Health literacy on oral health practice and condition in an adult and elderly population

Health literacy, oral diseases, and contributing pathways: results from the Lifelines Cohort Study

OBJECTIVE

Health literacy (HL), the ability to deal with information related to one's health, may affect oral health via several routes. Therefore, this study aimed to examine the association of HL with oral diseases, and whether this association is mediated by oral health behaviour and dental care utilisation.

METHODS

We included 26,983 participants from the prospective multigenerational Dutch Lifelines Cohort Study to estimate the association between limited health literacy, and self-reported oral health outcomes (edentulism and gingivitis), and mediation by oral health behaviour and dental care utilisation. Structural equation modelling was used to assess HL's direct, indirect, and total effects on oral health outcomes.

RESULTS

Limited health-literate participants had increased odds of having poor oral health outcomes, i.e. edentulism (odds ratio: 1.41; 95 %-confidence interval: 1.24 to 1.58) and gingivitis (1.22; 1.14 to 1.30). After adjustment for age, income, and education, brushing behaviour and dental care utilization showed a significant mediation effect. Brushing behaviour mediated 7.4 % of the association between HL and edentulism and 6.7 % for gingivitis. Dental visits accounted for 38.0 % of the association between HL and edentulism and 16.4 % for gingivitis.

CONCLUSIONS

Limited HL makes edentulism and gingivitis more likely, with poor oral health behaviour and inadequate dental care utilisation being important mediators. The findings suggest that interventions should focus on helping dental professionals recognize patients with limited HL and providing training in patient-centered communication to improve oral health outcomes.

CLINICAL SIGNIFICANCE

This study demonstrates that limited health literacy significantly increases the risk of edentulism and gingivitis, mediated by inadequate oral health behaviours and dental care utilization. These findings highlight the need for targeted interventions to improve HL, thereby enhancing oral health outcomes and reducing disparities in clinical dental practice.

Exploring the Association Between Oral Health Literacy and Oral Health-Related Quality of Life Among Young Women in the Eastern Province of the Kingdom of Saudi Arabia: A Cross-Sectional Study

OBJECTIVES

One approach for improving oral health is focusing on oral health literacy (OHL). In this study, we aimed to investigate the association between OHL and oral health-related quality of life (OHRQoL) and to identify relevant OHL intervention targets that can be used to improve oral health.

METHODS

We performed a cross-sectional questionnaire study among 1889 10th grade female students in the Eastern Province of the Kingdom of Saudi Arabia (KSA). We then assessed OHL using the Arabic version of the short version of the Health Literacy in Dentistry scale (A-HeLD-14). OHRQoL was assessed using the 14-item oral health impact profile (OHIP-14). Information on socio-demographics and oral health-related behaviours (e.g., toothbrushing, sugary diet consumption and dental attendance) was also collected. The relationship between OHL and OHRQoL was investigated using binary logistic regression adjusted for sociodemographic information and oral health-related behaviours.

RESULTS

In both the adjusted and unadjusted models, poor OHL was significantly associated with OHRQoL problems (odds ration [OR] = 2.90, p < 0.001). Having any OHL problem was significantly associated with having an OHRQoL problem (p < 0.001). The ORs were highest for the domains of financial barriers (OR = 2.49, p < 0.001) and receptivity (OR = 2.16, p < 0.001).

CONCLUSION

Interventions targeted at individuals with low OHL are crucial to improving OHRQoL in the population. The most relevant interventions concern (a) dedicating time and attention to oral health and (b) financial barriers.

The low health literacy in Latin America and the Caribbean: a systematic review and meta-analysis

BACKGROUND

Health literacy (HL) impacts people's health and well-being. In Latin America and the Caribbean (LAC), there are no general estimates of the prevalence of low HL. This study aimed to estimate the prevalence of low HL among citizens of LAC and identify the tools used to measure it.

METHODS

We included observational studies quantifying the prevalence of low HL in people living in LAC. We searched PubMed, CINAHL, EMBASE, ERIC, LILACS, PsycINFO, Redalyc, SciELO, Web of Science, PQDT, and the reference lists of the included studies in June 2023. Two reviewers independently conducted the selection, extraction, and risk of bias assessment using the JBI Critical Appraisal Tools. Meta-analysis of proportions using random effects models was used to summarize the prevalence of low HL estimated. This prevalence was measured in each study using different classification methods: word recognition items, reading and numeracy comprehension items, and self-reported comprehension items.

RESULTS

Eighty four studies involving 23,914 participants from 15 countries were included. We identified 23 tools to assess HL, and most of the studies were carried out in health services. The pooled prevalence of low HL were 44.02% (95%CI: 36.12-52.24) for reading and numeracy comprehension items, 50.62% (95%CI: 41.82-59.39) for word recognition items, and 41.73% (95%CI: 31.76-52.43) for self-reported comprehension items.

CONCLUSION

Despite the variability in the prevalence of low HL and a diversity of tools, the average of low HL is of concern. Almost half of the participants in the included studies have low HL. Most of the studies targeted users of healthcare services. Further research investigating the prevalence of low HL in the general population and actions focused on health education, communication, and information are necessary.

TRIAL REGISTRATION

PROSPERO (CRD42021250286).

Oral health literacy, knowledge and perceptions in a socially and culturally diverse population: a mixed methods study

BACKGROUND

Poor oral health literacy has been proposed as a causal factor in disparities in oral health outcomes. This study aims to investigate oral health literacy (OHL) in a socially and culturally diverse population of Australian adults visiting a public dental clinic in Western Sydney.

METHODS

A mixed methods study where oral health literacy was assessed using the Health Literacy in Dentistry scale (HeLD-14) questionnaire and semi-structured interviews explored oral health related knowledge, perceptions and attitudes. Interviews were analysed using a thematic approach.

RESULTS

A sample of 48 participants attending a public dental clinic in Western Sydney was recruited, with a mean age of 59.9 (SD16.2) years, 48% female, 50% born in Australia, 45% with high school or lower education, and 56% with low-medium OHL. A subgroup of 21 participants with a mean age of 68.1 (SD14.6) years, 40% female, 64% born in Australia, 56% with a high school or lower education, and 45% with low-medium OHL completed the interview. Three themes identified from the interviews included 1) attitudes and perceptions about oral health that highlighted a lack of agency and low prioritisation of oral health, 2) limited knowledge and education about the causes and consequences of poor oral health, including limited access to oral health education and finally 3) barriers and enablers to maintaining good oral health, with financial barriers being the main contributor to low OHL.

CONCLUSIONS

Strategies aimed at redressing disparities in oral health status should include improving access to oral health information. The focus should be on the impact poor oral health has on general health with clear messages about prevention and treatment options in order to empower individuals to better manage their oral health.

The Association between Electronic Health Literacy and Oral Health Outcomes among Dental Patients in Saudi Arabia: A Cross-Sectional Study

OBJECTIVE

This cross-sectional study aimed to investigate the association between electronic health (eHealth) literacy and oral health outcomes, including the number of teeth and brushing frequency.

METHODS

A total of 478 participants were included in the study and assessed for their eHealth literacy levels. Demographic variables, including age, gender, income, and education, were collected. The participants' number of teeth and brushing frequency were also recorded. Multiple regression analyses were performed to examine the relationship between eHealth literacy and oral health outcomes, adjusting for sociodemographic variables.

RESULTS

The study sample consisted of both males (66.5%) and females (33.5%), with a mean age of 31.95 years. Among the participants, 16.95% were classified as having inadequate eHealth literacy, 24.06% had problematic eHealth literacy, and the majority (59.00%) demonstrated sufficient eHealth literacy. There was a significant association between eHealth literacy and oral health outcomes. Individuals with problematic eHealth literacy had a higher likelihood of having a greater number of teeth (RR = 1.12, 95% CI: 1.05-1.20, p < 0.001) compared to those with inadequate eHealth literacy. Similarly, individuals with sufficient eHealth literacy showed a higher likelihood of having more teeth (RR = 1.14, 95% CI: 1.07-1.21, p < 0.001) compared to the inadequate eHealth literacy group controlling for age, gender, income, and education. Individuals with problematic eHealth literacy exhibited a tendency towards lower odds of irregular brushing (OR = 0.39, 95% CI: 0.15-1.02, p = 0.054), although this result was marginally significant. In contrast, individuals with sufficient eHealth literacy had significantly lower odds of irregular brushing frequency (OR = 0.24, 95% CI: 0.10-0.62, p = 0.003) compared to the inadequate eHealth literacy group.

CONCLUSION

The findings suggest a positive association between eHealth literacy and oral health outcomes. Improving eHealth literacy may have implications for promoting better oral health behaviors and outcomes.

Associations of health literacy with dental care use and oral health status in Japan

BACKGROUND

The concept of health literacy has gained prominence in the context of oral health. In Japan, curative dental care is generally under universal health coverage, while preventive dental care requires effort. We used this situation to test the hypothesis that high health literacy is associated with preventive dental care use and good oral health status, but not with curative dental care use, in Japan.

METHODS

A questionnaire survey was conducted from 2010 to 2011 among residents aged 25-50 years in Japanese metropolitan areas. Data from 3767 participants were used. Health literacy was measured using the Communicative and Critical Health Literacy Scale, and the total score was categorized into quartiles. Poisson regression analyses with robust variance estimators were conducted to examine the associations of health literacy with curative dental care use, preventive dental care use, and good oral health, adjusted for covariates.

RESULTS

The percentages of curative dental care use, preventive dental care use, and good oral health were 40.2%, 28.8%, and 74.0%, respectively. Health literacy was not associated with curative dental care use; the prevalence ratio (PR) of the highest relative to the lowest quartile of health literacy was 1.04 (95% confidence interval [CI], 0.93-1.18). High health literacy was associated with preventive dental care use and good oral health; the corresponding PRs were 1.17 (95% CI, 1.00-1.36) and 1.09 (95% CI, 1.03-1.15), respectively.

CONCLUSIONS

These findings may provide clues for the design of effective interventions to promote preventive dental care use and improve oral health status.

Amazon Amandaba-Sociodemographic Factors, Health Literacy, Biochemical Parameters and Self-Care as Predictors in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

BACKGROUND

Health literacy (HL) and its domains (functional, critical, and communicative) appear to be related to self-care adherence in people with type 2 diabetes mellitus (DM2). This study aimed to verify if sociodemographic variables are predictors of HL, if HL and the sociodemographic factors affect biochemical parameters together, and if HL domains are predictors of self-care in DM2.

METHODS

We used the baseline assessment data from 199 participants ≥ 30 years in the project, "Amandaba na Amazônia: Culture Circles as a Strategy to Encourage Self-care for DM in Primary Health Care," which took place in November and December 2021.

RESULTS

In the HL predictor analysis, women (p = 0.024) and higher education (p = 0.005) were predictors of better functional HL. The predictors of biochemical parameters were: glycated hemoglobin control with low critical HL (p = 0.008); total cholesterol control with female sex (p = 0.004), and low critical HL (p = 0.024); low-density lipoprotein control with female sex (p = 0.027), and low critical HL (p = 0.007); high-density lipoprotein control with female sex (p = 0.001); triglyceride control with low Functional HL (p = 0.039); high levels of microalbuminuria with female sex (p = 0.014). A low critical HL was a predictor of a lower specific diet (p = 0.002) and a low total HL of low medication care (p = 0.027) in analyses of HL domains as predictors of self-care.

CONCLUSION

Sociodemographic factors can be used to predict HL, and HL can predict biochemical parameters and self-care.

Is oral health literacy associated with conceptions of care and behavior related to the prevention of COVID-19?

The aim of the present study was to investigate the impact of oral health literacy (OHL) on conceptions of care and behaviors related to COVID-19. The sample came from two preliminary cross-sectional studies that determined the level of OHL of parents/guardians of six-to-12-year-old children in two major Brazilian cities (Curitiba and Belo Horizonte). Functional OHL was measured using the Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry (BREALD-30) and the Health Literacy Dental Scale (HeLD-14) for the evaluation of interactive OHL. Participants were recruited through e-mail, social media, and telephone contact. The questionnaire on conceptions of care and behaviors related to COVID-19 was created based on the guidelines of the World Health Organization. Two hundred nineteen individuals participated in the study. There was no significant difference in socioeconomic and demographic variables and in the medians of BREALD and HeLD-14 between the two cities (P>0.05). Higher levels of functional OHL were associated with an appropriate conception that individual care affects collective care (P=0.038), but with an inappropriate conception of seeking medical assistance in cases of mild symptoms (P=0.030). Higher levels of interactive OHL were related to social distancing behavior in the city of Curitiba (P=0.049) and in the overall sample (P=0.040). It is concluded that functional OHL was associated with two of the investigated conceptions about COVID-19, while interactive OHL was associated with social distancing behavior. These data may suggest that different dimensions of the OHL can have an impact on different aspects of coping with the pandemic.

Assessment of the oral health literacy and oral health behaviors among nurses in China: a cross-sectional study

PURPOSE

Oral health is important for general health; nurses are expected to possess good oral health awareness and work together for public oral health promotion. The purpose of this study is to investigate oral health literacy (OHL)and oral health behaviors of nurses, and explore the association between oral health literacy with demographic variables and oral health behaviors.

METHODS

A cross-sectional study in a tertiary hospital was conducted using a short-form Health Literacy in Dentistry-14 (HeLD-14) and a 16-items oral health behaviors questionnaire. Information about the subjects' demographic details including age, gender, place of residence, marital status, marital status, education level, monthly household income, working experience, etc. were collected. Independent sample t- test, One- way ANOVA, and multivariable regression were used to identify the association of oral health literacy with demographic variables and oral health behaviors.

RESULTS

A total number of 317 nursing nurses participated in the survey, with a mean OHL score of 36.72, SD10.531, 21.8% were categorized as good, 34.1% medium and 44.2% poor oral health literacy; monthly household income, self-rated oral health, brushing time, use of fluoride toothpaste, and regular oral examination were signficantly associated with OHL scores.

CONCLUSION

The overall oral health literacy of the nurse population is at a moderate to low level. These findings may help to map and design an oral health education intervention to improve oral health literacy amongst nurses, especially nurses with low monthly household income and poor self-assessed oral health status. Nursing administrators and nursing educators should pay more attention to the oral health status of the nurse population.

Interplay of health literacy, healthcare access and health behaviors with oral health status among older persons

This study contributes to the ongoing debate on social determinants of oral health of older persons. Specifically, it examines the direct and indirect effects of health literacy and access to healthcare on oral health status of older persons. The study also investigates whether general health status and health behavior (routine medical check-ups) explain the association of health literacy and healthcare access with oral health status. The gender dimensions of these relationships are also explored. Data were derived from 522 participants aged 50 years and older located in five regions in Ghana. Path analyses in structural equation modeling (SEM) were used to analyse the data. General health status (β = -0.049, p < 0.005), medical check-up (β = 0.124, p < 0.01), and health literacy (β = 0.133, p < 0.01) were positively associated with oral health status. General health status mediated the positive relationship between health literacy and oral health status (β = 0.048, p < 0.01). General health status (β = 0.016, p < 0.05) and medical check-ups (β = 0.025, p < 0.05) mediated the association between access to healthcare and oral health status. The mediational role of routine medical check-up in the association between access to healthcare and oral health status was significantly stronger (B = 0.063, p < 0.01) among men (β = 0.051, p < 0.01) than women (β = 0.003, p > 0.05). Analyses of oral health issues among older persons in Ghana and settings alike must recognize the complex interplay among critical social determinants to initiate pragmatic health and social policy interventions.

Association between the interval of worksite dental check-ups and dental and medical expenditures: a single-site, 12-year follow-up study in Japan

OBJECTIVES

The purpose of this study was to identify the effective intervals of worksite dental check-ups to reduce cumulative dental expenditures (CDEs) and cumulative medical expenditures (CMEs), based on 12 years of follow-up dental check-ups.

SETTING, DESIGN AND PARTICIPANTS

A longitudinal study was conducted between 2002 and 2014 fiscal years. A total of 2691 full-time employees (2099 males and 592 females) aged 20-59 years in a manufacturing company in Japan were recruited.

PRIMARY AND SECONDARY OUTCOME MEASURES

Based on the follow-up of 12-year dental check-ups, the interval of dental check-ups visits was classified into the following categories: 'Once per year' as the regular group, 'At least once per 2 years' as the subregular group and others as the irregular group. CDEs and CMEs per capita were examined by the three groups of dental check-ups interval after adjustment for sex, age, occupation and total CMEs at baseline. For sensitivity analysis, decayed teeth, missing teeth and Community Periodontal Index were added as adjustment factors.

RESULTS

Compared with the irregular group, the pooled CDEs (including dental check-ups fee) per capita in the subregular group (OR 0.91, 95% CI 0.85 to 0.98) and regular group (OR 0.87, 95% CI 0.81 to 0.93) were significantly lower overall. The younger adults in the subregular group and younger-aged and middle-aged adults in the regular group had significantly lower CDEs. Sensitivity analysis confirmed these findings.

CONCLUSIONS

Our findings suggest that regular and subregular worksite dental check-ups were related to reduction of CDEs. It is important to promote a yearly interval between dental check-ups.

Regular dental visits, periodontitis, tooth loss, and atherosclerosis: The Ohasama study

Objective

We aimed to explore the association between regular dental visits and atherosclerosis and between periodontitis, number of remaining teeth, and atherosclerosis among community dwellers in Japan.

Background

Few studies have examined the association between regular dental visits, periodontitis, tooth loss, and atherosclerosis in community dwellers in Japan.

Methods

The participants of this cross‐sectional study included community dwellers aged ≥55 years and residing in Ohasama. Exposure variables were regular dental visits; periodontitis, defined as radiographic alveolar bone loss (BL); the Centers for Disease Control/American Academy of Periodontology (CDC/AAP) classification; and number of remaining teeth. The primary outcome was atherosclerosis, defined as maximum carotid intima‐media thickness ≥1.1 mm or confirmation of atheromatous plaque.

Results

Of 602 participants, 117 had atherosclerosis. In the multivariate model, compared to those with regular dental visits, the odds ratio (OR) (95% confidence intervals [CIs]) of atherosclerosis among those with the absence of regular dental visits was 2.16 (1.03–4.49). Regarding BL‐max, compared with those in the first quartile, ORs (95% CIs) of those in the second, third, and fourth quartiles were 1.15 (0.65–2.30), 0.65 (0.32–1.35), and 1.57 (0.81–3.01), respectively. Regarding CDC/AAP classification, compared to those with no or mild periodontitis, ORs (95% CIs) for those with moderate and severe periodontitis were 2.48 (0.61–10.1) and 4.26 (1.01–17.5), respectively. Regarding the number of remaining teeth, compared to those with ≥20 teeth, ORs (95%CIs) for those with 10–19 and 1–9 teeth were 1.77 (1.004–3.12) and 0.96 (0.52–1.80), respectively.

Conclusion

The absence of regular dental visits and presence of periodontitis are associated with atherosclerosis among community dwellers in Japan.

The role of health literacy as a factor associated with tooth loss

OBJECTIVE

The objective was to analyze the role of health literacy (HL) as a factor associated with tooth loss among users of the Brazilian Health System with chronic non-communicable diseases.

METHODS

The cross-sectional analytical study was conducted with adult and elderly users chosen at ten Family Health Clinics in a draw in the town of Piracicaba, São Paulo State, Brazil. A questionnaire was applied with sociodemographic data (sex, age, skin color and education), behavioral data (brushing and flossing), determinants in health (type of dental health services and how often) and clinical data (pain). Mouth conditions were collected by intraoral examination of visible dental biofilm and community Pediodontal Index. The systemic clinical conditions (blood glucose, glycated hemoglobin and blood pressure) were extracted from the medical records. The explanatory variable was HL (low, medium and high), measured with the Health Literacy Scale (HLS-14).

RESULTS

The outcome was tooth loss measured by the index of decayed, missing and filled teeth. Logistic regression was performed using a conceptual model for HL (p < 0.05). For the 238 subjects, the mean age was 62.7 years (± 10.55). Tooth loss was associated with HL in regression models adjusted by type of dental service, dental frequency, and dental floss. In the final model, the factors associated with tooth loss are older age (OR = 1,12; 95%CI: 1,07-1,17), a lower education (OR = 3,43; 95%CI: 1,17-10,10), irregular use of dental floss (OR = 4,58; 95%CI: 1.75 in-7,31), irregular use of dental services (n = 2,60; 95% 1,32-5,12), periodontal pocket (> 4 mm) (n = 0,31; 95%CI: 0,01-0,08), having visible dental biofilm (OR = 7,23; 95%CI: 3,19-16,41) and a higher level of blood sugar (glucose) (n = 1,98; 95%CI: 1.00-3,92).

CONCLUSIONS

tooth loss was associated with HL when adjusted by health behaviors; when sociodemographic variables and clinical conditions were included, it was less significant. In the final model, behaviors, determinants in health and clinical conditions were risk indicators of tooth loss, showing the multifactorial nature of this phenomenon.

Association of Health Literacy and Socioeconomic Status with Oral Health Among Older Adults in Ghana: A Moderation Analysis of Social Capital

We examined the moderating role of social capital (SC) in the association of socioeconomic status (SES) and health literacy (HL) with oral health (OH) status and the intentions to use OH services (IUOHS) among older Ghanaians. Data were derived from a cross-sectional survey (n = 522) and analyzed using ordinal and binary logistic regressions. Bridging SC moderated the relationship between HL and oral health status (B = 0. 0.117, p < .05) and the association of SES with IUOHS (adjusted odds ratio [AOR] = 1.144; 95% confidence interval [CI] = [1.027, 3.599]). Trust modified the association between HL and IUOHS (AOR = 1.051; 95% CI = [1.014, 3.789]). Bonding SC moderated the association between SES and oral health status (B = 0.180, p < .05). However, bonding SC negatively modified the association between SES and IUOHS (AOR = 0.961; 95% CI = [0.727, 0.997]). Cognitive and structural SC modify the associations of SES and HL with OH and IUOHS.