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

Developing a codesigned text message-based digital oral health education resource (TOOTH)

Objective

Digital health technologies offer a more equitable way of providing access to health education. This study engaged consumers and clinicians from two Australian regions with a high burden of oral disease to develop a digital oral health resource called "TOOTH" tailored for adults.

Methods

A total of three focus groups (one clinician and two consumers) were conducted to identify themes that were used to draft text message content. The study team reviewed, refined, and mapped these messages to behaviour change techniques and developed videos to support key concepts.

Results

Eight multidisciplinary clinicians (dentist, oral health therapist, dietician, cardiac nurse, and dental nurse), 75% female with a mean age of 48 ± 10 years, and seven consumers from a metropolitan and a regional area in New South Wales, 43% female with a mean age 62 ± 11.6 years participated in the focus groups. Key themes identified by clinicians included (1) limited support from medical and allied health teams for integrating oral health care into the healthcare system, (2) government-supported measures enable prevention, and (3) poor oral health of Australians. Consumers highlighted (1) barriers to accessing oral health care, (2) negative attitudes towards oral health, and (3) limited oral health-related knowledge. The final resource developed includes 81 text messages sequenced to ensure a gradual increase in knowledge and skill and five supporting videos.

Conclusions

The TOOTH resource has the potential to improve awareness and knowledge regarding oral disease prevention, enabling more equitable access to oral health education and better self-management of oral health.

Apply the information-motivation-behavioral model to explore the relationship between oral health literacy and oral health behaviors among community-dwelling older adults

OBJECTIVE

Oral health is a critical area in healthy aging. Oral health literacy (OHL) plays an important role in improving oral health behaviors and oral health status. However, few studies have investigated OHL among community-dwelling older adults and the influential mechanism of OHL on oral health behaviors has not been clarified. The aim of this study is to explore the interaction pathways through which OHL influences oral health behaviors among community-dwelling older adults.

METHODS

This is a cross-sectional study. 429 community-dwelling older adults were recruited by a convenience sampling method from the activity service center in Zhenjiang, Southern China. The data were collected between September and November 2021 using the Oral Health Literacy Adult Questionnaire (OHL-AQ) and other sophisticated scale assessments. A theoretical model based on the information-motivation-behavioral skills model (IMB model) and previous research was developed and then validated using a structural equation model with AMOS v24.0.

RESULTS

The proposed model revealed a good fit to the data (χ2/df = 3.349, goodness of fit index = 0.957, adjusted goodness of fit index = 0.921, root mean squared error of approximation = 0.074, comparative fit index = 0.955, normed fit index = 0.938). Oral health information (β = 0.23) and motivation (β = 0.56) positively affected OHL. OHL (β = 0.20) and motivation (β = 0.25) positively affected self-efficacy; self-efficacy (β = 0.98) had a direct effect on oral health behavior. OHL had an indirect effect on oral health behaviors through self-efficacy (β = 0.19). Motivation can both directly influence oral health behavior (β = 0.18) and indirectly influence oral health behavior through OHL and self-efficacy(β = 0.35).

CONCLUSIONS

The study findings make a valuable contribution to the influential mechanism of OHL on oral health behaviors. OHL improved oral health behaviors through self-efficacy among community-dwelling older adults. Oral health information directly affected OHL. Motivation directly affected oral health behaviors as well as influence oral health behaviors by changing OHL.

Modified Oral Health Assessment Tool (M-OHAT) for Residential Aged Care: A Co-Design Protocol

Background: Older adults in residential aged care facilities (RACFs) experience disproportionate levels of poor oral health relative to other groups in the general population, affecting their physical and mental wellbeing. The Oral Health Assessment Tool (OHAT) is a validated and widely used dental assessment tool; however, recent systematic reviews have identified shortcomings with respect to its measurement properties. Objective: The objective of this protocol is to provide a detailed overview of a multidisciplinary qualitative study that aims to (a) co-design and develop a modified OHAT for RACFs and (b) inform the development of an OHAT training package and implementation strategies. Methods: This study will utilize a co-design methodology with aged care residents, caregivers, staff members, and health professionals. The co-design workshops will: (1) investigate the barriers to and enablers of optimal oral healthcare in RACFs; and (2) co-design a modified version of the Oral Health Assessment Tool and a referral to treatment pathway that is appropriate for use in RACFs. The co-design workshops will facilitate group discussion and involve interactive activities using, for example, mind mapping and Sticky Notes. Qualitative data (transcripts and artefacts from co-design activities) will be analyzed in NVivo using an inductive codebook thematic analysis, specifically a template analysis. Conclusion: The findings of this study will inform a modified OHAT (M-OHAT), as well as future study phases regarding training and implementation strategies. It is expected that the M-OHAT will have enhanced usability and relevance to RACFs, facilitating the identification of poor oral health and timely referral to dental treatment.

SmilesUp text message intervention for early childhood dental caries prevention: A protocol for a randomised controlled trial

INTRODUCTION

Despite improvements in health outcomes for children, early childhood dental caries (ECC) remains a chronic lifestyle-mediated disease that affects an estimated 600 million children worldwide. Parental influence on oral health-promoting behaviours is pivotal in preventing ECC. The latest WHO publications Ending Early Childhood Dental Caries and Mobile Technologies for Oral Health highlights the opportunity for mobile Health programs (including text message programs) to improve oral health behaviours and oral health self-efficacy. In response, our team of parents, oral health professionals (academics and health promotion experts), and IT specialists co-designed a 12-week, behavioural theory-informed text message program (called SmilesUp) to address behavioural risk factors specific to ECC. This randomised trial aims to assess whether the SmilesUp program improves parents' oral health promoting behaviours (like tooth brushing twice a day with toothpaste) and oral health self-efficacy for their children compared to usual care.

METHODS AND ANALYSIS

A randomised controlled trial with a 1:1 parallel design will be conducted among 150 parents with children diagnosed with ECC and accessing public dental care in NSW, Australia. Patients will be stratified by hospital site, and modality of care (Dental General Anaesthetic (DGA) or not) and then randomly assigned to either immediately receive the SMILESup text messaging intervention or receive the program at the end of the study period. The primary outcome at 12 weeks is twice daily brushing with fluoride toothpaste. Secondary outcomes include changes in the intake frequency of sugared drinks and foods, oral health promoting bedtime routines and oral health self-efficacy. The primary analysis will follow an intention-to-treat principle. In addition, a process evaluation will examine barriers, enablers, and opportunities to scale the program.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the Western Sydney Local Health District Human Research Ethics Committee 2022/ETH01920. Study results will be disseminated via peer-reviewed publications and presentations at conferences.

TRIAL REGISTRATION

Trial registration number: This clinical trial has been prospectively registered on the ANZCTR from the 27th of March 2023. Registration number: ACTRN12623000325606.

Promoting Health Literacy in the Workplace Among Civil Servants: Cross-Sectional Study

Background

In 2022, the World Health Organization highlighted the alarming state of oral health (OH) worldwide and urged action to include OH in initiatives on noncommunicable diseases. The population needs improved OH skills and attitudes and an adequate level of OH literacy (OHL) and general health literacy (HL). The implementation of health promotion actions in the workplace, which is a part of most people's lives, appears to be an opportunity. In France, civil servants have several socioprofessional levels and represent an excellent model with results transposable to the population.

Objective

This study aimed at determining the OHL and HL level of civil servants in France in order to implement specific prevention actions in their workplaces.

Methods

A cross-sectional study of French civil servants was conducted in France from October 2023 to February 2024. Participants completed three validated questionnaires in French: (1) a questionnaire on OH knowledge, (2) the Oral Health Literacy Instrument, French version (OHLI-F; this is composed of reading comprehension and numeracy sections) to assess the OHL level, and (3) the Short Test of Functional Health Literacy in Adults, French version (s-TOFHLA-F) to assess the HL level. The scores for OH knowledge, the OHLI-F, and the s-TOFHLA-F were reported as means (SD) and the 95% CI. These scores were classified into 3 categories: adequate (75-100), marginal (60-74) and inadequate (0-59). ANOVA and binary logistic regression were performed. The OHLI-F reading comprehension and OHLI-F numeracy scores were compared using the Welch 2-sample t test and a paired t test (both 2-tailed). For the correlation matrix, the Pearson correlation and related tests were computed.

Results

A total of 1917 persons completed the 3 questionnaires, with adequate levels of OHL (n=1610, 84%), OH knowledge (n=1736, 90.6%), and HL (n=1915, 99.9%). The scores on the s-TOFHLA-F (mean 98.2, SD 2.8) were higher than the OHLI-F (mean 80.9, SD 7.9) and OH knowledge (mean 87.6, SD 10.5). The OHLI-F was highly correlated with OH knowledge (P<.001), but the OHLI-F and OH knowledge had a low correlation with s-TOFHLA-F (P=.43). The OHLI-F reading comprehension score was significantly higher than the OHLI-F numeracy score (P<.001). Age, education level, and professional category impacted the 3 scores (P<.001). The professional category was a determinant of adequate OHLI-F and OH knowledge scores.

Conclusions

Some French civil servants had inadequate or marginal levels of OH knowledge (n=181, 9.5%) and OHL (n=307, 16%) but none had an inadequate level of HL. Results highlighted the relevance of implementing OH promotion programs in the workplace. They should be nonstandardized, adapted to the literacy level of professional categories of workers, and focused on numeracy skills. Thus, appropriate preventive communication and improved literacy levels are the means to achieve greater disease equity and combat the burden of noncommunicable diseases.

The association between oral health literacy and oral health-related behaviours among female adolescents in the Kingdom of Saudi Arabia: A cross-sectional study

Objectives

Oral health literacy (OHL) is suggested as an important denominator of oral health. This study aimed to identify ways to improve oral health by exploring the association between oral health literacy and oral health-related behaviours among female adolescents in the Eastern Province of the Kingdom of Saudi Arabia (KSA).

Methods

This cross-sectional study assessed OHL among 1,889 10th grade female students in the Eastern Province of the KSA. OHL was assessed using an Arabic version of the short version of the Health Literacy in Dentistry scale (A-HeLD-14). Self-reported socio-demographic information and oral health-related behaviours (toothbrushing, dental attendance, and sugary diet consumption) were also collected. The relationship between OHL and oral health-related behaviours was investigated using binary logistic regression, adjusted for socio-demographic information.

Results

The binary logistic regression analyses showed that poor OHL was significantly associated with infrequent toothbrushing (p < 0.001) and irregular dental attendance (p = 0.005) but not with consumption of sugary diets. All A-HeLD-14 domains were significantly associated with infrequent toothbrushing, and the domains concerning access, receptivity, and financial barriers were significantly associated with irregular dental attendance. The highest odds ratios (ORs) for infrequent toothbrushing were found in the domains of receptivity (OR = 4.19) and understanding (OR = 3.85) and for irregular dental attendance in the financial barriers (OR = 1.61) and access (OR = 1.49) domains, followed by the receptivity domain (OR = 1.35).

Conclusion

Poor OHL was significantly associated with infrequent toothbrushing and irregular dental attendance. Interventions focusing on OHL are warranted to improve oral health-related behaviours and thereby oral health in the population. The aspects that seem most vital to target are improved access to dental care, including the reduction of economic barriers, as well as increased awareness of oral health in the population.

Factors associated with oral health care behavior of people with type 2 diabetes mellitus: A hospital-based, cross-sectional study

BACKGROUND

Oral healthcare behavior determines oral health status and the incidence of oral diseases. People with type 2 diabetes mellitus (T2DM) are at-risk of having low oral healthcare behavior and disease-related oral health.

OBJECTIVE

To investigate the oral health status and factors associated with oral healthcare behavior among people with T2DM in Thailand.

METHODS

In total, 401 people with T2DM participated in the study based on their attendance at a non-communicable disease clinic at sub-district health promotion hospitals in Bueng Kan, a north-eastern province in Thailand. A structured questionnaire was used to obtain variables of interest. Linear regression analysis at the 95% confidence interval (CI) was applied.

RESULTS

The majority of participants were female (73.8%). More than three-quarters had more than 20 permanent teeth (77.6%), a decay missing filling tooth index was 10.6 teeth/person. Many participants had four permanent occlusal pairs (69.6%), had tooth decay (74.6%), and some participants had tooth filling (32.2%). Statistically significant factors associated with oral healthcare behavior were: having complications associated with diabetes mellitus (Beta = -0.097, 95%CI = -1.653, -0.046), oral health literacy (Beta = 0.119, 95%CI = 0.009, 0.150), educational level (Beta = 0.123, 95%CI = 0.103, 0.949), oral healthcare attitude (Beta = 0.258, 95%CI = 0.143, 0.333), and oral health services (Beta = 0.430, 95%CI = 0.298, 1.408).

CONCLUSIONS

People with T2DM had good oral health status. People with T2DM with low oral health literacy, low attitude, and low level of oral health services were at a higher risk of poor oral healthcare behavior.

The Role of Parental Health Literacy in Establishing Health-Promoting Habits in Early Childhood

In early childhood, children are extremely susceptible to the acquisition of habits and the establishment of health-promoting habits. Therefore, the patterns, routines, and rules transmitted and expected by the adults surrounding the child are of paramount importance and can correlate with the level of their health literacy. Our cross-sectional, quantitative, exploratory study aimed to examine the relationships between parental health literacy and preschool children's health-related habits, using simple, non-random sampling (n = 598). In addition to the sociodemographic characteristics, the measuring tool we compiled included the standardized European Health Literacy Survey Questionnaire (HLS-EU-Q16), as well as a set of questions containing 30 statements suitable for exploring children's habit systems. The health literacy of the parents involved in our study proved to be more favorable than that of the general population. Regarding children's habit systems, we found significant differences in several areas by age group (p < 0.05) and gender (p < 0.05). The levels of parental health literacy (0.003 ≤ p ≤ 0.048) and parents' education (p < 0.05) show a correlation with the children's health-related habit systems: the indicators of children with parents who have a higher level of health literacy and a higher level of education are more favorable in terms of established habits. In the long term, the formation of health-promoting habits may facilitate the internalization of favorable health behavior motives for the future, contributing to the establishment of positive physical, mental, and social health in adulthood.

Role of Artificial Intelligence (AI) in Patient Education and Communication in Dentistry

Effective patient education and communication are integral components of quality dental care, contributing to informed decision-making, treatment compliance, and positive clinical outcomes. However, traditional methods face challenges such as language barriers, anxiety, and information retention issues. Artificial intelligence (AI) presents innovative solutions to enhance patient engagement and communication in dentistry. This review explores the transformative role of AI in redefining patient education and communication strategies, focusing on applications, benefits, challenges, and future directions. A literature search identified articles from 2018 to 2024, encompassing empirical evidence and conceptual frameworks related to AI in dental patient engagement and communication. Key findings reveal AI's potential to offer personalized educational materials, virtual consultations, language translation tools, and virtual reality simulations, improving patient understanding and experience. Despite advancements, concerns about overreliance, accuracy, implementation costs, patient acceptance, privacy, and regulatory compliance persist. Future implications suggest AI's ability to track patient progress, analyze feedback, streamline administrative processes, and provide ongoing support, enhancing oral health outcomes. However, ethical, regulatory, and equity considerations require attention for responsible AI deployment and widespread adoption. Overall, AI holds promise for revolutionizing dental patient education, communication, and care delivery, emphasizing the need for comprehensive strategies to address emerging challenges and maximize benefits.

Pediatric Oral Health Online Education for Rural and Migrant Head Start Programs in the United States

Children living in rural and migrant areas in the United States disproportionately suffer from poor oral health. Additionally, there continues to be a shortage of pediatric dentists practicing in rural/migrant areas. The purpose of this formative research study was to assess whether staff, teachers and families from rural/migrant Head Start/Early Head Start (HS/EHS) programs in California were receptive to oral health online education workshops conducted by pediatric dental residents who were assisted by bilingual (English and Spanish) community oral health workers (COHWs). Our findings suggest that partnering pediatric dental residents with bilingual COHWs to educate HS/EHS teachers, staff and parents on oral health care in rural/migrant areas could result in a rewarding experience for pediatric dentists that might lead them to practice in these communities upon graduation from their residency program. Furthermore, the positive feedback received from the teachers, staff and parents who participated in the workshops indicates they were receptive to receiving oral health information related to oral health literacy from the dental providers and COHWs. COHWs can help increase access to oral health care by serving as a bridge between families and providers by relaying information in a cultural, linguistic and sensitive manner.

The transcultural adaptation and validation of the Chinese version of the Oral Health Literacy Scale for Diabetic Patients

BACKGROUND

Diabetic patients' oral health concerns are a reality for every diabetic patient in China. The attitudes of diabetic patients toward early identification of oral literacy influence oral literacy in diabetes patients. Diabetes patients' oral health literacy is critical for providing focused education and therapies. However, no instrument exists to measure oral health literacy in Chinese diabetic patients. In this study, the English version of the oral health literacy among people living with diabetes (OHLD) scale was cross-culturally validated to provide a reliable tool for assessing the oral health literacy of diabetic patients in China.

OBJECTIVE

The oral literacy among people living with diabetes (OHLD) scale was Chineseized and its reliability and validity tested, and the OHLD scale was revised to test the reliability and validity of the Chinese version of the OHLD scale and to provide a tool for assessing the oral health literacy of diabetic patients in China.

METHODS

A modified version of the Brislin translation model was used, cross-cultural adaptation was performed through expert consultation and pre-survey, and expert opinion was used to assess content validity to form the Chinese version of the Oral Health Literacy Scale for Diabetic Patients, which was administered to 420 diabetic patients in two tertiary hospitals in Liaoning Province from March to August 2023. The reliability of the scale was tested. SPSS 25.0 and AMOS 23.0 were used to analyze the data.

RESULTS

The Chinese version of the OHLD scale consisted of three dimensions and 10 entries. Structure of the validity analysis: three factors were extracted from the exploratory factors with a cumulative variance contribution of 79.794%; Content validity results:An item's content validity index (I-CVI) was 0.857 to 1 at the entry level, and the content validity index of the scale (S-CVI) was 0.928 at the scale level. The results of the reliability analyses were: the Cronbach's alpha coefficient for the total scale was 0.908; the Cronbach's alpha coefficients for the factors and dimensions were 0.853 to 0.922; the split-half reliability was 0.827; and the test-retest reliability was 0.848. The results of the validation factor analysis showed that (χ2/df) was 1.430, the root mean square of the error of approximation (RMSEA) was 0.045, the comparative fit index (CFI) was 0.989, and the Tucker Lewis index (TLI) was 0.985, which showed that the model had an overall good fit.

CONCLUSION

The Chinese version of the OHLD scale has good reliability and validity and can be used as a valid tool for assessing diabetes mellitus patients in China.

Supporting health education policies: translation, cross-cultural adaptation and validation of a health literacy instrument, in French

Background

Oral health is a fundamental human right and is inseparable and indivisible from overall health and well-being. Oral Health Literacy (OHL) has been proved to be fundamental to promoting oral health and reducing oral health inequalities. To our knowledge, no OHL instrument to evaluate OHL level is currently validated in French language despite the fact it is the fifth most widely spoken languages on the planet. The Oral health literacy Instrument (OHLI) appears to be the most interesting OHL instrument to adapt into French because it is already available in English, Spanish, Russian, Malaysian, and it contains both reading comprehension and numeracy sections. Its psychometric properties have been rated as adequate.

Objective

The aim of this study was to translate and adapt cross-culturally the OHLI into French, to evaluate its psychometric properties and to compare its results to oral health knowledge.

Method

This study followed and applied well-established processes of translation, cross-cultural adaptation and validation, based on the recommendations of the World Health Organization guidelines and on the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) study design checklist for patient-reported outcomes. Two psychometric assessments were planned, the comparison of OHLI-F scores according to education level and frequency of dental visits, and the test-retest reliability of the OHLI-F.

Results

A total of 284 participants answered the OHLI-F. The OHLI-F scores were significantly different between participants with different levels of education and frequency of dental visits (p < 0.001). Participants with an education level lower than the baccalaureate, and those who never visit the dentist or only in case of pain, had significantly lower OHLI-F scores. Internal consistency was excellent (Cronbach's alpha = 0.881-0.914). Test-retest reliability was very high (intraclass correlation = 0.985 to 0.996).

Conclusion

The OHLI-F has demonstrated adequate psychometric properties and can therefore be used to measure oral health literacy in French-speaking populations.