The relationship of oral health literacy and self-efficacy with oral health status and dental neglect

Abstract

Objectives: We examined the associations of oral health literacy (OHL) with oral health status (OHS) and dental neglect (DN), and we explored whether self-efficacy mediated or modified these associations.

Methods: We used interview data collected from 1280 female clients of the Special Supplemental Nutrition Program for Women, Infants and Children from 2007 to 2009 as part of the Carolina Oral Health Literacy Project. We measured OHL with a validated word recognition test (REALD-30), and we measured OHS with the self-reported National Health and Nutrition Examination Survey item. Analyses used descriptive, bivariate, and multivariate methods.

Results: Less than one third of participants rated their OHS as very good or excellent. Higher OHL was associated with better OHS (for a 10-unit REALD increase: multivariate prevalence ratio = 1.29; 95% confidence interval = 1.08, 1.54). OHL was not correlated with DN, but self-efficacy showed a strong negative correlation with DN. Self-efficacy remained significantly associated with DN in a fully adjusted model that included OHL.

Conclusions: Increased OHL was associated with better OHS but not with DN. Self-efficacy was a strong correlate of DN and may mediate the effects of literacy on OHS.

FIGURE 1—

Conceptual model of the association of self-reported OHS with OHL, self-efficacy, and dental neglect among female WIC participants (n = 1280): Carolina Oral Health Literacy study, North Carolina, 2007–2009. Note. NHANES = National Health and Nutrition Examination Survey; OHL = oral health literacy; OHS = oral health status; REALD = Rapid Estimate of Adult Literacy in Dentistry; WIC = Supplemental Nutrition Program for Women, Infants and Children. Dashed arrow represents effects of OHL on OHS. Solid arrows represent pathways explored and hypothesized to mediate the effect of OHL on OHS. Education and other socioeconomic and unknown or unmeasured factors are also believed to confound or mediate this association (arrows omitted for parsimony).

FIGURE 2—

Univariate distributions of (a) dental neglect scores and (b) oral health literacy overlaid by polynomial fit functions with self-efficacy among female WIC participants (n = 1280): Carolina Oral Health Literacy study, North Carolina, 2007–2009. Note. CI = confidence interval; DNS = Dental Neglect Scale; REALD = Rapid Estimate of Adult Literacy in Dentistry; SEF = Self-Efficacy Scale; WIC = Supplemental Nutrition Program for Women, Infants and Children.