Development and validation of the Oral health behavior questionnaire for adolescents based on the health belief model (OHBQAHBM)

Development and Validation of an Adult Periodontal Health Knowledge and Belief Questionnaire in Thai Adults

INTRODUCTION AND AIMS

Periodontal diseases pose a significant oral health challenge, with many adults lacking adequate understanding of these conditions. This study aimed to develop and validate a questionnaire, designed for standardized assessment of periodontal health knowledge and beliefs in adults (ALPHABET).

METHODS

The ALPHABET questionnaire, initially composed of 70 items focusing on periodontal health knowledge (ALPHA-K) and belief (ALPHA-B), underwent thorough development and validation via expert panel review. Structural validity of ALPHA-B was evaluated using confirmatory factor analysis, while convergent validity was confirmed by expected relationship between the scores of ALPHA-K and ALPHA-B, and reliability was assessed through internal consistency. A cross-sectional analysis involving 380 Thai adult dental patients examined the association between ALPHABET scores and patient types, as well as the association with oral health behaviours.

RESULTS

After refinement, the final 40-item ALPHABET questionnaire showed a strong fit with the underlying model, confirming its structural validity. The correlations between the scores of ALPHA-K and ALPHA-B were proved its convergent validity. It also demonstrated high reliability, with Cronbach's alpha coefficients exceeding 0.7, and favourable item-total correlations ranging from 0.406 to 0.773. Patients with a history of periodontal treatment scored significantly higher on all ALPHABET subscales compared to new patients (P < .05). The logistic regression analysis demonstrated association of both knowledge and self-efficacy with both brushing and flossing behaviours.

CONCLUSIONS

To our knowledge, this questionnaire is the first to validate and assess periodontal health and belief in adults. It should serve as a valuable standardized tool that would potentially drive intervention and raise awareness of the disease and improve periodontal health outcomes.

CLINICAL RELEVANCE

This questionnaire should improve clinician insights into patient perspectives on periodontal disease so as to provide individualized oral health education, guiding tailored interventions for better outcomes.

Cross-cultural adaptation and validation of the Persian version of the oral health values scale

BACKGROUND

The decisions individuals make regarding oral health reflect their values. Prioritizing oral and dental health is essential for public health. This study aimed to evaluate the validity and reliability of the Persian version of the Oral Health Values Questionnaire.

METHODS

A cross-sectional study was conducted involving 500 adults aged 18 years and older at health centers in Shiraz in 2023. The Original Oral Health Values Scale (OHVS) questionnaire was translated into Persian using a forward-backward translation. Participants completed the Persian version of the OHVS, which comprises a 12-item scale with a four-factor structure: professional dental care, appearance and health, flossing, and preservation of natural teeth. The Content Validity Index (CVI), Content Validity Ratio (CVR) and Scale-Level Content Validity Index (S-CVI/Ave) were assessed. Test-retest reliability and Cronbach's alpha were used to evaluate the internal consistency of the questionnaire. To determine the adequacy of the sample size, the Kaiser-Meyer-Olkin (KMO) index, with a minimum value of 0.7, Bartlett's test of sphericity, eigenvalues greater than 1, and the Varimax rotation method were utilized, using SPSS Version 24 statistical software.

RESULTS

All questions demonstrated satisfactory Content Validity Ratio (CVR) and Content Validity Index (CVI), scoring above the expected thresholds of 0.8 and 0.9, respectively. The test-retest correlation results confirmed the reliability of the questionnaire, with correlation coefficients exceeding 0.7 for all questions and their sub-areas. Internal consistency was also established usings domains. Factor analysis revealed four primary components with eigenvalues greater than 1, which collectively accounted for 58.963% of the total variance.

CONCLUSIONS

The Persian version of the OHVS demonstrated excellent validity and reliability. Consequently, it can be regarded as a reliable and valuable tool for epidemiological and behavioral dental studies.

Knowledge, attitude, and practice toward oral health management among orthodontic patients: a cross-sectional study

BACKGROUND

This study aimed to investigate the knowledge, attitude, and practice (KAP) toward oral health management among orthodontic patients.

METHODS

A cross-sectional study on orthodontic patients was conducted at Suzhou Dushu Lake Hospital from December 20, 2023, to March 19, 2024. Demographic data and KAP scores were collected using self-designed questionnaires. The cutoff for adequate KAP dimension scores was 70%.

RESULTS

The study included 418 orthodontic patients, of whom 274 (65.55%) were female, and 144 (34.45%) were male. The average age was 32.70 ± 8.47 years (33.72 ± 8.46 in females and 32.17 ± 8.44 in males). The mean knowledge, attitude, and practice scores were 11.80 ± 4.06 (possible range: 0-16), 27.00 ± 3.18 (possible range: 6-30), and 31.13 ± 6.01 (possible range: 8-40), respectively. The proportions of participants who scored above a cutoff of 70% were 247 (59.09%) for knowledge, 403 (96.41%) for attitude, and 290 (69.38%) for practice. Multivariate logistic regression showed that knowledge score (OR = 1.243, 95% CI: [1.152-1.342], P < 0.001), attitude score (OR = 1.255, 95% CI: [1.140-1.381], P < 0.001), and wearing an appliance for 3 to 6 months (OR = 4.309, 95% CI: [1.565-11.861], P = 0.005) were independently linked to proactive practice. Structural equation modeling demonstrated that knowledge directly influenced attitude (β = 0.684, P < 0.001) and practice (β = 0.527, P < 0.001), while attitude had a direct impact on practice (β = 0.587, P < 0.001).

CONCLUSIONS

The majority of orthodontic patients demonstrated adequate knowledge, positive attitudes, and proactive practices toward oral health management. Nonetheless, continuous education is still essential for certain groups, such as recently fitted orthodontic patients, to ensure sustained improvement in oral health outcomes.

Development and validation of VTE prevention beliefs questionnaire for neurosurgical hospitalized patients based on HBM: a cross-sectional study

Patients hospitalized for neurosurgical procedures are highly susceptible to venous thromboembolism (VTE). It is crucial to evaluate the prevention beliefs of VTE among neurosurgical inpatients and analyse the influencing factors. This research sought to create an instrument grounded in the Health Belief Model (HBM) to evaluate the beliefs about VTE prevention and the factors influencing these beliefs among neurosurgical inpatients. A questionnaire comprising 28 questions was designed, validated, and distributed offline to 386 neurosurgical inpatients through random sampling. The data analysis was conducted using SPSS 26.0 and Amos 27.0. The measurement model was assessed through reliability, validity, and confirmatory factor analyses. Additionally, multiple linear regression analysis was utilized to identify the factors influencing VTE prevention beliefs. Statistical significance was determined by P values less than 0.05. The questionnaire encompassed six constructs, all of which exhibited strong internal consistency along with solid convergent and discriminant validity. VTE prevention beliefs score among neurosurgical inpatients was 99.56 (SD = 10.11). Among the belief dimensions, the scoring rate of perceived benefits and cues to action ranked highest, while perceived barriers were the lowest. The influencing factors of VTE prevention beliefs were educational attainment (β = 0.343, P < 0.001), receipt of VTE knowledge education from healthcare providers (β = 0.214, P < 0.001), Personal history of VTE (β = 0.175, P < 0.001), surgical history (β = 0.116, P < 0.01), sources of VTE-related information (β = 0.113, P < 0.01) and method of paying medical expenses (β = 0.112, P < 0.05). The questionnaire showed strong reliability and validity, and the results indicating that neurosurgical inpatients hold moderate beliefs about VTE prevention. While they recognize its benefits, barriers to preventive behaviors persist. Addressing these barriers and enhancing self-efficacy through targeted education and interventions is key to improving VTE prevention awareness and actions.

Development of a Questionnaire for Dental Utilization Based on the Andersen Model

Background and aim Oral health is an integral part of overall general health. Understanding the variables that affect the use of dental services can help overcome the challenges and lessen disparities in oral health. There are no significant reliable questionnaires available for determining factors that influence dental care utilization. This study aimed to develop and validate a questionnaire based on the Andersen model of healthcare utilization to assess these factors. Materials and methods A preliminary questionnaire consisting of 34 items was developed based on the Andersen model of healthcare utilization. The questionnaire's final version consisted of 24 items after five subject area experts analyzed its face validity and content validity. Content validity ratio (CVR) was used to evaluate the validity of the questionnaire. The Cronbach's alpha coefficient was then used to establish the internal consistency and test-retest for the reliability of the questionnaire. Results The final version of the questionnaire included 24 items based on CVR, and the data of the final version suited the model well. The internal consistency measured with Cronbach's alpha coefficient was above the threshold for each item. The Cronbach's alpha value for test-retest reliability was found to be 0.72, which was acceptable. Conclusions The current results show that the proposed questionnaire for dental utilization based on the Andersen model has satisfactory validity and reliability. This questionnaire can be used as an instrument to determine the various factors that affect the utilization of dental services.

Family behavior theory-based intervention via mobile messaging to improve oral health of adolescents: study protocol for a cluster randomized controlled trial

Background

Due to some unique physical, social and psychological features in the adolescent population, adolescents can be a time of heightened caries activity and periodontal disease. Oral health-related behaviors can be modified to improve oral health status. The family networks and the built environment can promote or inhibit health behaviors. The aim of this study is to implement and evaluate a behavior theory-based, integrated family intervention via mobile messaging to improve oral health of adolescents.

Methods

This is a three-arm parallel-design cluster-randomized controlled trial. This trial will allocate 12 local secondary schools (clusters) in Hong Kong to three test or comparison groups with a ratio 1:1:1. The enrolled Form II to IV students (ages 12 to 15) will be eligible for participation. The intervention to three study groups will be (i) Health Belief Model (HBM)-based mobile messaging to the adolescents and their parents, which will consist of several blocks of HBM-based messages and reinforcement during 24 weeks; (ii) same HBM-based messaging to adolescents only; and (iii) delivering e-version of oral health education pamphlets to adolescents. The primary outcome will be caries increment 2 years post-intervention. Changes in oral health self-efficacy and behaviors, oral hygiene, and gingival status will be the secondary outcomes.

Discussion

No school dental care service is available to secondary school students in Hong Kong. This study will be the first to test a theory-driven and family-engaged preventive intervention among adolescents in Hong Kong. Findings will contribute to developing a low-cost, feasible, and efficient oral health preventive program for adolescents.

Trial registration

ClinicalTrials.govNCT05448664. Registered on 7 July 2022.

Developing an Exercise Attitudes and Behavior Intentions Questionnaire for Survivors of Aortic Dissection: An Exploratory Factor Analysis

Purpose

Our study aimed to develop a questionnaire to assess the reliability and validity of exercise attitudes and behavior intentions among survivors of an aortic dissection (AD).

Methods

There were two phases to the study between April 2021 and April 2022. Phase I involved the development of an initial version of the Exercise Attitudes and Behavior Intentions Questionnaire (EABIQ) through literature reviews, qualitative interviews, Delphi expert consultations and a pre-experimental study. During Phase II, the reliability and validity of the questionnaire was assessed in 160 survivors with AD.

Results

A 62-item EABIQ for AD survivors was developed. Eleven common components with eigenvalues larger than 1 were identified by exploratory factor analysis. The scale's variance explained cumulatively rate was 75.216%. The content validity index at the item level for the EABIQ varied from 0.813 to 1.000 and the S-CVI/Ave was 0.934. The correlation coefficients between each scale dimension and the overall scale ranged from 0.405 to 0.785, with all p-values less than 0.05. Cronbach's alpha for the whole scale was 0.929, with Cronbach's alpha for each domain ranging from 0.835 to 0.965. The overall scale split-half reliability coefficient was 0.960, with each domain's split-half reliability coefficient ranging from 0.844 to 0.962.

Conclusions

The AD exercise attitudes and behavior intentions questionnaire has high reliability and validity and is generally consistent with the hypothetical theoretical framework. It can be used as a judgment tool to measure the exercise behavior for AD patients.

Development and validation of the health belief model questionnaire to promote smoking cessation for nasopharyngeal cancer prevention: a cross-sectional study

OBJECTIVE

Lifestyle-induced nasopharyngeal carcinoma is a serious but preventable risk factor. This study serves to develop and validate a questionnaire that aims to predict the health behavioural intention on smoking cessation in Sarawak, Malaysia using the Health Belief Model (HBM).

DESIGN

A cross-sectional study.

SETTING

Urban and suburban areas in Sarawak, Malaysia.

PARTICIPANTS

The preliminary items of the instrument were developed after extensive literature review. The instrument was translated into the Malay language using the forward-backwards method before commencing with the content validity by a panel of 10 experts. Face validity was done both quantitatively and qualitatively by 10 smokers. The construct validity of the instrument was evaluated through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). A total of 100 smokers participated in phase 1 for EFA, while 171 smokers participated in phase 2 for CFA. Internal consistency was measured using Cronbach's alpha coefficients to evaluate the reliability.

RESULTS

In the exploratory stage, the factor loading of each item remained within the acceptable threshold. The final revised CFA yielded appropriate fit of the seven-factor model with the following model fit indices: χ²=641.705; df=500; p<0.001; comparative fit index=0.953; Tucker-Lewis Index=0.948; root mean square error of approximation=0.041. Satisfactory convergent validity and divergent validity were shown, with the exception of one pairwise construct. The internal reliability of these scales was above the desirable threshold, with Cronbach's alpha coefficients ranging from 0.705 to 0.864 and 0.838 to 0.889 in phases 1 and 2, respectively.

CONCLUSIONS

The study substantiated the instrument to be valid and reliable for predicting smokers' health behavioural intention to reduce cancer risk. The instrument is made up of 34 items, categorised into two sections, six HBM constructs and health behavioural intention. The instrument can be utilised for other smoking cessation-related cancers in different at-risk populations.

Romanian Version of the Oral Health Values Scale: Adaptation and Validation

Background and Objectives: Oral health values are an indicator of how people decide their priorities for oral health—an integral part of general health. The purpose of the study was the validation of the Oral Health Values Scale (OHVS), which measures the extent to which individuals invest in their oral health and which includes four factors: Professional dental care, Appearance, Flossing, and Retention of teeth. Materials and Methods: A cross-sectional study was conducted on a sample of adults (n = 869; Mean age = 32.98) who completed the online questionnaire set. The OHVS was translated into Romanian through the forward-backward translation procedure. The construct validity was assessed through a confirmatory factor analysis (CFA) based on the maximum likelihood estimation method. The convergent validity was assessed by associating the OHVS with scales that evaluate the oral health quality of life (OHIP-14), the attitude towards one’s dentist (R-DBS), oral self-care (DNS), and general health literacy (GHL). The internal consistency was examined using Cronbach’s α and McDonald’s ω. Results: The CFA supports the four-factor model of the scale. The OHVS total score and its subscales are negatively associated with the impact of oral health on the quality of life (except for the Appearance subscale) and with a distrust in the dentist’s treatments; they are positively associated with oral self-care and general health literacy. The gender difference shows females have higher scores on all four subscales. The internal consistency is good for Appearance, Flossing, and the OHVS total score, but weak for Professional dental care and Retention. Conclusions: OHVS is a valid instrument in the Romanian context that can enrich the set of tools that contribute to oral health research, especially in epidemiological studies.

The Efficacy of a Multi-Theory-Based Peer-Led Intervention on Oral Health Among Hong Kong Adolescents: A Cluster-Randomized Controlled Trial

PURPOSE

This study aimed to investigate the effects of a peer-led oral health intervention based on the Health Belief Model and the Social Cognitive Theory on improving oral health among Hong Kong adolescents.

METHODS

The study adopted a cluster-randomized controlled trial design, and 1184 students in 12 schools were randomized to intervention or control groups. After baseline assessment, the intervention group received a peer-led theory-based oral health intervention, while the control group received booklets for oral health promotion. Self-reported brushing and flossing, Health Belief Model/Social Cognitive Theory constructs, and oral health-related quality of life (OHRQoL) were measured at baseline, 6 months, and 12 months, and dental plaque accumulation and caries status were measured at baseline and 12 months. The trial was registered at https://www.clinicaltrials.gov (NCT03694496).

RESULTS

Brushing, flossing, and OHRQoL improved more in the experimental group than in the control group at the 6-month follow-up compared with baseline (p < .001). The mean gain score difference was .81 for brushing, .47 for flossing, and -2.51 for OHRQoL. At the 12-month follow-up, the mean gain score of brushing frequency, plaque index, caries status, and OHRQoL were .18, -.28, -.32, and -2.79, respectively, which all sustained the significant difference (p < .001).

CONCLUSIONS

Our findings suggested that the Health Belief Model combined with Social Cognitive Theory in a peer-led intervention is effective to increase self-reported brushing frequency and improve oral hygiene status and OHRQoL among adolescents.

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

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

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

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

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

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

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

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

Background

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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