Development and evaluation of the Stages of Change in Oral Health instrument

Abstract

Oral health personnel are limited in their ability to assess the readiness of patients to make changes to improve oral health. We aimed to develop and test the Stages of Change in Oral Health (SOCOH) model, a scaled index of the stages of change - pre-contemplative, contemplative or active - with particular emphasis on pregnancy. Items were collected in a self-report questionnaire conducted among a convenience sample of 446 mothers (age range: 14-43years) pregnant with Aboriginal children in South Australia, Australia. Scales representing openness (four items; Cronbach's alpha=0.73), value (four items; Cronbach's alpha=0.71), inconvenience (six items; Cronbach's alpha=0.79) and permissiveness (four items; Cronbach's alpha=0.66) were developed. Participants were categorised according to the Stages of Change model and were evaluated against key self-reported oral health outcomes. Some 11.9% of participants were classified as pre-contemplators, 46.4% as contemplators and 41.7% as active. A higher proportion of active participants had a higher education, last visited a dentist less than a year previously, had no dental fear, owned a toothbrush, brushed the previous day, used toothpaste, had no difficulties paying a $100 dental bill, self-reported their dental health as 'excellent' and in the previous 12months did not experience dental pain, embarrassment related to their dental appearance or difficulties eating food. The SOCOH model offers an internally consistent and valid instrument for detailed assessment of the readiness for change in regarding oral health behaviours in pregnancy and has potential benefits for clinical decision making and research.