Relationship between oral health-related knowledge, attitudes and behavior among 15-16-year-old adolescents: a structural equation modeling approach

Acta Odontol Scand. 2012 Mar;70(2):169-76. doi: 10.3109/00016357.2011.600722. Epub 2011 Jul 27.


Objective: The aim of this study was to confirm the previously observed attitudinal factor structure related to behavioral change and the knowledge-attitude-behavior model on dental health and hygiene among adolescents.

Materials and methods: The study population consisted of all 8(th) and 9(th) graders (15-16 years) who started the 2004-2005 school year in Rauma, Finland (n = 827). Data on knowledge, attitudes, toothbrushing and using fluoride toothpaste were gathered by questionnaires. Hypothesized structure included four attitudinal factors related to dental health and hygiene: 'importance of toothbrushing when participating in social situations' (F1), 'importance of toothbrushing for health-related reasons and better appearance' (F2), 'being concerned about developing caries lesions' (F3) and 'importance of toothbrushing for feeling accepted' (F4). Structural equation modeling (SEM) was used to test the hypothesized model: pathways lead from knowledge to behavior both directly and via attitudes. The hypothesized model was also modified by removing non-significant pathways and studying the inter-relationships between attitudes.

Results: A confirmatory factor analysis revealed that factor F4 had to be removed. In the final model, knowledge influenced behavior directly and via two attitude factors, F1 and F2, which were inter-related. 'Concern about developing caries lesions' was a background factor influencing only knowledge. The final factor structure and SEM model were acceptable-to-good fit. Knowledge had a smaller effect on behavior than on attitudes.

Conclusions: Our results support theories about the causal knowledge-attitudes-behavior chain, also for adolescents' oral health-related behaviors.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adolescent
  • Dental Caries / psychology
  • Dental Plaque / psychology
  • Factor Analysis, Statistical
  • Female
  • Finland
  • Gingivitis / psychology
  • Health Behavior
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Interpersonal Relations
  • Male
  • Models, Psychological*
  • Oral Health*
  • Surveys and Questionnaires
  • Tooth Discoloration / psychology
  • Toothbrushing / psychology*
  • Toothbrushing / statistics & numerical data