Iprc2014 presentation nathawut 12 aug 2014
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This document summarizes a study that examined the relationship between oral hygiene care behavior and oral hygiene status in early adolescents. The study tested a conceptual model using data from 391 students in Thailand. The results showed that the hypothesized causal model was a good fit for the data. Behavioral modification had the strongest direct effect on oral hygiene care behavior. Knowledge, attitudes, perceived threats, and cues to action also indirectly influenced oral hygiene care behavior. The study provides insight into factors that affect oral hygiene practices in early adolescents.
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Iprc2014 presentation nathawut 12 aug 2014
- 1. A Causal Relationship Model of Oral Hygiene Care Behavior and the Oral Hygiene Status of Early Adolescents Nathawut Kaewsutha ,Ungsinun Intarakamhang , Patcharee Duangchan 11th International Postgraduate Research Colloquium 1
- 2. OUTLINE OF PRESENTATION Introduction Objective Method Results Discussion Conclusion Implications BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY 2
- 3. INTRODUCTION AND BACKGROUND Oral diseases, especially dental caries and gingivitis is one of the important public health problems Cause suffering to patients because of the chronic painfulness Adverse effects on mental health, personality, vocalization and life performance Malfunction of teeth in childhood has direct impact on eating ability of children and can result in children’s malnutrition The children may have learning problems because of absenteeism Treatment of oral health problem is time- consuming and require a huge amount of budget and number of dental health professional Economic and social impact. BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY 3
- 4. 4 BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY INTRODUCTION AND BACKGROUND Year 1989 1994 2001 2007 Prevalent 49.2 53.9 57.3 56.9 DMFT 1.50 1.55 1.64 1.64 Dental public health division, Ministry of public health, Thailand, 2007) THAILAND SITUATION
- 5. children of 12 years old , which are secondary school grade 7th No surveillance program among secondary school students. Number of secondary school students with oral disease is still untowardly increasing risky group - Frequency of carbohydrate consumption and inappropriate dental hygiene Significant epidemiological aspect fully permanent teeth Prevalence rate of dental caries and gingivitis among this group is good predictor of dental problem among future adults (Thailand National Dental Health Survey, 2012) EARLY ADOLESCENTS BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY 5
- 6. ORAL HYGIENE CARE BEHAVIOR A proper oral hygiene care during the early stage can prevent dental caries, gingivitis and the loss of permanent teeth in adult The data from Thailand National Dental Health Survey, 2012 - 7.62 % of children aged 12 brushed their teeth more than twice a day - 9.06% brushed their teeth after having snack Lack of behavioral science study about causal relationship model of oral hygiene care behavior in early adolescent group BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY 6
- 7. RESEARCH OBJECTIVES The purposes of this study were to examine consistency of a hypothetical causal relationship model of oral hygiene care behavior with empirical data to examine the influence of causal relationship factors related oral hygiene care behavior in early adolescent group BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY 7
- 8. THEORY AND CONCEPT RELATED TO HEALTH BEHAVIOR BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY 8
- 9. THEORY AND CONCEPT Health belief model Social Learning (Cognitive)Theory Action competence : K-A-P BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY 9
- 10. The Health Belief Model Rosenstock, Irwin (1974). "Historical Origins of the Health Belief Model". Health Education Behavior 2 (4): 328–335. 10 BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY
- 11. Rosenstock, Irwin M.; Strecher, Victor J.; Becker, Marshall H. (1988). "Social learning theory and the health belief model". Health Education & Behavior 15 (2): 175–183. 11 BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY
- 12. 12 BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY Social Cognitive Theory Bandura, A. (1977) Toward A Unifying Theory Of Behavioral Change. Psychol Rev. 1977 Mar; 84(2):191-215. Bandura, A., (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, p. 122-147. Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman
- 13. 13 BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY •Social Learning Theory (Bandura ,1986) •Model Of Reciprocal Determinism •Self-Belief , Cognition , Self- Efficacy, Self-regulatory (controls), Self-reflective process, Self Management •“coach approach” taken by professional life coaches and professional wellness coaches Social Cognitive Theory Bandura, A. (1977) Toward A Unifying Theory Of Behavioral Change. Psychol Rev. 1977 Mar; 84(2):191-215. Bandura, A., (1982). Self-efficacy mechanism in human agency. American Psychologist, 37, p. 122-147. Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman
- 14. 14 Action competence : KAP Model BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY Saugstad-Gabrielsen T, Mach-Zagal R. Sundhedspædagogik for praktikere [Educating for health among practitioners]. 2nd edn. Copenhagen, Munksgaard Danmark, 2003. Action competence includes: • knowledge about the problem • an attitude towards the problem • the ability to act to solve the problem Knowledge Attitude Practice
- 15. CONCEPTUAL FRAMEWORK Knowledge in oral hygiene and oral diseases : Knowledge and understand : Apply knowledge Attitude toward oral health care : Cognitive : Affective : Behavior Perceived threatened diseases : Percieved susceptibility : Percieved severity Behavioral modification : Self efficacy : Self control Cues to actions :Oral health information and media :Family support : Friend support Oral hygiene care behavior : Eating behavior : Tooth brushing behavior Oral hygiene status : Debris indexes 15 BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY
- 16. MATERIALS AND METHODS Collect data from 391 students, Nakhon-Nayok Province, selected through the stratified random sampling method. Seven latent variables of the study were measured from 15 observed variables. The exogenous latent variables included 1. knowledge in oral hygiene and oral diseases 2. perceived threatened diseases 3. cues to actions The endogenous latent variables included 1. attitude toward oral health care 2. behavioral modification 3. oral hygiene care behavior 4. oral hygiene status 16 BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY
- 17. The instrument used for collecting data was 6-point rating scale questionnaires : 13 variables Oral examination sheet: 2 variables MATERIALS AND METHODS 17 BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY
- 18. 18 6-point rating scale questionnaires BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY
- 19. 19 BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY Oral examination sheet
- 20. 20 BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY Questionnaires The plaque debris check-up evaluated tooth brushing practice The step of the collect data
- 21. 21 Data were analyzed by descriptive statistics and examined for consistency of hypothetical a causal model with empirical data using LISREL. MATERIALS AND METHODS BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY
- 22. THE RESULTS the hypothetical a causal model was consistent with empirical data χ2 = 132.87, df = 75, p-value = 0.001, χ2/ df = 1.77; RMSEA = 0.044; RMR = 0.053; CFI = 0.94; AGFI = 0.93; GFI = 0.96 The variables that directly effected oral hygiene care was behavioral modification; their standardized path coefficient was .54 respectively. The variables that indirectly effected to oral hygiene care behavior were knowledge in oral hygiene and oral diseases, attitude toward oral health care, perceived threatened diseases and cues to actions; their standardized path coefficients were .13 .45, -.32 and .10 respectively. 22 BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY
- 23. RESULTS BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY χ2 = 132.87, df = 75, p-value = 0.001, χ2/ df = 1.77; RMSEA = 0.044; RMR = 0.053; CFI = 0.94; AGFI = 0.93; GFI = 0.96 23
- 24. RESULTS BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY χ2 = 132.87, df = 75, p-value = 0.001, χ2/ df = 1.77; RMSEA = 0.044; RMR = 0.053; CFI = 0.94; AGFI = 0.93; GFI = 0.96 24 Behavior modification
- 25. 25 BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY THE RESULTS
- 26. DISCUSSION BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY The causal relationship model of oral hygiene care behaviors by hypothetical is matched with the empirical data after adjust model 26 Fit index Criteria Before adjust model After adjust model χ 2 , p p > .05 308.13, 0.00 132.87, 0.00 χ 2 /df < 5.00 3.76 1.77 GFI > .90 0.9 0.96 CFI > .90 0.76 0.94 AGFI > .90 0.86 0.93 RMR < .08 0.13 0.053 RMSEA < .08 0.086 0.044
- 27. DISCUSSION BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY Recommendation for Future study, Qualitative research techniques such as the in-depth interviews and participatory observation in the students group to find answers about the meaning and terms of the factors that related oral hygiene care behaviors 27
- 28. DISCUSSION BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY This study focus on group of students in Nakhon Nayok province that represent the urban area in Thailand The result of this study may be used to describe the phenomenon is limited Further research should examine the invariance of the model in a group of students in urban and rural area in Thailand. 28
- 29. CONCLUSION BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY The hypothetical a causal model was consistent with empirical data The knowledge in oral hygiene and oral diseases factor, attitude toward oral health care factor, perceived threatened diseases, cues to actions and behavioral modification factor can explained the variance of oral hygiene care behavior 29
- 30. IMPLICATIONS BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY In the future Experiment study about effect of behavior modification program that using self-efficacy and self-control as part of a behavior modification program for change the oral hygiene care behavior in early adolescent. useful in generating new knowledge for prevent and control tooth decay and gum disease in secondary school children in Thailand 30
- 31. REFERRENCES BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY Bandura, A. (1977). Social Learning Theory. Englewood Cliffs, NJ: Prentice-Hall. Bandura. A. (2000). Self efficacy: The Exercise of Control. 4th ed. New York: W.H. Freeman & Co. Becker,MH. & Maiman, L. (1975,January). Sociobehavioral Determinants of Compliance with Health Medical Care Recommendation. Medical Care,13(1),12. Backman, Desiree R.; et al. (2002). Psychosocial Predictors of Healthful Dietary Behavior on Adolescents. J Nutr Educ Behav, 34, 184-93. Bogers, R.P. et al. (2004) Explaining Fruit and Vegetable Consumption: the Theory of Planned Behaviour and Misconception of Personal Intake Levels. Appetite, 42, 157-66. Borzekowski Dina LG & Robinson TN. (2001). The 30-second effect: an experiment revealing the impact of television commercials on food preferences of preschools. J Am Diet Assoc, 101, 42-46. Conner,M., Norman,P., Bell,R. (2002). The Theory of Planned Behavior and Healthy Eating. Health Psychology, 21(2), 194-201. Joreskog, K. G. & Sorbom, D. (1996). LISREL 8:User's reference guide. Chicago, IL: Scientific Software International. Kassem, Nada O. et al. (2003). Understanding Softdrink Consumption among Female Adolescents Using the Theory of Planned Behavior. Health Education Research,18(3), 278-91. Kelloway, E. K. (1998). Using LISREL for structural equation modeling : a researcher's guide. Thousand Oaks, Carifornia: Sage. Masalu, J.R.& Astrom, A.N. (2001). Predicting Intended and Self-perceived Sugar Restriction among Tanzanian Students Using the Theory of Planned Behavior. Journal of Health Psychology, 6(4), 435- 45. 31
- 32. THANK YOU & Q&A BEHAVIORAL SCIENCE RESEARCH INSTITUTE, SRINAKHARINWIROT UNIVERSITY
Editor's Notes
- Good afternoon everyone, I would like to present my research topic about A Causal Relationship Model of Oral Hygiene Care Behavior and the Oral Hygiene Status of Early Adolescents
- This is outline of my presentation, Today ^^
- Oral diseases, especially dental caries and gingivitis is one of the important public health problems Because it’s effect on the chronic painfulness, mental health, personality, vocalization , life performance ,children’s malnutrition and learning problems Moreover, it’s also influent on economic and social impact.
- In my research topic , I’m focusing on 12th yrs old or 7th grade students. Because this group is a risky group for oral diseases, the prevalence of disease is high and increased, and it’s no surveillance program in secondary school. And the prevalence rate of disease among this group is a predictor of problem among future adults also.
- We know that, the cause of the oral health problem come from oral hygiene care behavior. A proper oral hygiene care can prevent dental caries, gingivitis and the loss of permanent teeth. But, in Thailand the student did not pay attention about their oral hygiene. From the Thailand National Dental Health Survey, 2012 . show that, more than 80% of children aged 12 do not brushed their teeth more than twice a day and not brush after they having snack. Ortherthan that , we have a few behavioral science study about relationship of oral hygiene care behavior and factor related in this age group
- The purposes of this study were to examine consistency of a hypothetical causal relationship model of oral hygiene care behavior with empirical data and the influence of causal relationship factors related oral hygiene care behavior in early adolescent group
- There are several theories on how health behavior is established; different theories have dominated in different eras. Nevertheless, no theory so far has been able to explain fully how oral health behavior can be changed in the long term ,
- My research topic has focused on some theory that related the health behavior Such as the parts of the health belief model, Self-efficacy and self-control theoryof Albert Bandura and the principles of action competence: KAP model
- The first theory that related //is Health Belief Model. This theory is one of the most well-known and widely used theories in health behavior research. it explain that behavior can best be understood, if beliefs about health are clear. The model predicts that// individuals will act to protect or promote their health if they believe that. For example, if the Health Belief Model was applied to prevent the spread of oral disease, individuals would be more likely to oral hygiene care behavior if they believe that: 1. they are at risk of oral disease 2. the consequences of the oral disease are serious 3. oral hygiene care behavior (e.g., eating and brushing) are effective in reducing the risk of oral disease 4. and the benefits of oral hygiene care behavior outweigh the potential costs and barriers
- Self-Efficacy and cue to action was added to the four components of the health belief model in 1988. It’s added to the model in an attempt to better explain individual differences in health behaviors. The model was originally developed in order to explain engagement in one-time health-related behaviors such as being screened for cancer or receiving an immunization. Eventually, the health belief model was applied to more substantial, long-term behavior change such as diet modification, exercise, and also tooth brushing. Developers of the model recognized that confidence in one's ability to effect change in outcomes (i.e., self-efficacy) was a key component of health behavior change. And a stimulus, or cue to action, must also be present in order to trigger the health-promoting behavior also.
- Next theory, we used the Social learning cognitive theory of bandura -The Social cognitive theory emphasizes the importance of observing and modeling the behaviors, attitudes, and emotional reactions - This theory focuses on learning by observation and modeling. - And now includes many of the ideas that cognitivists some times called social cognitive learning theory. - This theory showed how both environmental and cognitive factors interact to influence human learning and behavior.
- A Social Cognitive Theory of Bandura (1986) advanced a view of human functioning that accords a central role to cognitive, self-regulatory, and self-reflective processes in human adaptation and change Reciprocal causation: behavior can also influence both the environment and the person. Each of the three variables: environment, person, behavior influence each other. (p, be, e) Self efficacy: Self efficacy means learners self confidence towards learning. People are more likely to engage in certain behaviors when they believe they are capable of implementing those behaviors successfully, this means that they have high self-efficacy. Self regulation: Self-regulation is when the individual has his own ideas about what is appropriate or inappropriate behavior and chooses actions accordingly. There are several aspects of self regulation.
- Next concept we used K-A-P model to explained oral health behavior This theory has described the concept of action competence for health. The component including – Knowledge – attitude and practice It’s very important that we should motivate patients to adopt attitudes based on their newly acquired knowledge and experience and especially to demonstrate new ways of converting the new knowledge into action or practice.
- From the relationships between the various theories that we used, we conduct the conceptual framework that the same as a hypothetical causal relationship model of oral hygiene care behavior
- Collect data from 391 students, Nakhon-Nayok Province, selected through the stratified random sampling method. Seven latent variables of the study were measured from 15 observed variables.
- The instrument used for collecting data was 6-point rating scale questionnaires : 13 variables Oral examination sheet: 2 variables
- We used 6-point rating scale questionnaires for 13 observed variables.
- We used Oral Hygiene Skill Achievement Index or S.A.I indexes for tooth brushing behavior variable. And we used Debris indexes for Oral hygiene status variable.
- The step of the collect data, first student do the questionnaire And second, The plaque debris check-up And the last, evaluated tooth brushing practice by S.A.I Indexes
- After that, Data were analyzed by descriptive statistics and examined for consistency of hypothetical a causal model with empirical data using LISREL program.
- the hypothetical a causal model was consistent with empirical data χ2 = 132.87, df = 75, p-value = 0.001, χ2/ df = 1.77; RMSEA = 0.044; RMR = 0.053; CFI = 0.94; AGFI = 0.93; GFI = 0.96 The variables that directly effected oral hygiene care was behavioral modification; their standardized path coefficient was .54 respectively. The variables that indirectly effected to oral hygiene care behavior were knowledge in oral hygiene and oral diseases, attitude toward oral health care, perceived threatened diseases and cues to actions; their standardized path coefficients were .13 .45, -.32 and .10 respectively.
- The result of this study showed that, the hypothetical a causal model was consistent with empirical data with fit statistics; χ2 = 132.87, df = 75, p-value = 0.001, χ2/ df = 1.77; RMSEA = 0.044; RMR = 0.053; CFI = 0.94; AGFI = 0.93; GFI = 0.96
- The directly effected oral hygiene care was behavior modification; their standardized path coefficient was .54 indirectly effected to oral hygiene care behavior were knowledge in oral hygiene and oral diseases, attitude toward oral health care, perceived threatened diseases and cues to actions; their standardized path coefficients were .13 .45, -.32 and .10 respectively.
- This table is show that, The direct, indirect and total effect of various factor that related the oral hygiene care behavior
- Discussion -The causal relationship model of oral hygiene care behaviors by hypothetical is matched with the empirical data after adjust model Please looking at the table, all fit index after adjusting model is better than before adjusting model
- my recommendation for Future study should be add a Qualitative research techniques such as the in-depth interviews and participatory observation in the students group For find the meaning and terms of the factors that related oral hygiene care behaviors
- This study focus on group of students in Nakhon Nayok province that represent the urban area in Thailand The result of this study may be used to describe the phenomenon is limited so in order to verify the ability of the model to be used to describe this phenomenon among secondary school students in thailand We need a Further research Future study should examine the invariance of the model in a group of students in urban and upcountry with.
- The conclusion is….. The hypothetical a causal model was consistent with empirical data And The knowledge in oral hygiene and oral diseases factor, attitude toward oral health care factor, perceived threatened diseases, and cues to actions and behavioral modification factor can explained the variance of oral hygiene care behavior
- For the implications In the future, We should create a experimental study about effect of behavior modification program that using self-efficacy and self-control as part of a behavior modification program for change the oral hygiene care behavior in early adolescent. It’s useful in generating new knowledge for prevent and control tooth decay and gum disease in secondary school children in Thailand