Oral health literacy and its determinants among adults in Southeast Iran

Relationship between oral health literacy and oral health-related quality of life in patients with bladder cancer

Introduction

Bladder cancer is one of the most important diseases that threatens oral and dental health due to its nature and side effects of chemotherapy. Therefore, the present study was conducted to investigate the relationship between oral health literacy and oral health-related quality of life in patients with bladder cancer.

Methods

This cross-sectional study was conducted on patients with bladder cancer in Ahvaz, 2023. Subjects were selected randomly from the patients those were registered in Cancer Registry Center in Ahvaz Jundishapur University of Medical sciences and invited to Golestan Hospital for data collection through clinical evaluation, the Oral Health Literacy Adult Questionnaire (OHL-AQ), and the Oral Health Impact Profile-14 (OHIP-14PER) questionnaire. The data were analyzed using Pearson correlation coefficient, independent t-test, and analysis of variance.

Results

The number of participants was 194. The mean oral health literacy in patients with bladder cancer was 9.74 ± 2.39, indicating insufficient oral health literacy. A significant association was observed between OHL-AQ and DMFT index, but no significant association was found between OHIP-14PER and DMFT index. Furthermore, a significant correlation was found between OHL-AQ and OHIP-14PER (r = -0.68) in patients with bladder cancer.

Conclusion

Based on the findings of the present study, all dimensions of oral health literacy have correlation with the oral health-related quality of life in patients with bladder cancer. Therefore, adopting oral health behaviors and increasing oral health literacy can be the best way to improve the oral health-related quality of life to among patients with bladder cancer.

Oral Health Literacy and Its Determinants in Young Couples

Objectives: Oral health literacy (OHL) is an interplay of cultural, social and individual factors and plays an effective role in public health promotion. This study aimed to assess OHL and its socioeconomic and demographic determinants among young couples. Materials and Methods: This analytical cross-sectional study was conducted on 828 adults between 15 to 35 years in 2018 in Zanjan city. Data regarding their OHL were collected by using a 17-item Oral Health Literacy-Adult Questionnaire (OHL-AQ) that was filled out by a combination of self-report and interview. OHL was categorized as adequate, marginal, and inadequate. The effects of age and gender as demographic variables, and floor area per person as a proxy of financial status on OHL were also assessed. Data were analyzed using the linear and multinomial logistic regression models. Results: The mean OHL score was 7.86±3.83 out of 17 in equal number of males and females. Only 21% of the couples had adequate OHL. The socioeconomic, but not demographic variables had significant correlations with the qualitative and quantitative variables of OHL even after controlling for the effect of confounders. A correlation was particularly found between inadequate OHL and years of education [odds ratio:6.00; 95% CI: 3.86-9.28); P<0.001]. Conclusion: Socioeconomic factors had independent correlations with inadequate OHL. Participants with higher levels of education, those living in urban areas, and individuals with better financial status had higher levels of OHL and lower odds of inadequate OHL.

Association between Oral Hygiene Information Sources and Daily Dental and Denture Care Practices in Urban Community-Dwelling Older Adults

The purpose of this cross-sectional study was to explore the sources of daily oral hygiene information among urban community-dwelling older adults in Athens, Greece and associate them with their dental and denture care habits. One hundred and fifty-four older adults (aged 71.7 ± 9.2 years) participated in the study, and their dental status, denture use, daily oral care habits according to current gerodontology recommendations, and oral care information sources were investigated. Daily oral hygiene practices were poor, and a small number of individuals recalled having received oral hygiene advice from a dentist. Only 41.7% of the 139 dentate participants performed toothbrushing with fluoride-based toothpaste at least twice a day, and 35.9% completed regular interdental cleaning. Among 54 denture wearers, 68.5% removed their denture(s) at night, and 54% cleaned them at least twice a day. Oral hygiene information sources included dentists (for approximately half of the participants), media, friends/relatives, non-dental health care providers and dental technicians. Dentate participants who had received oral hygiene information from dentists had a greater probability of brushing their teeth with fluoride toothpaste at least twice a day (p = 0.049, OR = 2.15) and performing regular interdental cleaning (p < 0.001, OR = 29.26). Denture wearers who had received instructions about denture hygiene from dentists were more likely to use a brush and mild soap (p = 0.016, OR = 14.67) and remove their denture(s) at night (p = 0.003, OR = 8.75). Dentists should improve their oral health prevention and promotion strategies for their older patients.

Defining the Connotations of Oral Health Literacy Using the Conceptual Composition Method

Due to advancements in research, the concept of oral health literacy (OHL) has become rich in connotations, with over 250 definitions present in the literature and government and organizational reports. The diversity of OHL definitions and connotations not only produces conflicting results but also limits the production of accurate OHL measurement and assessment tools while simultaneously hindering the construction of health literacy intervention policies. To clarify the connotations of OHL and establish a scientific basis for evaluation, we conducted a systematic review, searching and analyzing the literature related to the conceptual connotations of OHL. Additionally, we extracted basic, methodological, and OHL conceptual connotation information from the literature. With reference to the review framework, we classified the conceptual connotations of OHL into antecedents of OHL, the core of OHL, mediators, and outcomes of OHL. The comprehensive conceptual connotations of OHL were obtained through a systematic review and concept mapping based on the related literature. Our analysis revealed that the antecedents of OHL can be classified in two categories: personal factors and external factors. The core conceptual connotations of OHL include three core dimensions (with 16 subdimensions): (1) basic skills-literacy, reading comprehension, numeracy, hearing, oral expression, communication, and knowledge; (2) information-related abilities-information acquisition, information understanding, information communication, information evaluation, information utilization, and information decision-making; and (3) oral health maintenance abilities-interpersonal skills, self-regulation, and goal achievement. The mediator of these connotations is oral health behaviors, with oral health being the result of OHL. This study further clarifies the conceptual connotations of OHL, serving as a reference for future OHL-related studies.

Oral health literacy in Malang City, Indonesia

Dental and oral health are the main indicators of health, well-being, and quality of life. The concept of Oral Health Literacy (OHL) has become important because it regards individual capacity to understand and use dental information to transform into oral health behaviours. Thus, the aim of this study was to discover and describe the OHL status of adults in Malang City and its relationship with sociodemographic status so that it can be used as a basis for making policy. This study used observational analytical study design involving 450 respondents in Malang by quota random sampling method. The data was collected by the self-administered 29-item HeLD-ID (Health Literacy in Dentistry Indonesian Version) questionnaire. The study resulted that the overall HeLD-ID score was 3.68±0.69. The HeLDID score significant difference was affected by sex (p<0.05) and the other sociodemographic determinants (age, last education, and income) were not. However, there were significant differences of HeLD scores in communication domain (p<0.05) affected by age, sex, and income.

Validation of the Brazilian Oral Health Literacy-Adults Questionnaire

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Gender differences in the association between oral health literacy and oral health-related quality of life in older adults

BACKGROUND

Poor oral health affects quality of life; oral health literacy studies are increasing as it plays an essential role in promoting oral health. However, little is known regarding the gender differences in oral health literacy and oral health-related quality of life (OHRQoL) among older adults. This study aimed to explore the gender differences in oral health literacy and OHRQoL among community-dwelling older adults in Taiwan.

METHODS

A cross-sectional study design with convenience sampling was undertaken to recruit participants at two community service centres. Data were collected using a structured survey consisted of the demographic characteristics, instrumental activities of daily living, nutrition assessment, oral health literacy and OHRQoL. The logistic regression was used to examine the gender differences in the relationship between oral health literacy and OHRQoL.

RESULTS

A total of 202 participants completed the survey. Of which 56.4% (n = 114) were female. Logistic regression analyses showed that after controlling for age, instrumental activities of daily living, nutrition, education level, and average monthly income, better oral health literacy was associated with better oral health quality of life (p = 0.006) in men.

CONCLUSIONS

The relationship between oral health literacy and OHRQoL was only significant for men. No significant relationship between women's oral health literacy and their OHRQoL. However, good OHRQoL is an integral part of overall health, but it is affected by differences in oral health and the accessibility of healthcare services. We suggest that gender-specific oral health literacy education should be offered through community health-education programs.

Attention-deficit Disorder, Family Factors, and Oral Health Literacy

Introduction

Relationships amongst attention-deficit/hyperactivity disorder (ADHD), family factors, and oral health literacy (OHL) in adolescents are unclear. The objective of this research was to investigate whether family environment and signs of ADHD are associated with OHL at the onset of adolescence.

Methods

A cross-sectional study was performed with 448 twelve-year-old adolescents enrolled in schools in Cajazeiras, Brazil. Adolescents responded to an instrument measuring OHL (Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry [BREALD-30]) and a validated questionnaire addressing family cohesion and adaptability (Family Adaptability and Cohesion Scales [FACES III]). Parents and teachers answered subscales of the Swanson, Nolan, and Pelham Questionnaire (SNAP-IV) and a socioeconomic questionnaire. Adjusted Poisson regression analysis was employed for the data analysis (P < .05).

Results

Greater OHL was found in adolescents with higher family cohesion scores (rate ratio [RR], 1.02; 95% confidence interval [CI], 1.01–1.03), those whose mothers had more than 8 years of schooling (RR, 1.07; 95% CI, 1.03–1.12), and those whose families earned more than the Brazilian minimum salary (RR, 1.08; 95% CI, 1.03–1.12). Higher family adaptability scores (RR, 0.99; 95% CI, 0.98–0.99) and more signs of ADHD (teachers’ reports) (RR, 0.95; 95% CI, 0.91–0.99) were associated with lower OHL.

Conclusions

OHL in adolescents was influenced by family adaptability and cohesion, signs of ADHD, maternal schooling, and family income.

Family structure, sociodemographic factors and type of dental service associated with oral health literacy in the early adolescence

The aim of this study was to evaluate associations between oral health literacy and family, sociodemographic and dental service characteristics in early adolescents. A cross-sectional study was conducted with 740 schoolchildren. The following variables were investigated using validated questionnaires: oral health literary (BREALD-30), sociodemographic characteristics, type of dental service and family functioning (FACES III). Associations were tested using robust Poisson regression analysis (α=5%). Higher oral health literacy was associated with the female sex (RR=1.09; 95%CI: 1.03-1.14), connected type of family cohesion (RR=1.12; 95%CI: 1.05-1.20), rigid (RR=1.14; 95%CI: 1.04-1.25) and structured (RR=1.11; 95%CI: 1.04-1.20) types of family adaptability, more than eight years of mother's schooling (RR=1.16; 95%CI: 1.10-1.22), age of caregiver more than 38 years (RR=1.07; 95%CI: 1.02-1.13) and the use of private dental services (RR=1.06; 95%CI: 1.01-1.12). The level of oral health literacy in early adolescents was associated with sex, family structure, mother's schooling, caregiver's age and type of dental service used.

Oral health literacy and socio-demographics as determinants of oral health status and preventive behavior measures in participants of a pre-marriage counseling program

This analytical cross-sectional study aimed to assess the correlation of oral health literacy (OHL) and oral health status and behavior in participants of a pre-marriage counseling program. Also, it aimed to determine the target population's OHL needs to design necessary interventions. A total of 828 couples with a mean age of 24.22 years participating in a pre-marriage counseling program were evaluated. Data were collected using the oral health literacy-adult questionnaire (OHL-AQ). Clinical oral examinations were performed to measure the gingival index (GI), plaque index (PI), and DMFT. The mean OHL score of the couples was 7.86±3.83 out of 17; while, the mean DMFT score was 6.30±5.73. After controlling for the confounders, OHL had a significant correlation with the frequency of dental visits, and smoking status, and inverse correlation with the number of decayed teeth and missing teeth, and PI, and GI (p<0.05). The current results highlight the necessity of OHL interventions to fill the existing gaps. This is an unmet need of the couples, and such interventions are required to promote their own oral health as well as the oral health of their future children.

Association Between Oral Health Literacy and Number of Remaining Teeth Among the Thai Elderly: A Cross-Sectional Study

Purpose

Limited oral health literacy is associated with poor oral health status. This study aimed to determine the association between oral health literacy (OHL) and the number of remaining teeth (NRT) among Thailand’s older population.

Patients and Methods

This cross-sectional study was conducted between July 1, 2020 and September 30, 2020 at the Subdistrict Health Promoting Hospitals in Panare, Pattani, Thailand. A total of 361 independent-living older adults, male and female, participated in the study. OHL data were obtained using the Thai version of Health Literacy in Dentistry (HeLD‐Th) questionnaire. Trained interviewers performed face-to-face interviews for oral health-related behavior information. The NRT was collected through intraoral examination by a trained examiner. Data were analyzed using SPSS version 22. Mann–Whitney U-tests, chi-square tests, and binary logistic regression analysis were performed. A multivariate logistic regression model was developed to test associations between OHL and NRT and other potential covariates. All analyses were two-sided with a 95% confidence interval.

Results

There were significant associations between limited OHL and fewer than 20 remaining teeth (odds ratio [OR]=1.986, P = 0.018), older age (OR=1.743, P = 0.023), and lower educational levels (OR=2.365, P = 0.007).

Conclusion

The significance of this evidence is that OHL influences NRT among older Thai people who have lower education levels. Therefore, OHL intervention is an essential strategy for better oral health-related behaviors to reduce tooth loss and to improve the oral health status of Thai older adults.

Investigating the Level of Knowledge of the Community about Oral and Dental Health

Objectives  This study aimed to determine the knowledge and approaches of the participants about oral and dental health.

Materials and Methods  This was a questionnaire-based cross-sectional survey. Participants’ demographic characteristics, tooth brushing habits, selection of toothpaste, and reasons for visiting the dentist were examined in this study. Participants’ knowledge levels of fluoride and their attitudes toward the most common fluoride applications among preventive treatments were also evaluated. Data entry and analyses were performed using SPSS statistical software. Descriptive and inferential statistics and chi-square test were used for analyzes.

Results  A total of 2,744 voluntary participants including 1,938 (70.6%) females and 806 (29.4%) males responded; 1,391 (50.7%) participants know the contents of their toothpaste; 1,680 (61.2%) participants point out that fluoride is effective in preventing dental caries. Female participants reported a statistically significant difference in their knowledge of what is fluoride when compared with male participants ( p = 0.0001). The knowledge level of participants who had higher levels of education were statistically significantly different when compared with the participants who had lower education levels about fluoride and fluoride applications ( p = 0.0001).

Conclusions  The results of this study indicate that participants’ attitudes toward oral health and dental care need to be improved.

Factors Affecting Dental Service Utilisation in Indonesia: A Population-Based Multilevel Analysis

This study aimed to examine the prevalence of dental service utilisation in Indonesia and its association with social determinants at individual and community levels. Cross-sectional data from the 2014 Indonesian Family Life Survey (IFLS-5) was analysed. Individual independent variables included age, sex, marital status, educational attainment, economic status, health insurance, dental pain, self-reported mouth ulcers, self-rated health status, unmet healthcare needs and smoking status, while community independent variables included cognitive, structural social capital and residential area. Multilevel logistic regressions were performed to explore the associations between independent variables at different levels and the outcome of dental service utilisation. Of the total sample of 16,860 adults aged 15 years or older in our study, around 86.4% never visited a dentist. Dental service utilisation was associated with older age, female, currently not married, higher education level and economic status, health insurance, dental pain, self-reported mouth ulcers, met healthcare needs, never smoking, living in urban areas and communities with high structural social capital. Both individual and broader social determinants influenced dental service utilisation in Indonesia. These factors should be considered in the formulation of oral health policies and programmes aiming to improve dental service utilisation in the country.

Systematic review of the tools of oral and dental health literacy: assessment of conceptual dimensions and psychometric properties

BACKGROUND

This article aims to provide a description of conceptual dimensions and psychometric properties of the tools of oral and dental health literacy.

METHODS

Two authors in this study conducted electronic searches in the Medline (via PubMed), and Embase databases to find relevant articles from 1990 to present day. Evaluation of the tools was carried out in two parts; general evaluation of the tools using skills introduced by Sørensen et al., and qualitative assessment of psychometric properties using COSMIN checklist.

RESULTS

After reviewing 1839 articles on oral and dental health literacy and evaluating 33 full text articles for eligibility, 21 articles entered the study. The sample size varied from 20 to 1405 subjects and the items of each tool ranged from 11 to 99 items. Of the 21 tools examined, 16 tools were evaluated for word recognition. For the studies examined, the evaluation of COSMIN scores was often fair or good. Of the 21 tools examined, 9 tools at least in one dimension were in the category of "poor", 19 tools were in the category of "fair", 20 tools were in the category of "good", and 4 tools were in the category of "excellent" in at least one dimension.

CONCLUSION

The findings of this study showed that some aspects of oral and dental health literacy are being ignored in the existing tools. Therefore, the authors of present study emphasize on the necessity to design and develop a comprehensive tool and take into account two characteristics of simplicity and briefness for international use.

Oral health knowledge in relation to educational level in an adult population in Spain

Background

To analyze the relationship between oral health knowledge and educational level among an adult population in Spain, and between oral health knowledge and subjects’ oral hygiene practices, dietary habits, toxic habits, and oral quality of life.

Material and Methods

This transversal study used the Comprehensive Measure of Oral Health Knowledge (CMOHK) questionnaire to evaluate subjects’ knowledge and understanding of oral health, and the World Health Organization oral health questionnaire for adults to evaluate dietary, oral hygiene, toxic habits, and oral quality of life. Participants (n=400) gave their informed consent and data release permission before taking part in the study, which was approved by the University of Valencia Ethics Committee (certificate No.: H145160675341). Statistical analysis was performed using SPSS v22.0 software, applying Student’s t-test, ANOVA, and chi2 test, with significance set at p<0.05.

Results

Oral health knowledge results were: low 41.5% and high 58.5%. An association was found between educational level and oral health knowledge (Chi2: p=0.000). Oral hygiene habits presenting an association with higher levels of oral health knowledge were dental floss use, a higher number of teeth present, and lower prevalence of partial prostheses. A significant association was found between oral quality of life and oral health knowledge.

Conclusions

Oral health knowledge is associated with the individual subject’s educational level. But oral health knowledge is not necessarily reflected in the practice of healthy habits.

Key words:Oral health literacy, oral health habits, oral health knowledge, CMOHK.

Validation and evaluation of the Mandarin version of the oral health literacy adult questionnaire in Taiwan

OBJECTIVES

This study aimed to translate the Oral Health Literacy Adult Questionnaire into a Mandarin version (MOHL-AQ) and to examine its psychometric properties.

METHODS

A methodological research using psychometric testing and evaluation of a translated instrument. A convenience sample of 402 participants from northern Taiwan were recruited for the validation of the MOHL-AQ. Internal consistency reliability, split-half reliability, inter-rater reliability, face validity, content validity, and construct validity were evaluated.

RESULTS

The value of internal consistency and split-half reliability of the MOHL-AQ were 0.77 and 0.78, respectively. Content validity reported a high content validity index (CVI = 95%). Exploratory factor analysis (EFA) and parallel analysis (PA) were used to determine a unidimensional model and confirmatory factor analysis (CFA) was employed to confirm the model. The indices of good fit model were achieved at GFI = 0.93, AGFI = 0.92, RMSEA = 0.04, CFI = 0.90, PGFI = 0.73, χ² /df = 1.86 (p < .001). Most of the item-total correlations indicated adequate and acceptable convergent validity (r > .30).

CONCLUSION

MOHL-AQ demonstrates adequate psychometric properties for measuring the oral health literacy in Mandarin-speaking population. Public health nurses can use MOHL-AQ to assess oral health literacy in the community settings and further screen potential population with inadequate oral health literacy.