Abstract
BackgroundTo investigate the association between oral health literacy (OHL) and oral health-related quality of life (OHRQoL) and explore the racial differences therein among a low-income community-based group of female WIC participants.MethodsParticipants (N = 1,405) enrolled in the Carolina Oral Health Literacy (COHL) study completed the short form of the Oral Health Impact Profile Index (OHIP-14, a measure of OHRQoL) and REALD-30 (a word recognition literacy test). Socio-demographic and self-reported dental attendance data were collected via structured interviews. Severity (cumulative OHIP-14 score) and extent of impact (number of items reported fairly/very often) scores were calculated as measures of OHRQoL. OHL was assessed by the cumulative REALD-30 score. The association of OHL with OHRQoL was examined using descriptive and visual methods, and was quantified using Spearman's rho and zero-inflated negative binomial modeling.ResultsThe study group included a substantial number of African Americans (AA = 41%) and American Indians (AI = 20%). The sample majority had a high school education or less and a mean age of 26.6 years. One-third of the participants reported at least one oral health impact. The OHIP-14 mean severity and extent scores were 10.6 [95% confidence limits (CL) = 10.0, 11.2] and 1.35 (95% CL = 1.21, 1.50), respectively. OHL scores were distributed normally with mean (standard deviation, SD) REALD-30 of 15.8 (5.3). OHL was weakly associated with OHRQoL: prevalence rho = -0.14 (95% CL = -0.20, -0.08); extent rho = -0.14 (95% CL = -0.19, -0.09); severity rho = -0.10 (95% CL = -0.16, -0.05). "Low" OHL (defined as < 13 REALD-30 score) was associated with worse OHRQoL, with increases in the prevalence of OHIP-14 impacts ranging from 11% for severity to 34% for extent. The inverse association of OHL with OHIP-14 impacts persisted in multivariate analysis: Problem Rate Ratio (PRR) = 0.91 (95% CL = 0.86, 0.98) for one SD change in OHL. Stratification by race revealed effect-measure modification: Whites--PRR = 1.01 (95% CL = 0.91, 1.11); AA--PRR = 0.86 (95% CL = 0.77, 0.96).ConclusionsAlthough the inverse association between OHL and OHRQoL across the entire sample was weak, subjects in the "low" OHL group reported significantly more OHRQoL impacts versus those with higher literacy. Our findings indicate that the association between OHL and OHRQoL may be modified by race.
Highlights
To investigate the association between oral health literacy (OHL) and oral health-related quality of life (OHRQoL) and explore the racial differences therein among a low-income community-based group of female WIC participants
Study population and recruitment This investigation relied upon interview data from the Carolina Oral Health Literacy (COHL) Project [30], a study exploring OHL in a low-income population of caregivers in the Women, Infants, and Children’s Supplemental Nutrition Program (WIC) in North Carolina (NC)
Pronounced OHL gradients were noted relative to education as follows: less than high school–13.0 (4.8), high school or General Education Diploma (GED)–15.0 (4.9), some technical or college–18.0 (4.7) and college degree or higher–20.1 (4.8)
Summary
To investigate the association between oral health literacy (OHL) and oral health-related quality of life (OHRQoL) and explore the racial differences therein among a low-income community-based group of female WIC participants. The United States (US) Surgeon General’s report on Oral Health in America underscores and emphasizes the importance of OHRQoL, and its improvement on a population-level is defined as a goal [7] For these reasons, subjective oral health (SOH) instruments have been used to capture the multi-dimensional concept of OHRQoL [8,9] and are used to quantify patient outcome experiences, monitor oral health status on national level, and identify dental public health goals [10,11]. Subjective oral health (SOH) instruments have been used to capture the multi-dimensional concept of OHRQoL [8,9] and are used to quantify patient outcome experiences, monitor oral health status on national level, and identify dental public health goals [10,11] During this past decade the critical role of health literacy in medicine and public health has gained considerable attention [12,13]. Health literacy is considered an underlying cause of health disparities and has become a national health priority [18,19]
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