anxiety to discuss their medications. Only half of students knew correctly that alprazolam (53.7%) and diazepam (50.0%) are categorized as anxiolytics. Undertaking a course in psychiatry was significantly associated with better students' knowledge in PM (P < 0.05).

CONCLUSION

Despite positive attitudes towards providing PC to patients with anxiety, policy makers should include courses on psychiatric pharmacotherapy in pharmacy curricula to improve pharmacy students' knowledge of PM.

Determinants of intention to improve oral hygiene behavior among students based on the theory of planned behavior: A structural equation modelling analysis

INTRODUCTION

The prevalence of oral hygiene behaviors (OHB) is very low among school children in Ethiopia. However, the determinants of student's readiness/intention to perform those behaviors have been remained unstudied.

OBJECTIVE

This study aimed to identify the determinants of oral hygiene behavioral intention (OHBI) among preparatory school students based on the theory of planned behavior (TPB).

METHODS AND MATERIALS

An institution-based cross-sectional study was conducted among 393 students. A 98-item self-administered questionnaire was used to evaluate oral hygiene knowledge (OHK), oral hygiene behavior (OHB), and OHBI based on TPB variables [attitude (ATT), subjective norms (SN) and perceived behavioral control (PBC)]. Descriptive statistics and structural equation modeling analysis (SEM) were employed to confirm relationships and associations among study variables. A p-value of less than 0.05 and a 95% confidence interval were used to declare statistical significance.

RESULTS

A total of 393 students were participated with a response rate of 97.5%. The mean age of the participants (54% females) was 18 (± 1.3) with an age range of 16 to 24. The TPB model was well fitted to the data and explained 66% of the variance in intention. ATT (β = 0.38; 95% CI, (0.21, 0.64)), SN (β = 0.33; 95% CI, (0.05, 0.83)) and PBC (β = 0.29; 95% CI, (0.13, 0.64)) were significant predictors of OHBI, where ATT was the strongest predictor of OHBI.

CONCLUSION

The TPB model explained a large variance in the intention of students to improve their OHB. All TPB variables were significantly and positively linked to stronger intent, as the theory suggests. Furthermore, these results suggest that the model could provide a framework for oral hygiene promotion interventions in the study area. Indeed, these interventions should focus on changing the attitudes of students towards OHB, creation of positive social pressure, and enabling students to control over OHB barriers.

Effect of a hospital-based oral health-education program on Iranian staff: evaluating a theory-driven intervention

BACKGROUND

Tooth decay and periodontitis are among the most prevalent dental diseases globally with adverse effects on an individual's general health. Recently the prevalence of dental caries has decreased significantly, but caries epidemiology remains a major problem in dental public health. This study investigated the impact of an oral health education intervention on Theory of Planned Behavior (TPB) variables, and whether changes in these variables persisted and were associated with changes in identified oral health behaviors at 2-month follow-up.

METHODS

This descriptive pre/post test study was conducted with 160 staff in the Baqiyatallah Hospital in Tehran. Six hospital wards were selected using a randomized multi-stratified sampling frame. The size for each cluster was calculated as 22 with each ward being allocated to either the intervention or the control arm of the study. Self-report questionnaires were used to evaluate socio-demographic factors, dental attendance as well as the constructs of the augmented TPB model (attitudes, subjective norms, perceived behavioral control intentions). The intervention was an educational program based on TPB constructs delivered via direct training to half the participants. The control group was provided with usual training only. The independent-samples T-test, Repeated-Measures one-way ANOVA, and matched T-test with the significance level set at p < 0.05 were applied.

RESULTS

Findings revealed significant variations between the two groups immediately after the educational intervention concerning the attitudes, subjective norms, perceived behavioral control, intentions to seek treatment, oral health behavior as well as decayed, missing, and filled teeth and bleeding on probing (p<0.001). Two months after the intervention, except for the brushing construct (p = 0.18), the differences between the two groups were all statistically significant (p<0.001).

CONCLUSION

Our findings affirm the positive effect an oral health education program has on enhancing the attitudes, subjective norms, perceived behavioral control, intentions and behavior of staff in this hospital. The results of our study confirm that developing and applying an educational intervention in accordance with the theory of planned behavior can lead to significant changes in the knowledge, attitudes, and behavior of hospital staff regarding preventing tooth decay.

Effect of a motivational video on flossing behaviour: A pilot study

OBJECTIVES

Motivational interviews used for health behavioural change requires several sessions and expert consultations. A practical method is needed to promote oral hygiene habits. The aim of the study was to develop a video as a new motivational intervention method combining several health behaviour change theories to improve flossing behaviour.

METHODS

A questionnaire about individual psychosocial characteristics was conducted to 30 volunteer dental patients. Plaque index (PI) scores were calculated and a video about flossing was shown the patients. The second PI measurements were performed after 2 months. The video including flossing instructions and expressions of performers acting dental patients was produced to test as a motivational method. Cues used in the video were generated according to health behaviour change theories and models under the supervision of an expert team. Content validity ratio (CVR) and content validity index (I-CVI) of the video and reliability of the questionnaire was determined. First and second PI scores were compared to assess the effect of the video. Correlation between answers of the questionnaire and PI changes were tested.

RESULTS

The average I-CVIs of the video was 0.93, CVR of video items was 1, I-CVIs of 5 items was 80% and of 10 was 100%. Cronbach's alpha of the questionnaire was 0.93. PI scores significantly decreased after 2 months (p < 0.001).

CONCLUSION

A single session motivational intervention via a video based on health psychological models and theories was efficacious in improving oral hygiene and flossing behaviour in the short term.

Factors influencing intention to follow the “stay at home” policy during the COVID-19 pandemic

Purpose

This research seeks to simultaneously test the effect of attitude towards the behavior of following the “Stay at Home” policy, subjective norm, perceived behavioral control, perceived susceptibility and perceived severity on people's intention to follow the “Stay at Home” policy during COVID-19 pandemic.

Design/methodology/approach

The data were collected through an online survey with 148 respondents in the Greater Area of Jakarta, Indonesia. The data were then analyzed using multiple regressions.

Findings

The findings show that attitude towards the behavior, subjective norm and perceived behavioral control positively and significantly affect intention to follow “Stay at Home” during the COVID-19 pandemic. However, perceived susceptibility and perceived severity of COVID-19 do not significantly influence the intention to follow “Stay at Home” during the COVID-19 pandemic.

Research limitations/implications

This research was limited to the Greater Area of Jakarta, Indonesia. Furthermore, sampling was done through convenience sampling. Therefore, future research should be conducted in a different context to test the generalization of this research's findings.

Practical implications

To encourage citizens' adherence to the stay-at-home policy during the COVID-19 pandemic, they must be directed to have positive attitudes toward the policy. Financial and non-financial supports are critical to ensure citizens' ability to sufficiently observe the policy sufficiently. Another important aspect is the influence of leaders and public figures to consistently call for obedience consistently.

Originality/value

This is the first research that studies citizens' behavior related to the “Stay at Home” policy requisitioned by the government to hinder the spread of COVID-19.

Behavioral barriers of tuberculosis notification in private health sector: policy implication and practice

Purpose

Underreporting of new tuberculosis (TB) cases is one of the main problems in TB control, particularly in countries with high incidence and dominating role of a private sector in TB cases diagnosing. The purpose of this paper was to explore behavioral determinants of underreporting of new TB cases among private sector physicians in Iran.

Design/methodology/approach

The authors conducted a population-based, cross-sectional study of physicians working in private clinics. The data collection tool was designed using the theory of planned behavior (TPB). The authors used structural equation models with maximum likelihood estimation to examine attitude toward the notification behavior.

Findings

Of 519 physicians, 433 physicians completed the questionnaire. Attitude toward notification had the highest score (mean score = 87.65; sd = 6.79; range: 0–100). The effect of perceived behavioral controls on the notification behavior ((β^) = 0.13; CI: 0.01–0.25) was stronger than the total effect of attitude ((β^) = 0.06; CI: 0.00–0.12) and subjective norms ((β^) = 0.01; CI: −0.00–0.03) on the behavior. However, the attitude was the main predictor of intention and justified 46% of the intention variance. Intention had a significant effect on the behavior ((ß^) = 0.09; CI: 0.1–0.16).

Practical implications

Considering stronger effect of perceived behavioral control on the behavior, interventions aiming at facilitating notification process would be more effective than those aiming at changing the attitude or enhancing intention among physicians.

Originality/value

To the best of our knowledge, no other study previously explored determinants of underreporting from the behavioral and cognitive perspective. Specifically, the authors explored the role of the TPB constructs in predicting intention to notify new TB cases.

Self-Reported Oral Health Attitudes and Behaviors, and Gingival Status of Dental Students

Aim

The aim of this study was to assess self-reported oral health attitudes and behaviors of the Iraqi dental students and compare the variations in these attitudes and behaviors that linked to dental education level and gender.

Materials and Methods

A self-administered questionnaire depended on the English version of the Hiroshima University Dental Behavioral Inventory (HU-DBI) was prepared, the questionnaire given to 198 dental students.

Results

About 91.4% of the dental students were worried about the teeth colour, and merely minor percentage of them (18.8%) thought it is not crucial to seek dental advice until they acquire a tooth pain; however, 26.3% of the students were disturbed because of their gum colour, and 75.3% of them examined their teeth after brushing. Besides, 72.2% of the students replied that gum disease could not be prevented by tooth brushing only, 60.1% of the students do not give visiting the dentist such concern, and 14.1% of dental students were smokers. The plaque and gingival indices were significantly higher in preclinical students than clinical students.

Conclusion

Iraqi dental students had somewhat good oral health behavior and attitudes; however, extra concentrating is required on the anticipatory and behavioral aspects of oral self-care practices. Female dental students displayed better oral health behavior and attitudes than male colleagues on some issues.

Differences in Preventive Behaviors of COVID-19 between Urban and Rural Residents: Lessons Learned from A Cross-Sectional Study in China

Purpose: The purpose of this study is to examine the differences in preventive behaviors of COVID-19 between urban and rural residents, as well as identify the factors that might contribute to such differences. Methods: Our online survey included 1591 participants from 31 provinces of China with 87% urban and 13% rural residents. We performed multiple linear regressions and path analysis to examine the relationship between rural status and behavioral intention, attitude, subjective norms, information appraisal, knowledge, variety of information source use, and preventive behaviors against COVID-19. Findings: Compared with urban residents, rural residents were less likely to perform preventive behaviors, more likely to hold a negative attitude toward the effectiveness of performing preventive behaviors, and more likely to have lower levels of information appraisal skills. We identified information appraisal as a significant factor that might contribute to the rural/urban differences in preventive behaviors against COVID-19 through attitude, subjective norms, and intention. We found no rural/urban differences in behavioral intention, subjective norms, knowledge about preventive behaviors, or the variety of interpersonal/media source use. Conclusions: As the first wave of the pandemic inundated urban areas, the current media coverage about COVID-19 prevention may not fully satisfy the specific needs of rural populations. Thus, rural residents were less likely to engage in a thoughtful process of information appraisal and adopt the appropriate preventive measures. Tailoring health messages to meet rural populations' unique needs can be an effective strategy to promote preventive health behaviors against COVID-19.

Modeling the Theory of Planned Behaviour to predict adherence to preventive dental visits in preschool children

Objectives

Dental caries is the most common chronic childhood disease that occurs in a continuum and can be prevented by children and their parents’ adherence to recommended oral health behaviors. Theory-driven tools help practitioners to identify the causes for poor adherence and develop effective interventions. This study examined the Expanded Theory of Planned Behaviour (TPB) Model by adding the concept of Sense of Coherence (SOC) to predict parental adherence to preschooler’s preventive dental visits.

Methods

Data regarding socio-economic demographics were collected from parents of children aged 2–6 years. Constructs of TPB including parental attitudes, subjective norms (SN), Perceived Behavioural Control (PBC), and intention to attend preventive dental visits for their preschoolers were collected by questionnaire, alongside parents’ sense of coherence (SOC). Dental attendance was measured by asking if the child had a regular dental visit during the last year. Structural Equation Modeling Analysis (SEMA) was carried out to identify significant direct and indirect (mediated) pathways in the extended TPB model.

Results

Three hundred and seventy-eight mothers (mean age = 34.41 years, range 22–48) participated in the study. The mean age of children was 3.92 years, range: 2–6), and 75.9% had dental insurance. Results of the final model showed that predisposing factors (child’s birthplace and mother’s birthplace) significantly predicted enabling resources (family monthly income and child’s dental insurance status); both predicted the TPB components (PBC, SN, and attitude). TPB components, in turn, predicted behavioural intention. However, contrary to expectation, intention did not significantly predict dental attendance in the past 12 months. Parent’s SOC significantly predicted TPB components and dental attendance. Overall, 56% of the variance in dental attendance was explained by the expanded TPB model.

Conclusions

The expanded TPB model explained a great deal of variance in preschooler’s dental attendance. These findings suggest that the expanded model could be used as the framework for designing interventions or strategies to enhance dental attendance among preschoolers; in particular, such strategies should focus specifically on enhancing parental SOC including empowerment.

Assessment of Safe Listening Intentional Behavior Toward Personal Listening Devices in Young Adults

Recreational noise-induced hearing loss (RNIHL) is a highly preventable disorder that is commonly seen in teenagers and young adults. Despite the documented negative effects of RNIHL, it is still challenging to persuade people to adopt safe listening behaviors. More research is needed to understand the underlying factors guiding listeners’ intentions to engage in safe listening habits. We used the Theory of Planned Behavior (TPB) to identify attitudes, social norms, and behavioral control in 92 young adults toward two intentional behaviors related to safe listening habits while listening to their personal listening devices: (1) lowering the intensity of loud music, and (2) shortening the listening duration of loud music. Using a Qualtrics survey, the major factors of the TPB model as they relate to the participants’ intention to engage in risk-controlling behavior were assessed. Behavioral intentions to turn the music down and listen for shorter durations were thought to be predicted by the TPB factors (attitudes, social norms, and perceived behavioral control). Linear regression findings indicated that the overall TPB models were significant. Positive attitudes toward turning the music down and shortening the durations were significantly associated with intentions to engage in non-risky behavior, more so for the former behavior.

Application of the Integrated Behavioral Model to oral self-care behavior of community-dwelling middle-aged and older people in Taiwan

OBJECTIVES

This study evaluated the Integrated Behavioral Model and examined oral self-care behavior of community-dwelling middle-aged and older people.

DESIGN

A cross-sectional design was used.

SAMPLE

Purposive sampling was employed to recruit middle and older age community-dwelling individuals, with research locations in public health centers in northern Taiwan.

MEASUREMENTS

Structured questionnaires comprised: participant demographics, oral health literacy, oral self-care attitude, self-efficacy, intention, and behavior, and significant others' perceptions and beliefs as well as environmental constraints. The Model verification was evaluated by path analysis.

RESULTS

Two hundred and sixty-three participants (N = 263) completed the questionnaire survey. Results identified significant direct effects of the independent variables of oral health care literacy, intention of oral self-care, and perception of environmental constraints on the dependent variable of oral self-care behavior; and significant indirect effects on attitude of oral self-care, perception of significant other beliefs, self-efficacy of oral self-care.

CONCLUSION

Public health nurses work with the whole community and can potentially improve the oral self-care behavior of middle-aged and older adults by enhancing their oral health knowledge, maintaining their positive attitudes, assisting acceptance of recognition and support from others, increasing their ability to perform oral self-care, reducing environmental constraints, and thereby enhancing their oral self-care awareness.

Using the Theory of Planned Behavior to Understand Factors Influencing South Asian Consumers' Intention to Seek Pharmacist-Provided Medication Therapy Management Services

The study purpose was to use the theory of planned behavior to understand factors influencing South Asian consumers’ intention to seek pharmacist-provided medication therapy management services (MTMS). Specific objectives were to assess effects of attitude, subjective norm (SN), perceived behavioral control (PBC), and socio-demographics on South Asian consumers’ intention to seek MTMS. Participants who were ≥18 years of age, of South Asian origin, with a previous visit to a pharmacy in the US for a health-related reason, and with ability to read and comprehend English were recruited from independent pharmacies in New York City. Responses were obtained through a self-administered survey. Descriptive statistics were performed, and multiple linear regression analysis was conducted to assess the study objective. SPSS was used for data analyses. Out of 140 responses, 133 were usable. Mean scores (standard deviation) were 4.04 (0.97) for attitude, 3.77 (0.91) for SN, 3.75 (0.93) for PBC, and 3.96 (0.94) for intention. The model explains 80.8% of variance and is a significant predictor of intention, F (14,118) = 35.488, p < 0.05. While attitude (β = 0.723, p < 0.05) and PBC (β = 0.148, p < 0.05) were significant predictors of intention, SN (β = 0.064, p = 0.395) was not. None of the socio-demographics were significant predictors of intention. Strategies to make South Asians seek MTMS should focus on creating positive attitudes and removing barriers in seeking MTMS.

The Effect of Oral Health Promotion Program on Early Dental Decay in Students: a Cluster Randomized Controlled Trial

Introduction: The use of different models play a significant role in health education and its promotion. Therefore, the present study aims to investigate the effect of the Theory of Planned Behavior (TPB) on early dental decay in elementary students.

Methods: This study was a single-blinded, cluster randomized controlled trial, in which 470 elementary students in the fourth, fifth and sixth grades in Saveh, Iran were participated. A demographic questionnaire and a 5-item questionnaire consisting of questions on awareness, attitude, practice, tooth brushing, diet and referring to dentist, were used to data collection. The samples of the intervention (n=234) and control (n=236) groups filled out the questionnaires before intervention (pre-test), immediately after intervention and one month after intervention. The educational intervention based on the TPB was held in three 45-minute sessions. Finally, the data were analyzed, using the SPSS version 13. For analyzing, the Independent t-test, Chi-square, and repeated measures ANOVA were used.

Results: This study showed that there is a significant difference in the mean scores obtained from knowledge, attitude, subjective norm, perceived behavioral control, behavioral intention and behavior among students in the experimental group (immediately after and one month after the intervention) and students in the control group.

Conclusion: The results of this study showed that using of TPB, as a framework for providing behavior-led training, can be effective in promoting oral and dental health of students. Nurses as an important member of the treatment team can use the results of this study in school health programs.

Perioperative changes in knowledge and attitude toward oral health by oral health education

OBJECTIVES

Perioperative oral health care can prevent postoperative complications, but it is also important to maintain oral health afterward to avoid later adverse events. This study examined (a) the relationship between knowledge and attitude toward oral health (KAOH) and oral/periodontal status (OPS) in patients receiving surgery, and (b) the changes in KAOH by perioperative oral health care and education.

METHODS

Patients receiving surgery who visited our hospital's dental clinic beforehand were prospectively recruited. All participants received oral health care and education. In questionnaires assessing KAOH before and after surgery, respondent answers were generally classified as positive or negative. OPS was assessed before surgery. Associations between KAOH and OPS and perioperative changes in KAOH were statistically tested.

RESULTS

A total of 507 patients answered the questionnaire before surgery, among whom 324 patients also completed it afterward. Preoperative OPS was significantly worse in the negative than in the positive KAOH group. Positive answers for KAOH increased significantly from 68.6% to 92.2% during the perioperative period.

CONCLUSIONS

We found that patients with poor KAOH also had poor OPS, but KAOH could be improved by perioperative oral health care and education, suggesting that perioperative oral health management could improve oral health knowledge and attitudes.

The role of psychological theories in oral health interventions: A systematic review and meta-analysis

OBJECTIVE

In the present study, we attempted to assess how psychological theories (health belief model [HBM], theory of planned behaviour [TPB], social cognitive theory [SCT], clinical theories [CT] and other theories [OT]) influence oral health interventions.

METHODS

PubMed, Scopus, Cochrane and Web of Knowledge databases from 2000 to 2017 were searched. We defined psychological theories based on five subgroups: (A) HBM, (B) TPB, (C) SCT, (E) CT and (F) OT.

RESULTS

From the 156 identified studies, 19 studies based on PICO were included. Our findings indicated that the standardized mean difference (SMD) of HBM was 0.37 (95% CI: 0.24, 0.51), which was statistically significant in improving oral health. The SMD of SCT was not significant (0.05 [95% CI: -0.33, 0.44]) in improving oral health. The SMD of TPB was significant (1.66 [95% CI: 1.06, 2.27]) in improving oral health. The SMD of CT (-4.6 [95% CI: -6.49, -2.71]) and OT (2.93 [95% CI: 1.55, 4.32]) revealed significant differences in improving oral health.

CONCLUSION

The current meta-analysis showed that in general, psychological interventions that used OT, CT, HBM and TPB were effective in enhancing oral health status, and interventions that used SCT did not have an effect on improving oral health status. Oral health care providers who work with patients to take methods and improve behaviours that are related to appropriate oral health need to comprehend their applicability and strengths.

Use of Oral Cleaning Devices and Their Perceived Benefits among Malaysians in Kuala Lumpur and Johor Bahru: An Exploratory Structured Approach

Background and Objectives

Various devices have been used to maintain oral hygiene. These include toothbrush and toothpaste, mouthwash, dental floss, miswak, and toothpick. This study attempts to investigate the use of various oral cleaning devices and their perceived benefits among Malaysians.

Methods

A quantitative cross-sectional study conducted in two different cities of Malaysia. A convenience sampling approach was adopted. A total of 787 participants agreed to participate in the current research. A validated questionnaire translated into national language was used for data collection.

Statistical Analysis Used

Data analysis was performed using Statistical Package for Social Sciences version 20.

Results

About 302 respondents were in the age range of 18 - 25 years old (38.4%). There were marginally more females (55.7%) than males (44.3%). Although 99.9% of the participants used a toothbrush, a significant majority (n = 590, 75%) used more than a single device to maintain their oral hygiene. Only 311 respondents knew that toothpicks were inappropriate to use to remove food between teeth and gums, while a majority (n = 592, 75.2%) did not realize that some mouthwashes can stain the teeth. Less than half (42.1%) knew that improper use of miswak might harm the teeth.

Conclusions

Although their oral hygiene behaviors are relatively at a higher level, their perceived oral health benefits did not compare well.

Development of a battery of tests to measure attitudes and intended behaviours of dental students towards people with disability or those in marginalised groups

INTRODUCTION

Recommended curricula in Special Care Dentistry (SCD) outline learning objectives that include the domain of attitudes and behaviours, but these are notoriously difficult to measure. The aims of this study were (i) to develop a test battery comprising adapted and new scales to evaluate values, attitudes and intentions of dental students towards people with disability and people in marginalised groups and (ii) to determine reliability (interitem consistency) and validity of the scales within the test battery.

MATERIALS AND METHODS

A literature search identified pre-existing measures and models for the assessment of attitudes in healthcare students. Adaptation of three pre-existing scales was undertaken, and a new scale was developed based upon the Theory of Planned Behaviour (TPB) using an elicitation survey. These scales underwent a process of content validation. The three adapted scales and the TPB scale were piloted by 130 students at 5 different professional stages, from 4 different countries.

RESULTS

The scales were adjusted to ensure good internal reliability, variance, distribution, and face and content validity. In addition, the different scales showed good divergent validity.

DISCUSSION

These results are positive, and the scales now need to be validated in the field.

CONCLUSIONS

It is hoped that these tools will be useful to educators in SCD to evaluate the impact of teaching and clinical exposure on their students.

Oral hygiene practices and knowledge among stroke-care nurses: A multicentre cross-sectional study

AIMS AND OBJECTIVES

To investigate oral health knowledge for stroke care and the clinical practices performed for oral hygiene care in Malaysia.

BACKGROUND

Oral hygiene care following stroke is important as the mouth can act as a reservoir for opportunistic infections that can lead to aspirational pneumonia.

DESIGN

A national cross-sectional survey was conducted in Malaysia among public hospitals where specialist stroke rehabilitation care is provided.

METHODS

All (16) hospitals were invited to participate, and site visits were conducted. A standardised questionnaire was employed to determine nurses' oral health knowledge for stroke care and existing clinical practices for oral hygiene care. Variations in oral health knowledge and clinical practices for oral hygiene care were examined.

RESULTS

Questionnaires were completed by 806 nurses across 13 hospitals. Oral health knowledge scores varied among the nurses; their mean score was 3.7 (SD 1.1) out of a possible 5.0. Approximately two-thirds (63.6%, n = 513) reported that some form of "mouth cleaning" was performed for stroke patients routinely. However, only a third (38.3%, n = 309) reported to perform or assist with the clinical practice of oral hygiene care daily. Their oral health knowledge of stroke care was associated with clinical practices for oral hygiene care (p < .001).

CONCLUSIONS

The clinical practice of providing oral hygiene care is less than ideal, and there are deficiencies in oral health knowledge for stroke care. Oral health knowledge was associated with clinical practice of providing oral hygiene care. This has implications for training and integrating oral hygiene care within stroke rehabilitation.