Developing and Testing a Theoretical Model to Determine Children’s Adherence to Oral Health Behaviours

• Author / Creator

  Elyasi, Maryam

• Background: Adherence to health care advice is a complex health concern especially when it involves children. Dental caries has been identified as the most common chronic childhood disease that occurs in a continuum. At the same time, it can be prevented by adherence to proper oral health behaviours including proper oral hygiene care, restricting the amount and frequency of sugar intake, and adopting a regular check-up. Orthodontic treatments for child patients are also therapeutic measures requiring full adherence of patients to oral health treatments for ideal clinical outcome because of the prolonged nature of the treatment. Orthodontic treatments proceed mostly in outpatient settings, requiring patients to engage in self-care with the involvement of their parents. Theory-driven tools may help the practitioners identify the causes of children’s poor adherence and develop effective interventions. The Theory of Planned Behaviour (TPB) is a well-established theory that has been rigorously applied to predict health behaviours; however, its application in children’s oral health research is relatively new. TPB is capable of accepting additional constructs contributing to the elicitation of a particular behaviour. One of the important psychosocial factors rarely analyzed in adherence behaviours is the patient’s ability to cope with daily life-stressors enabling them to identify and mobilize resources to adhere to healthy practices. This concept can be evaluated through the construct of Sense of Coherence (SOC).
  Objectives: The overall aim of this research was to build and test a theoretical model to predict children’s adherence to oral health preventive measures. The goal was to develop a theory-based model to identify the determinants of children’s adherence to preventive oral health
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  care practices in a population-based setting. The developed model was also tested in a clinical setting with children undergoing orthodontic treatments for future authenticity of our results.
  Methods: This multi-center cross-sectional study was granted ethics approvals from the University of Alberta (UofA) Research Ethics Board and Alberta Health Services. Followed by a systematic review on the impact of SOC on oral health behaviours, an expanded TPB model was developed to measure adherence to preventive behaviours among parents of children aged 2-6 years attending community health centers for immunization. Questionnaires included items to measure the TPB and SOC constructs as the psychological determinants of adherence behaviours. Information regarding participant’s demographics and self-reported behaviours including tooth brushing frequency, sugary intake frequency, as well as frequency and pattern of dental visits for their children were collected. As the second stage and to set the grounds for our future research, we conducted a prospective longitudinal single-center study of patient adherence to orthodontic treatment at the UofA Orthodontic Clinic. The expanded TPB model was tested in a clinical setting by predicting adherence behaviours among parents and their children aged 12-18 years old undergoing orthodontic treatments. Questionnaires were developed to assess the psychological determinants of adherence to orthodontic treatments based on the TPB and SOC constructs. Adherence to orthodontic treatment was measured directly by monitoring appointment keeping and oral hygiene behaviours, and indirectly through measuring buccal white spot lesions. Measurements were done at the time of fitting the fixed appliance, after six months, and 12 months following the baseline. Structural Equation Modeling (SEM) analysis was applied to investigate the direct and indirect relationships between SOC (the proposed added construct), attitudes, subjective norms, perceived behavioural control, and intention (the TPB original constructs) using the TPB model as the prior framework. Regarding the future steps for
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  the second phase of this research, SEM will be applied to specify the scale items, perform reliability and validity tests, and specify the measurement and structural models.
  Results: 378 mothers (34.41 ± 8.1 years) participated in phase 1 of the study. 75.9% of children (3.92 ± 1.8 years) had dental insurance. SEMA showed that predisposing factors (child and mother’s birthplace) significantly predicted enabling resources (family income and dental insurance); both predicted TPB components (PBC, SN, and attitude). TPB components, in turn, predicted behavioural intention. However, intention did not predict dental attendance. Parent’s SOC significantly predicted TPB components and dental attendance. Overall, 56% of the variance in dental attendance was explained by the expanded TPB model. For the second phase of this research, 168 pair of orthodontic patients with the mean age of 14.47±1.52 years and their parents with a mean age of 44.65±5.1 years were recruited and followed up for one year. Among patients, 90 (53.6 %) were girls and about 40% had other siblings in orthodontic treatment before or at the same time. Among parents whose children participated in this research, 135 (80.4 %) were mothers, 43% of families had a monthly income of $5000 or higher and 80% of parents had post-secondary or college degree. 76% of parents reported their children brushed their teeth twice a day or more which was very close to the percentage reported by their children of about 73%. One year into the treatment, about 60% of patients had buccal white spot lesions with moderate to severe demineralization observed in 48% of those.
  Conclusions: The expanded TPB model explained a great deal of variance in preschooler’s dental attendance. These findings suggest that the expanded model could be used as the framework for designing interventions or strategies to enhance dental attendance among preschoolers. In particular, such strategies should focus on enhancing parental SOC and
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  providing more enabling resources. The results of both phases of this research will aid the construction and psychometric evaluation of surveys that will be used as valid and reliable screening tools for non-adherence among pediatric and orthodontic patients. Finally, this theory-based model can be applied to measure treatment adherence in other pediatric chronic health conditions, such as diabetes and asthma.

• Subjects / Keywords

  • Theory of Planned Behaviour
  • Adherence
  • Children
  • Oral Health Behaviours

• Graduation date

  Fall 2020

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/r3-zy6d-w124

• License

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