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

Bilu Xiang,Wangnan Cao,Hai Ming Wong,Antonio P Perfecto,Colman P J Mcgrath

doi:10.1186/s12889-020-08851-x

Abstract

BackgroundOral health belief is a prerequisite of changing oral health behaviors especially during adolescence. However, there is a paucity of well-established questionnaire for use among adolescents. This study aimed to develop and validate an instrument to evaluate adolescents’ beliefs about oral health behaviors using health belief model.MethodsA preliminary 43-item questionnaire was developed by an expert panel. Then the questionnaire was finalized by decreasing the number of items to 35 by analyzing the results from face validity and factor analysis from 421 Hong Kong secondary school students. The content validity were evaluated by a panel of 2 behavioral scientists, 2 dentists, 2 schoolteachers and 10 adolescents. The construct validity of the questionnaire was assessed by performing exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The Cronbach’s alpha coefficient, item-total correlation and intraclass coefficient were used to test its reliability. In addition, to confirm its applicability, multiple regression analysis and path analysis were used to evaluate the possibility of HBM as predictors for oral health behaviors and oral hygiene status.ResultsThe initial analysis extracted six factors that jointly accounted for 62.47% of the variance observed. Based on CFA, the final version of the questionnaire consisted of 35 items and the data of the final version fitted the model well. The Cronbach’s alpha coefficient for the subscale (> 0.7), item-total correlations (0.47–0.91) and the intraclass coefficient (0.82–0.91) were all above acceptable thresholds. The results of multiple regression analysis and path analysis confirmed its ability to predict oral health behaviors and status.ConclusionsThe present findings indicate satisfactory validity, reliability and applicability of the proposed Oral Health Behavior Questionnaire for Adolescents based on the Health Belief Model (OHBQAHBM) for measuring oral health beliefs of adolescents. This questionnaire can be used as an instrument to measure oral health beliefs and predict oral health behavior and oral hygiene status of adolescents.

Highlights

Oral health belief is a prerequisite of changing oral health behaviors especially during adolescence
This study aimed at developing and validating a specific instrument, the Oral Health Behavior Questionnaire for Adolescents based on the Health Belief Model (OHBQAHBM), which measures factors affecting oral health behaviors of adolescents based on the health belief model (HBM)
Phase II: item reduction and questionnaire testing exploratory factor analysis (EFA) results In total, 421 secondary school students were entered into the study

Summary

Introduction

Oral health belief is a prerequisite of changing oral health behaviors especially during adolescence. The expenditure on dental caries of children alone exceeds the total budget for children’s oral health care [4]. Some preventive measures, such as water fluoridation, help to reduce the occurrence of caries, but inadvertently increase the prevalence and severity of fluorosis [5]. Adolescence is a formative period for young people to develop their adult lifestyles, including oral health behaviors [6]. Inadequate attention and guidance have been given for dental health care [7], especially in Hong Kong. The use of dental floss and annual dental visitations among Hong Kong adolescents remain relatively unimportant [8]

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